Permit I pi ' ,M CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00212
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fGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/18/2007
PARCEL: 2S 111 AC - 00500
SITE ADDRESS: 14570 SW 91ST AVE ZONING: R - 4.5
SUBDIVISION: PINEBROOK TERRACE LOT: 046 JURISDICTION: TIG
PROJECT: KLEIN
Project Description: Gas line to 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 0
GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
JULIE KLEIN Description Date Amount
14570 SW 91ST
TIGARD, OR 97223 [MECH] Permit Fee 4/18/20W $72.50
[TAX] 8% State Surcha 4/18/20W $5.80
Total $78.30
Phone: 503- 650 -5036
Contractor:
JENSEN QUALITY CONSTRUCTION
PO BOX 2803
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 657 -8309
FAX same
Reg #: LIC 171408
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: 1 .� Permittee Signature: Kr'
Call 503.639.4175 by 7:00 a.m. for inspections that business d .
This permit card shall be kept in a conspicuous place on the job site until comp etion of the project.
Approved plans are required on the job site at the time of each inspection.
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_�'Iec�anical Permit A l v , t t , n 't TM
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P i' 0 a s J • i' 3• -; a. Received i
� _ City of Tigard Date/By: 1md • Permit No. :: . , ✓i1 _A0A/ •
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
f!• `. (': = Phone: 503.639.4171 Fax: 503.598.19 1 2007 Other Permit:
i ; DateBy:
ar qr ,: ti Inspection Line: 503.639.4175 Date Read /B Ju ris:
�T I' G A'R�D Ready /By:
r' .�riliWucitt' h Internet: www.tigard or.gov Notified/Method: ' ® See Page 2 for
Supplemental Information
lr:� f gin
�� .. ' - . - . COMMERCIAL' FEE* SCHEDULE USE CHECKLIST
❑ New construction Ad dition/alteration/replacemen[ 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 . Heatinglcooling
Job site address: / L/3 .7. �' 4) ' (Jr / 1- it' Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State /ZIP: 79a rd. Fumace 100,000 BTU ( ducts/vents) 14.00
L
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
t A Lt. 70 7> five 33rd Residential boiler (radiator or
/ e $ YDO `� 9(57 Unit h ic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
• • DESCRII'TION OF WORK . . Water heater 10.00
a l-61- / Gas fireplace 10.00
C G //L C 7p iV CW �t�Ct rl Flue vent for water heater or gas
U fif 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: /` (✓a. ti k / e t4 , Environmental exhaust and ventilation
Address: V � f' Range hood /other kitchen
y 7 0 6 ! / T equipment 10.00
City /State /ZIP: .7;`a ev Clothes dryer exhaust 10.00
j Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
r Other: 10.00
Business name: ,�/ � s4s-, l � 7 Fuel piping
Contact name: V V-�� f Po.-- $5.40 for first four; $1.00 for each additional
Address: /6 r d fled )
Furnace, etc.
X Gas heat pump
City /State /ZIP: �0) ® to 0 , 6-4 02 WalUsuspended/unit heater
Phone: ``�r''' r Q ! 7 p Water heater
JJ�/ e rJ Fax: : ( 7 Q
Fireplace
E -mail: �f ` 6V , �Af C4J ('i44 f 7»?J • GOP Range !
Q CONTRACTO6 - Barbecue
�— Clothes dryer (gas)
Business name:
�el4d CN ��ll u /�
,( efir Other:
Address: / ' 0 • ( 261 Z MECHANICAL PERMIT FEES*
C -
City /State /ZIP: , N 1j1 e: Q 104 1 ?0 y.(— Subtotal
^ Minimum permit fee ($72.50)
Phone: cS33) .., g r Fax: ( ) 6 ec o
Plan review (25% of permit fee) n
CCB lic.: /71 t j0 e 7/3/ State surcharge (8% of permit fee) r J •
TOTAL PERMIT FEE /lt .3
Authorized signature: This permit application expires if a permit is not obtain within 180
14/0 days after it has been accepted as complete.
Print name: 6vels y e �JC {� Date: 'T ' Fee methodology set by Tri- County Building Industry Service Board
\ \ 1: \BuildingPermitsMEC- Permit App.doc 04 /06/06 440 - 4466!7T (11 /02/CON//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.
$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.
I:\ Building \Permits\MEC- PermitApp.doc 12/30/05 2 •
CITY OF TIGARD - `_
BUILDING DIVISION PERMIT #: MEC2007 -00212
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/18/2007
Phone: (503) 639- 4171 iruh9�16" r _
Inspection Requests (24 Hrs.): (503) 639 -4175 . �' r'f l� �& c_ oo vO 2/2'
INSPECTION WORKSHEET FOR DATE: 4/19/2007 TIME: 7:01AM PAGE: 1/
SITE ADDRESS: 14570 SW 91ST AVE CLASS OF WORK:
SUBDIVISION: PINEBROOK TERRACE LOT #: 046 TYPE OF USE:
PROJECT NAME: KLEIN
DESCRIPTION: Gas line to range.
OWNER: JULIE KLEIN, PHONE #: 501650-5036
CONTRACTOR: JENSEN QUALITY CONSTRUCTION PHONE #: 603-657 -8309
Inspection Request Scheduled For: Date: 4/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 046807 -01 503. 320.5232 N
•
Corrections/Comments/Instructions:
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F PASS I l PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I l FAIL n CALL FOR, INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' Date: --! GI —0 Phone #: (503) 718-