10405 SW HIGHLAND DRIVE-3 A
A
d C11
y
2
Z
D
Z
v
v
f
f
1
b
10405 SW 1A1GHL.F ND DR
CITYOF T I GA R D MECHANICAL PERMIT
DEVELOPMENT SERVICES ''ERMIT #: MEC2003-00664
131 i SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 11/2C;03
PARCEL: 2S111 CC-12200
SITE ADDRESS: 10405 SW HIGHLAND DR
SUBDIVISION. SUMMERFIELD NOA ZONING: R-7
BLOCK: LOT: 113 JURISDICTION: TIG
CLASS OF WORK- OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O AP?L: VENT S)STEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
_ FUEL TYPES 0 - 3 HP: DOMES.
I_P( 3 15 HP: t-JMML. INCA J:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 1001' BTU: AIR HANDLING UNITS
FURN —100K BTI-1- <= 10000 cfm: OTHER UNITS. t
> 10000 cfm: GAS OUTLETS:
Remarks: Instahadon of gas invert. Lias piping hrr\iously(Ione under NII ('Ztut l-nu;l r,
Owner: _ Y- - FEES _
HERR, DONALD H + Description Date Amount
HERR, MARTHA M — ------ —
10405 SW HIGHI AND DR SII I I I I'rr'nil I rr 11/20/03 $72.50
TIGARD, OR 97224 I \\I `" Silk �urehart 11/20/03 $5.80
Phone: __ _ _ Total $78,30
Contractor:
OWNER
REQUIRED INSPECTIONS
Phv::s•
Mechanical Insp
Final Inspection
Reg#:
This permit is issued subject to the regulations contairiad in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if worts is
n Staff"d-within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
quires you to fbtt1w rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00
Issue 7 ` Permittee Signature:
-Eatt (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
Mechara .-al Permit Application Rweiv
ed Mechanical
lDate/By: 14, G. Permit No.'
City of Tigard f'IanningAit{,roval Building
g Date/By: Permit No
131?i SW Hall Blvd. Plan Review Other
Ttgaru,Oregon 97223 Date/By: Permit 14o.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
UateB : Case No.: _
[ntetnet: www.ei.tij, rd.Or.US Contaci J - See Pape 2 for
24-hour Inspection Request: 503-639-4175 Nama'Method -i—�-tin Icmental-In mnforation
-- --—
TYPE OF WORKr� _ COMMERCIAL FEE*SCHEDULE-USE CRECIMST
New construction F Demolition Mechanical permit fees*are based on the total value of the work
formed. Indicate the value(rounders to the nearest dollar)of all
ACdition/alterationireplacertent Other: Fu�
_ CATEGORY OF CONSTRUCTION rncchanical materials,equipment,labor,overhead and profit.
1 & 2-Family dwellingCommercial;'Industrial Vai te: S _ _ See Page?for Fee Schedule
Accessory Building _ Multi-Family _ VRESIDENTIAL EQUIPMENrSYSTEMS FEF.•SCREDULE
Description hFec�ma. Total
Master Builder Other: llcatln ccoonn __
JOB SITE INFORMATION and LOCATION Furnace-add-on air condrtionini•• 14.00
Job site address: l . �i S-' , c,' ( ,� Gas heat pump 14.00
Suite #: I Bldg./ Duct work _ 14.00
Project Name: C-' _N dronic hot water system 14.00
9. Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters(fuel,not electric)
in wall,in-duct,suspende I etc.) 14.00
Flue/vent for any of abo,.1 10.011)
Subdivision: Lot#: Repair units 12.15
----- ----- _ Other File!A lianrss
Tax ma / arcel #: wat r heater _ 10.00
DESCRIPTION OF WORK s fire c 'l- �_, 10.00
Flue vent(water heater'gas ttreplace) 10.00 _
r 9f Loglighter(gas) 10.00
h�- C� -3 cy .c�sa a .� �.���7 • Wood,`Pel let stove_-----_,, 10.00 --
.
Wood fire lac insert 10.00 —
__ Chimne /liner/ ent IUAO
PROPERTY OWNER 1_ Other: I o U0 I _
Name: c,,, � ,./- Environmental Exhaust&Ventilation
Address: 4L,' `% Range hood/other kitchen equipment _ 10.00 —
Clothes dryer exhaust 10.00
City/State/Zi .� . �> c'` ?
Phon .Sz,-; C,Av _ Single duct exhaust
.� ` Fax: _ (bathrooms,toilet compartments,
Ap ICANT CONTACT PERSON_ N utility rooms► 6.80
Name- — Attic/crawl space fans IO.OU
Other. IO.00
Address: - -
----- — _-- Fuel PI ip ng_ —
-City/State/Zip: •'(55.40 for first 4.St.00 each additional
••
Furnace,etc.
Phone: Fax: —
— -- -- -- Gas heat um •«
_ _
E-mail: _ _ Wall/suspended'unit heater ••
CONTRACTOR Water heater ••
Business Name: Fireplace ••
Address: -Range
•• --
_ BBQ
..
Cit /$tate/Zip_ _ _ _ _ A Clothes dryer(gas)
Phone: �ax: Other: ••
CCB Lic. #: I Total:
-- _--_-- --___..- - — --_.-J Mechanical Permit Fees* _ — --
Authotized `
Signature: Subtotal: S
TM'LL G`L J { .- f�atr 11 i't_' ��Y Minimum Permit Fee 572.50 S t�c)-
-�C��: Plan Review fee(25'u of Pei init Fee) $ —
(Please print name) State Surcharge(8%of Permit Fee) S f,• �
TOTAL PERMIT FEE S`'3v
Notice: This permit application expires If a permit is not obtained N ithin `Fee methodology set by Trl-(ouno Building Industry Service Board.
Igo dews after It has been accepted as complete. "Site plan required for exterior A/C units.
I Dsts Permit Forms MecPermitApp doc 01'03
Mechanical Permit Application - City of Tigard ,
Page 2 - Supplemental Information
Commercial Fee Schedule:
TOTAL VALUATION:_ PERMI: F1rL::_ _
$1.00 to$2,000.00 Minimum fee$72.50
$2,001.00 to$5.OU0.00 $72.50 for the first$2,000.00 and$2.30 for each 1
additional$100.00 or fraction thereof,to and
including$5,000.00.
$5,001.00 to$10,000.00 $141.50 for the first$5,000.00 and$1.80 for 1
each additional $100.00 or traction thereof,to
and including$10,000.00.
$10,001.00 to$50,000.00 $23..50 for the first$10,000.00 and$1.35 for
each additional $100.00 ur fraction thereof,to
_ and including$50,000.00.
$50,001.00 to$100,000,00 $771.50 tar the filet x50,000.00 and$1.25 for
each additional$100.00 or fraction thereof,to
and including$100,000.00.
$100,001.00 and up $1,306.50 for the First$100,000.000 and
$1.10 for each additional$100.00 or fraction
thereof.
All New Co.ninercial Buil(Nings require 2 sets of plans.
i TuddingTermit Forms\MecPermitAppPg2 09-01-03 do(.
CITY OF TIGARD 24-Hour
BUILDIiJG Inspection Line: (503) 639-4175
MST
INSPECTION DIVISION Business Line: (503) 639-4171 --
I I BUP
ReceivPa ._^�t "� Date Requested L-, AM-__ PM BUP
Location ' c'`; \\ Suite EC �?
�- �. I Ui
Contact Person V�'� u--r_ `"� Ph(—) PLM
Contractor _..__ _- __ _ Ph( ) —_.__-_ SWR _
BUILDING Tenant/Owner i 1 I,. 't- '/ V� 1 4 i -� _ ELC
Footing _ ELC _
Foundation Access:
Ftg Drain ELR --
Crawl Drain —- ---
Slab Inspection Notes: SIT
Post& Beam ---- - . ,. - - - --- ---- --- -- _
Sh4ar Anchors
Ext Sheath/Shear ----
Int Sheath/Shear
Framing - -- - _------...------- - — —
Insulation
Drywall Nailing - -- ---- —_.— --------_.... --
Firewall
Fire Sprinkler _ - _ ---- -- -
Fire Alarm
Susp'd Ceiling -- -- - - — --- --. _.— -
Roof
Other
Final -
PASS PAST FAIL
Post& Ream _
Under Slab — - --- -------
Rough-Ir.
Water Service - - - -- - -
Sanitary Sewer
Rain Drains --
Catch Basin/Manhole -
Storm Drain -- -
Shower Pan
Other: --
Final I
PASS PRT FAIL
��Posf& m
Rough-In -
Gas Line l
ke Dampers - - -- — - - — _ — -
PART FAIL ---
- PART ----
EL TRICAL
- --_ _.—
Service
Rough-In
UG/Slab
Low Voltage - —
Fire Alarm
Final Reinspection fee of$-_ _.�required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
—Sl ------.
TE �� Please call for reinspection RE: _-_—_._. _— L Unable to inspect-no access
Fire Supply Line
ADA Date ___112 7.�� pExt
Inspector � -
Approach/Sidewalk
Other
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL