Permit CITY TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007. -00566
O O
TIGARD 13125 SW Hall Blvd., Tigard,.' OR, 97223 503.639.4171 DATE ISSUED: 9/27/2007
PARCEL: 2S 103C B -08300
SITE ADDRESS: 12373 :SW QUAIL CREEK LN ZONING: R -4.5 •
SUBDIVISION: QUAIL HOLLOW - EAST LOT: 032 JURISDICTION: TIG
PROJECT: YUSON
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Project Description: 'Installation of gas line for bar- b -que.
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 < 1OOK BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= :10000 cfm: GAS OUTLETS: 1
> 1 0000 cfm:
Owner: FEES
JASON & KELSEY YUSON Description Date Amount
12373 SW QUAIL CREEK LN
TIGARD, OR 97223 [MECH] Permit Fee 9/27/2007 $72.50
[TAX] 8% State Surcha 9/27/2007 $5.80
Total $78.30
Phone: 503 - 521 -9383
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.
I sued By: 1 p. , ' ( Permittee Signature:
Call :503:639.4175 by 7:00 a.m. for inspections that b ness day.
This permit card shall be kept in +a•conspicuous place on the job site til completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application = ,x~ L; Fa o'~ yo 0
City of Tigard Re Date/ By: ~7 Permit No.: ,l
° 13125 SW Hall Blvd., Tigard, OR 97223 6 !"l ~e ~OD7~ SAO
Plan Review Other Permit
Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175 Date Ready/By: Juris.
Internet: www.ti and-or. ov ®See Page 2 for
g g Notified/b7ethod: ~ Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction Addition/alteration/replacement Mechanical permit fees` are based on the value of the work
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-family dwelling F1 Commercial/industrial El Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*.
For special information use checklist.
❑ Multi-family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
p Air conditioning or heat pump
Job site address:/237-3 l_ cf- tic (requires site plan showing placement) 14.00
Y~
City/State/ZIP: !(`4b,- d~f=,r ~j -7Z7. Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: Gas heat um 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot waters stem 14.00
Residential boiler (radiator or
h dronic) 14.00
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue/vent for an of above 6.80
Other: 10.00
Tax map/parcel no.: Other fuel appliances
DESCREMON OF WORK Water heater 10.00
Gas fireplace 10.00
7 G- LU' C'- t t r lx- b~ Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/ pellet stove 10.00
Wood fire lace/insert 10.00
PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name:.AAjo,V L) 2'V N Environmental exhaust and ventilation
A , Range hood/other kitchen
Address: Z Lbw' Lfv a ui ment 10.00
City/State/ZIP: r O v' 7 Y l Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
65,3 11 Phone: ) - * ?3 Fax: ( ) toilet compartments, utility rooms) 6.80
APPLICANT ❑ CONTACT PERSON Attic/crawls ace 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 um
City/State/ZIP: Wall/suspended/unit heater
Water heater
Phone:( ) Fax::( )
Fireplace
E-mail: Range
CONTRACTOR Barbecue
Business name: I4„~ Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City/State/ZIP: Czp"~ lw O Vie- ( Subtotal
Minimum permit fee ($72.50) ,3
Phone: (29) 72
7 Fax: ( ) Plan review (25% of permit fee)
CCB lic.: 1'02- 7 State surcharge (8°/n of permit fee) $
TOTAL PERMIT FEE
Authorized si nature: 61- /y-► This permit application expires if a permit is not obtained within 180
g nature: after it has been accepted as complete.
K~y V _M: Z:/7 Fee methodology set by Tri-County Building Industry Service Board
Print name:
l:\Building\Permits\MEC-P mitApp.doc 01/19/07 440-4617T (I I/02/CON11WEB)
Mechanical Permit Application - City of Tigard �-
Page 2 - Supplemental Information
Commercial Fee Schedule:
;Total Valuat><on ` , ' , f Permit Fee , x `:; 5
$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.
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1 \ Building \PermitsWMEC- PermitApp.doc 01/19/07 , 21 •
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CITY n� OF TIGARD ° - � .
BUILDING ��U��U��U��0� PERMIT =°~°,~~=�,,~~° ~~,�,~°,~~,~ k4��<�2O07'0O508
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: Ey27/2007
Phone: (503) 639-4171 49 Its
Inspection Requests (24 Hrs.): (503) 639-4175 , ��N� e��.
' INSPECTION WORKSHEET FOR DATE: TIME: P AGE
� f���/ � 7�OO PAGE: 16
SITE ADDRESS: 12373 SW QUAIL CREEK LN CLASS OF WORK:
SUBDIVISION: QUAIL HOLLOW EAST LOT #: 033 TYPE OF USE:
. PROJECT NAME: YUSON
DESCRIPTION: Installation, of gas line for bi4que,
OWNER: YUSQW, JASON &KELSEY PHONE #: 583-521'9383 •
CONTRACTOR: HOLMES INSTALLATION SERVICE PHONE #: 503-267'7574
Inspection Request Scheduled For: Date: 9/28/3007 Pour Time:
Code # Inspection Description Confirm # Contact # . Message
610 Gas line 056592,01 503-621'9383 N
Corrections/Comments/Instructions:
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I PARTIAL APPROVAL F CANCEL I I NO ACCESS
I FAIL | | CALL FOR INSPECTION | I ADDITIONAL FEES ASSESSED
Inspector: ^ Date: 'F S - 6? Phone #: (603) 718-
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