Permit :,....
..„._
-r CITY TIGARD MECHANICAL PERMIT
1 k DEVELOPMENT SERVICES PERMIT #: MEC2006 -00169
� I +s, DATE ISSUED: 4/26/2006
-- . �' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S110BB -05500
SITE ADDRESS: 14210 SW 121ST AVE ZONING: R -3.5
SUBDIVISION: ARLINGTON RIDGE LOT: 032 JURISDICTION: TIG
Project Description: Extend gas line to pool.
CLASS OF WORK: OTR 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODST UNITS:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
ROBERT & D HOSMAN Description Date Amount
14210 SW 121ST AVE
TIGARD, OR 97224 [MECH] Permit Fee 4/26/200E $72.50
[TAX] 8% State Surcha 4/26/200E $5.80
Total $78.30
Phone:
Contractor:
NATURAL GAS CUSTOM PIPING INC
4450 NE SUMNER
PORTLAND, OR 97218 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 335 -9950
FAX 503- 335 -9950
Reg #: LIC 125031
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: --71 iv Permittee Signature: ✓ 1 n ''t ' 2.
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 project.
Approved plans are required on the job site at the time of each inspection.
. . „ y `i Y .�?R.Z ML h` .i;- �°f,l���q h I 'k .
jechanical Permit Applic& -. h - tit ''''' ''' Fm 1�1 . 6 ti. io 01' a k�� ;
l
R eceived , 1
•
'a<<'zY" City Tigard / 6 R
Ci of Ti and � � Date/By �,�' � -� /�� Permit No.�`, C .�� ?C � �!/D
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
i ® Other Permit: l iti ° —k Phone: 503.639.4171 Fax: 503.598.1960 2 6 Dale/By
e ' i G R D Inspection Line: 503.639.4175 ppg 2 6 2006 Date RReady/By: lurk. ®See Page 2 for
IR24141174M1 Internet: www.tigard or.gov Notified/Method: -11(r Supplemental Information
TYPE. q 11 I( ri' �TST� )1-�I COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
is �� Mechanical permit fees* are based on the value of the work
El New construction Additio teration/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: $
1 - and 2 dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
• ' JOB SITE INFORMATION AND LOCATION , Heating/cooling
Job site address: �', � Air conditioning or heat pump
1 ` f�IC� W ��( (requires site plan showing placement) 14.00
City /State /ZIP'` i ,I S ' 7 -,-_- Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg./apt. no.: Project name: �( Furnace 100,000+ BTU (ducts/vents) 17.90
6' l�, D.,,,,-,,,.....,
Gas heat pump 14.00
Cross street /directions to job site: Duct work 14.00
Hydronic hot water system 14.00
,f Residential boiler (radiator or
I ID I '1 ' /' -(?' 4 4 hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Flue /vent for any of above 10.00
Subdivision: Lot no.:
Other: _ 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
r- Gas fireplace 10.00
- ci �G ( . &C rey1; V r? (.�cf Flue vent for water heater or gas
V fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
' 51 _ PROPERTY OWNER ❑ TENANT Chimney /liner /flue/vent 10.00
Other: 10.00
Name: :g19� I,,t,, Q „ ^ Environmental exhaust and ventilation
I 4.1 b, St J 5 Range hood/other kitchen
Address:
t A U6 equipment 10.00
City /State /ZIP'1 �( Clothes dryer exhaust 10.00 `7� Y
Single -duct exhaust (bathrooms,
r��
Phone: 10 1 _ ( 0(s- Fax: ( ) toilet compartments, utility rooms) 6.80
® APPLICANT. ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other:
Business name: " A S�� cjC k, L A- (- L „ „ ei 10.00 .
Fuel piping
Contact name: IM $5.40 for first four; 51.00 for each additional
a ( tto up p - M p P Furnace, etc.
Address: �"
Gas heat pump
City /State /ZIP: 1 Lk �, yL C /,--, Wall /suspended/unit heater
Phone: ( )? L -i _ Fix:: ( 3 L(1"/ -Ocian Water heater
Fireplace
E-mail: Range
• CONTRACTOR Barbecue
Business name: I v L rat C << < �- <-�� -P n „ - _ Other: dryer (gas)
�"' `" r Other:
Address: 1411-,, k) �f - J MECHANICAL PERMIT FEES*
City /State /ZIP: Mali q 1.D-. lg Subtotal
Phone: (g)3) `3 as F ( ) Minimum permit fee ($72.50)
(
Plan review (25% of permit fee)
CCB Iic.: 13_ 5 73 1 State surcharge (8% of permit fee)
r TOTAL PERMIT FEE 73 , .7 0
Authorized si ature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: ILA
A
4
� , / Date: - ' * Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Permits\MEC- PennitApp.doc 04/06/06 440 -4617T(II /02/COM/WEB)
Mechanical Permit Application - City of Tigard -'- ,
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuations 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:\ Buildin \Permits\MEC- PermitApp.doc 12/30/05 2
Y
CIT ■ OF TIGARD
BUILDING DIVISION -- PERMIT #: MEC2006 -00 169
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/26/2.00;
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: el/27/2006 TIME: 7:04A1 Vi PAGE: 100
SITE ADDRESS: 1i1210 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: ARLINGTON RI1):3E.: LOT #: 03:'. TYPE OF USE:
PROJECT NAME: HOSMAN
DESCRIPTION: Extend ga;; line to (pool.
OWNER: HOSMAN, ROBERT P., DARCI PHONE #: 14 i
CONTRACTOR: NATURAL. GAS CUSTOM PIPING INC.: PHONE #:
Inspection Request Scheduled For: Date: /1/27/2o0G Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 (;',as line 027'9 " -01 503-572.3067 N
Corrections /Comments/ Instructions:
6 PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
AIL ❑ CALL FOR INSPECTION 1 ADDITIONAL FEES ASSESSED
Inspector: / Date: ; Phone #: (503) 718-
/�/