Permit . � CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00507
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/20/2007
PARCEL: 2S 112CA -03700
SITE ADDRESS: 15540 SW 79TH AVE ZONING: R -12
SUBDIVISION: DURHAM ACRES LOT: 019 JURISDICTION: TIG
PROJECT: BROOKS
Project Description: Install wood stove.
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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: IT
REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR NIT S: 1
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
WALT & JOAN BROOKS Description Date Amount
15540 SW 79TH AVE
TIGARD, OR 97224 [MECH] Permit Fee 8/20/200% $72.50
[TAX] 8% State Surcha 8/20/200 $5.80
Total $78.30
Phone: 503- 639 -3228
Contractor:
LUDEMAN'S FIREPLACE & PATIO
12675 SW BEAVERDAM RD
BEAVERTON, OR 97005 -2129 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 646 -6409
FAX 503- 646 -8034
Reg #: LIC 51469
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 y: l . � � I. � . � J Permittee Signature: x /d, fiO
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.
Mechanical Permit Application .FOR OFFICE.USE ONLY
r ^. Received �/
1,1 City of °�>garel Date /By: j j 6 7 Permit No.: I l -d• r. s7
- ° 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
T I G A RD Inspection Line: 503.639.4175 Date Ready /By: MI ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction 1=1 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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
r /a— Air conditioning or heat pump
Job site address: r 5 40 ` a _) 7 ( _
n (requires site plan showing placement) 14.00
�a �"�
City /State /ZIP: /- / Q 97aaG{ Furnace 100,000 BTU (ducts /vents) 14.00
/ Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: `�,e_coie-,rj 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
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
- v 11
r I ao 5.722 J E- Gas fireplace vent 10.00
S LL !i( Flue vent foor water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 1 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: - /—i,) 'oQ /�S Environmental exhaust and ventilation
Address: ` 5 - 6 - VO ^. w 4-(J Range hood /other kitchen
equipment 10.00
•
City /State /ZIP: -77 n/_. O2 9 79- .4L Clothes dryer exhaust 10.00
U Single -duct exhaust (bathrooms,
Phone: (503) (p 3? _ 3 a-a- 0 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
Business name: k..-6( L` H/19.-/J /.3 Clothes dryer (gas)
n Other
Address: / 2.67 ,Ow / - ei�{Y� /�D/9yy , �( s ) MECHANICAL PERMIT FEES*
City /State /ZIP: 7 T 7 O2 9 700 3 Subtotal
/� Minimum permit fee ($72.50) 7 ,5C)
Phone: 573 ) (o 4 6- ep ye y Fax: ( ) Plan review (25% of permit fee)
CCB lic.: 51 yeq State surcharge (8% of permit fee) 15 W)
TOTAL PERMIT FEE .-7$'' 5c)
This permit application expires if a permit is not obtained //within 180
Authorized signature:
days after it has been accepted as complete.
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
(:\Building \Permits \MEC- PermitApp.doc 01/19/07 440 -4617T (11/02 /COM/WEB)
Mechanical Permit Application - City of Tigard . •
P
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. °
$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
CITY OF TJGARD
' BUILDING DIVISION PERMIT #: MEC2007'00507
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/20/2007
Phone: (503) 639 -4171 Al p i�@�Ib�
Inspection Requests (24 Hrs.): (503) 639 -4175
} INSPECTION WORKSHEET FOR DATE: 8/30/2007 TIME: 7:00AM PAGE: 42
SITE ADDRESS: 15540 SW 79TH AVE CLASS OF WORK:
SUBDIVISION: DURHAM ACRES LOT #: 019 TYPE OF USE:
PROJECT NAME: BROOKS
DESCRIPTION: Install wood stove.
OWNER: BROOKS, WALT & JOAN PHONE #: 503-69 -3228
CONTRACTOR: LUDEMAN'S FIREPLACE & PATIO PHONE #: 503 - 646'6409
Inspection Request Scheduled For: Date: 8130/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 054850 -01 503 - 635-3228 N
Corrections /Comments /Instructions:
•
I PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL n ALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector,: , Date: 5 -1()-O Phone #: (503) 718 -11 -��