Permit ar , 1? .
ili ` I�Y ��, MECHANICAL PERMIT
t ' .:. � ° COMMUNITY DEVELOPMENT
PERMIT #: MEC2007 -00090
'TIGARD, 13125 DATE ISSUED: 2/8/2007
w : 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S111 DD - 02600
SITE ADDRESS: 08870 SW HAMLET ST ZONING: R -4.5
SUBDIVISION: STRATFORD LOT: 032 JURISDICTION: TIG
Project Description: Extend gas line to range, log lighter & BBQ.
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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 3
> 10000 cfm:
GAS OUTLETS: 3
Owner: FEES
GRAHAM JACOBSON Description Date Amount
8870 SW HAMLET
TIGARD, OR 97223 [MECH] Permit Fee 2/8/2007 $72.50
[TAX] 8% State Surcha 2/8/2007 $5.80
Total $78.30
Phone: NA
Contractor:
DLH PLUMBING
PO BOX 3309
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 632 -4815
FAX 503 -632 -4819
Reg #: LIC 158878
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: Permittee Signature: 7,? --.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.
Feb 08 07 09:52a DLH PLUMBING 503 - 632 -4819 p.1
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Mechanical Permit Application ,. .-- �'�' i e ; , a �� ! `.- x
�° • . - x . ; r l)I���tI } l , l�_ 1 }5F �)�1 t� ,.. , t2 ) : � ?t 1
`i City of Tigard ( L fl $ oar �. Permit xo. c L D 9 0
13125 SW Hall Blvd., Tig 43R, %7223.r. � (1 7 � !'— ' \( ,u
., .0 .598.1960 Plan Review Other Permit:
ila ^1 Q Phone: 503.639.4171 Fax: 503 pates g.:
T,, , .,,, Inspection 1_ine: 503.639.4175 See Page r for
1 7 Date Ready /By; Bt
!d Internet: www.tigard L U �oo l NotitNotified/Method: lurs: I Supplemental Information
0
x �Fitliz y �� COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
1
- A4c11/fon'�a' C inottrep a] cement
-"f• 9 Mechanical permit fees* are based on the value of the work
❑ New construction K r . 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*
af 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
Air conditioning or heat pump
lob site address: bo a 70i Svu / &Li /( + t. , (requires site plan showing placement) 14.00
City/State /ZIP: 1, �f f O R..", Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
SuitelbldgJapt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
llydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Flu , venr for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel rto.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
A n Gas fireplace 10.00
l ' V a (�,f�',� �R.,, _ / i 1 f 1,'�•�(' 13 CR Flue vent for water heater or as
J ( fireplace 10.00
Log lighter (gas) 1 10.00 j 0,0t_
Woud/pellet stove 10-00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER ❑ TENANT
Chimney/liner/flue/vent 10.00
Other: 10.00 _
Name: Environmental exhaust and ventilation
Address: equipment hood /other kitchen
equipment 10 -00
City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6 -80
APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
DL. J y0/6 — Fuel piping
Contact name: �_ . F`0t 11 , '-'S 55.40 for first four; $7.00 for each additional
�� Furnace, etc.
Address: P O ,-3,_, , , > O 9 Gas heat pump
City /State/ZIP: Oie y`Co1 0 � �� ! QQ G , { 7C2( 5 Wall /suspended/unit heater
�I Water heater
Phone: (5 3 43
) . '( 5 1'5 Fax: : (SGi ) i32 _.-- - g i I Fireplace
E-mail: I (J ,, ;1�q ( . Vl/1t3t1 t ., L t/ \ Range 1 S `� 0
J CO CTOR Barbecue
Clothes dryer
Other:
s)
H Business name: 1
Address: (ga MECANICAL PERMIT FEES*
City/State/ZIP: Subtotal J 5. '•( 0. Phone: ( per- Minimum permit fee ($72.50)
( ) Plan review (25% of permit fee)
CCB lic.: j s s 6 18 State surcharge (8% of permit fee)
l TOTAL PERMIT FEE
Authorized si ature :/ ,
This permit application aspires if a permit is not obtained within 180
� I V w d ays a i t has been accepted as complete.
Print name: .1 ,,. u 1 — 4 11• d 5 Date: z — PJ - CA ' Fee methodology set by 'Tri- County Building Industry Service Board
t:' auildirOPermits ■MtEC- Pcrmi!.9pp4loe 04 440 -46177 (11102/COMJWE13)
. _
CITY OF ��nu w ��u uu���mun�w
BUILDING DIVISION pERM|T#: ME�2DO7'0�9O
1 13125 SW Hall 8hd..Tigard, OR 97223 DATE ISSUED: 20a/20O7
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 6394175 /Ve—/rgOm7~^100 2 a
INSPECTION WORKSHEET FOR DATE: 2/15/2007 TIME: 7:00Ah4 PAGE: 5
SITE ADDRESS: OH87OSW HAMLET 8T CLASS OF WORK:
SUBDIVISION: STRATFORD LOT #: 032 TYPE OF USE:
PROJECT NAME: JACOBSON
DESCRIPTION: Extend Qzi.E; Unn ,onyw. 4o9 Uyh\e/ & B80
OWNER: JACOBSON, GRAHAM PHONE #: NA
CONTRACTOR: E)LHpLUK4BIN<S PHONE #: 5O3.632'4815
■
Inspection Request Scheduled For: Date: 2y1600U7 Pour Time:
•
Code # Inspection Description Confirm # Contact # Message
810 Gas line 043462-01 503'314'5074 N
Corrections/Comments/Instructions: ���
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k «SS | PARTIAL APPROVAL ri CANCEL NO ACCESS
FAIL I l CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: t /�/ Date ° �� / Phone #: (503) 718' -�