Permit z. 0 ' CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00305
i T[GAD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/25/2007
PARCEL: 1 S133DD -06400
SITE ADDRESS: 12511 SW WINTER LAKE DR ZONING: R -4.5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 LOT: 103 JURISDICTION: TIG
PROJECT: VARNUM
Project Description: Install gas piping for gas range.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP:
WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
STEVEN VARNUM Description Date Amount
12511 SW WINTER LAKE DR
TIGARD, OR 97223 -7869 [MECH] Permit Fee 5/25/2007 $72.50
[TAX] 8% State Surcha 5/25/2007 $5.80
Total $78.30
Phone: 503 -524 -5251
Contractor:
HOLMES INSTALLATION SERVICE
33535 NW VADIS RD
CORNELIUS, OR 97113 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 267 -7574
Reg #: LIC 102473
This permit is issued subject to the regulations contained 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 work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: , 4/1 Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for inspections that bu i ess day.
This permit card shall be kept in a conspicuous place on the job site un it completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application *.: : ,r ; , FOR , OFF,I sE, 3 , ,
F lie; City of Tigard Received O! ) P No.: n �,�, p�
II 13125 SW Hal Blvd., Tigard, OR 97223 Date/By: ,, Of 7 D� �g(.. /545 --
e .) Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Date /By:
ET I G A R D Inspection Line: 503.639 Date Ready /By: lulls' ® - See Page 2 for
;: cvl r.1t Internet: www.tigard - or.gov Notified/Method: / a I Supplemental Information
'. OF WORK COMMERCIAL FEE *. SCHEDULE — USE.CHECKLIST
❑ New construction ddition /alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
1:1 Demolition Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF - CONSTRUCTION : - Value: $
IC
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
❑ Multi-family ❑Master builder 0 Other: RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
For special information use checklist.
Description Qty. Ea. I Total
. ' JOB SITE INFORMATION AND LOON.. ' Heating/cooling
Job site address: I��`/ f ` / ! Air conditioning ho or heat pump
l ` ! �/ (requires site plan showing placement) 14.00
City /State /ZIP: t o . /212.— Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: I Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: I Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DE SCRIPTION. OF WORK ' Water heater 10.00
^� en Gas fireplace 10.00
/�5 r � Vu /� j � "' f7 Flue vent for water heater or gas
tf /Iva) f ireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
1 W ,
PROPERTY r OWNER I 0 TENANT r Chimney/liner/flue/vent 10.00
� Other: 10.00
T� V ° , Y
Name: C 1 u ( ( � *" Environmental exhaust and ventilation
Address: J ,p Range hood/other kitchen
11 S (!- [ bit-- equipment 10.00
City /State /ZIP: ; L t d 0 /1 /A Clothes dryer exhaust 10.00
_ c / Single-duct (bathrooms,
t
Phone: ) J �_�i ' f i Fax: ( ) toilet t compartments, utility rooms) 6.80
❑ APPLICANT ` ❑ CONTACT PERSON - Attic /crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; 51.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR -
Business name: gitiett5 L;�T,f� �� Clothes dryer (gas)
�- - Other:
Address: 7 3 c m ids RA . • MECHANICAL PERMIT FEES*
City /State /ZIP: C o fl „A er r tvr 0 " �{ 7 Subtotal • ''''Or 2t, 7 � icyy I Minimum permit fee ( mit ) r �.
Phone. ) Fax: ( )
Plan review (25% of permit feeee)
CCB lic.: (c Z (e 73 State surcharge (8% of permit fee) WIZ Mg /
Z
TOTAL PEmMsT FEE
Authorized signature: This permit application expires if a permit is not obtained withi .0
da after it has been accepted as complete.
Print name: A /V ° ®�.5 Date: O • Fee methodology set by Tri- County Building Industry Service Board
(:)Building \ Permits \MEC -P mitApp.doc 01/19/07 f `-' 4 46 17T 1 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
.
Total Valuation : " Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each 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 each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or. \ \\\
fraction thereof, to and including \ \
$50,000.00.
'4 _■;
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2007 -00305
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/2572007
Phone: (503) 639 -4171 II
Inspection Requests (24 Hrs.): (503) 639 -4175 ,j' "__.. /'/ e"-G'. 0 9 - 00 305
INSPECTION WORKSHEET FOR DATE: 5/30/2007 TIME: 7:00AM PAGE: 11
SITE ADDRESS: 12511 SW W INTER LAKE DR CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 LOT #: 103 TYPE OF USE:
PROJECT NAME: VARNUM
DESCRIPTION: Install gas piping for gas range.
OWNER: VARNUM, STEVEN PHONE #: 503 - 524 -5251
CONTRACTOR: HOLMES INSTALLATION SERVICE PHONE #: 503 -267 -7574
Inspection Request Scheduled For: Date: 5/30/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 049258 -01 503.257 -7574 N
SD3 -a7 9'ea 2y 57
Corrections/Comments/Instructions:
•
1 1\1
•
ASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: Date: - -re `d7 Phone #: (503) . 4 - ��
p � ) 718-