Permit q CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00616
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/23/2007
= PARCEL: 2S104AA -11000
SITE ADDRESS: 12285 SW 128TH AVE ZONING: R -4.5
SUBDIVISION: BELLWOOD NO. 3 LOT: 129 JURISDICTION: TIG
PROJECT: BLESSING
Project Description: Installation of gas line for new 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:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
CAROL BLESSING Description Date Amount
12285 SW 128TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 10/23/20C $72.50
[TAX] 8% State Surcha 10/23/20( $5.80
Total $78.30
Phone: 503 - 537 - 7837
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -656 -1 184
FAX 503- 656 -4650
Reg #: LIC 447
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.
i •
Issu d By: , _./h.444 A Permittee Signature: ��A -
Call 503.639.4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the roject.
Approved plans are required on the job site at the time of each inspection.
. M '* k.i e. FOR OFFICE USE ONL).A> 4xti � ` � � T . -.
Mechanical Permit Application { 0 �;� � � = , f , ,�
TM i' 3 i 25 Of Tigard
Date/B
y: i& I Permit No.: I �J.,.r c /6
I N 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 4 �
C Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit:
-T I G5∎ K O' Inspection Line: 503.639.4175 Date Ready /By: Juri ® See Page 2 for
• . - Internet: www.tigard or.gov Notified/Method: 16 Supplemental information
TYPE OF WORK 'COMMERCIAL FEE* SCHEDULE - • USE CHECKLIST
Mechanical permit fees* are based on the value of the work
N ew construction
❑ ❑A ddition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF 'CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT/ SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building '
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: /,22 g� , , l2. • l/ ( • Air conditioning heat pump
(requires site plan shoo wing placement) 14.00
City /State /ZIP: 7; ' 4►+0e 0 fQ 9 72g3 Furnace 100,000 BTU (ducts /vents) 14.00
Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU (ducts /vents) 17.90
, �/Q S S i t5 Gas heat pump 14.00
Cross street/directions to job site: d 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: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION O F WORK - - ` • Water heater
Gas fireplace 10.00
/-/.r" e a. _4 S I.Ay - lo - -flea 6-a Art inc -r<er . Flue vent for water heater or gas
(/ fireplace 10.00
•
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: ..',, 6 67e SS ; Environmental exhaust and ventilation
Address: ( a Range hood /other kitchen
/a-2- K.- .54) /2g idles equipment 10.00
City /State /ZIP: -T;• � D k c 172 Clothes dryer exhaust 10.00
// �� Single -duct exhaust (bathrooms,
Phone: (6Z-2) s - y-7 7837 Fax: ( ) toilet 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; $1.00 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 , Barbecue
Clothes dryer (gas)
Business name: & // i-/e4.4fl -.�N Cr • Other:
Address: /. J o SE, A Q 7 4 AU L. MECHANICAL PERMIT FEES*
City /State /ZIP: .k7atc. k4wt4 S O) q76/s Subtotal
Minimum permit fee ($72.50) 7
Phone: 3) 205 b+5' o 3 Fax: ( ) Plan review (25% of permit fee)
CCB lic.: �' e/ -7 State surcharge (8% of permit fee) 5. so
TOTAL PERMIT FEE '7S • 70
•
Authorized signature: This permit application expires if a permit is not obtained within 180
�� �,� days after it has been accepted as complete.
Print name: G41 G / G i . etc. SS /'1. Date: 70/13 / 7 • Fee methodology set by Tri- County Building Industry Service Board
1 :\ Building ''Termits\MEC- PermitApp.doc 01/19/07 440 -4617T (1l /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
TotalValuation:: 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.
$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.
1:\ Building \Permits \MEC- PermitApp.doc 01/19/07 2
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CITY OF TIOAII1D
BUILDING DIVISION
A PERMIT #:
lA
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171 evitipotl,c+\
Inspection Requests (24 Hrs.): (503) 639-4175 --Al■ A I
--.. /1& .C 7 — 0 4' / 6'
INSPECTION WORKSHEET FOR DATE: 10/24/2007 TIME: 7:00AM PAGE: 63
SITE ADDRESS: 12286 SW 128TH AVE CLASS OF WORK:
' SUBDIVISION: BELLWOOD NO. 3 LOT #: 129 TYPE OF USE:
PROJECT NAME: EJLFSSING
DESCRIPTION: Installation of gas line for new gas range.
OWNER: BLESSING, CAROL PHONE #: 503-537-7837
CONTRACTOR: BELL HEATING PHONE #: 503-858-1184
Inspection Request Scheduled For: Date: 10/24/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 058239-01 503-209-8903 N
Corrections/Comments/Instructions:
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PASS PARTIAL APPROVAL fl CANCEL I I NO ACCESS
FAIL I I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
..--
Inspector: ir: Date:/ ZSI---c,2 Phone #: (503) 718- 2____„4