Permit ,q CITY OF TIGARD MECHANICAL PERMIT
` COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00004
,!R ; 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/4/2007
PARCEL: 2S 109AA -00700
SITE ADDRESS: 14255 SW 125TH AVE ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Install propane gas insert and line for tank.
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:
LPG 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: 1
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
DON MILLER Description Date Amount
14255 SW 125TH
TIGARD, OR 97224 [MECH] Permit Fee 1/4/2007 $72.50
[TAX] 8% State Surcha 1/4/2007 $5.80
Total $78.30
Phone: 503- 620 -7261
Contractor:
R & D INSTALLATIONS
5246 SE 62ND
PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 774 -7142
Reg #: LIC 95236
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: i ,f 4 f //� /' o f Permittee Signature: \ , ;1, ` � ` � �
Call 503.639.4175 by 7:00 a.m. for inspections that : "ess 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 A • • lication :-. J t ' i y p r c y
• ; . t`` m..1/I(rl_k(ISI ()tNi_,) -0?,.. k'4 sr � .. 1
,K.Y 4 ; t Received
0 lt)' of Tigard Date/By / / / Permit No.: kli 7 occo
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
® Other Pennit:
.w� (1 i Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Inspection Line: 503.639.4175 Date Ready/By: � ® S ee e 2 for
Pa
T Fl1
I G'A�I'I� luris g
tti�l'iIiansi Internet: www.tigard- or.gov Notified/Method: -- / f (j Supplemental Information
PE OF WORK .COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
❑ New construction d 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: $
211 and 2-family 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: /9'L$T (ti / ZS (requires Air conditioning ho heat p (requires site plan showing placement) 14.00
City /State /ZIP: "L((,/ ,, a At '37 1 ' Furnace 100,000 BTU (duds/vents) 14.00
• (( (f " / 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
/ ! ,}�, r ( ( f f?J ho t water system ` " 1 Residentia l boiler (radiator or 14.00
hydronic) 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
' DESCRIPTION OF WORK - Water heater 10.00
Gas fireplace / 10.00
' � G �
) 5 i � V U C e p vent for water heater or gas
° .� fireplace lace 10.00
I Log lighter (gas) 10.00
0 4, `(f 7 ?:, �J,[ r A r( /� C t-vz-J Wood /pellet stove 10.00
N ` �` /� Wood fireplace/insert 10.00
' ❑ PROPERTY OWNER . I - ❑ TENANT ( Chimney /liner /tlue/vent 10.00
Other: 10.00
Name: bov"\ ii/c ( ( e ir Environmental exhaust and ventilation
5' a 7'1 Range hood/other kitchen
Address: / z, 51 equipment 10.00
City /State /ZIP: h o U O� Clothes dryer exhaust 10.00
J ( � .5--.0 - y t � J ,�. t file exhaust (bathrooms,
Phone: Vol) J 7 j� (J oilet t compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
L rim
Other: 10.00
Business name: f2 � f� rte, } Fuel piping
R../._
Contact name: l " , i' I' v` $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: S---)if v z ,
!! /�_ Gas heat pump
City /State /ZIP: C 01-66
Water heater
� r e - / 7 C� v Wall /suspended/unit heater
Phone:gi)) 7 LJ._ '71 Cie_ Fax: : ( ) Fireplace
E- mail: // /! Range
CONTRACTOR Barbecue
•
Business name: Clothes dryer (gas)
•
ILv —_ Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal ��
Minimum permit fee ($72.50) 7e '
Phone:( ) Fax:( )
Plan review (25% of permit fee) `
CCB lic.: 932 Z J 6 16. (? f Q b r/ State surcharge (8% of permit fee) J• 1
TOTAL PERMIT FEE 75,
Authorized signature: This permit application expires if a permit is not obtained within 180
!'� days after it has been accepted as complete.
Print name: 4 _ / \( 0 1, ) Date: / -- V — • Fee methodology set by Tri- County Building Industry Service Board
\
I:Building \Permitss'MEC- PermitApp.doc 04 /06/06 440.4617T(11/02/COM/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.
•
1:\Buildin PermitApp.doc 12/30/05 2
•
CITY OP - TIGARD ,
..,„- 4:
BUILDING DIVISION
A PERMIT #: MEC2007-0000
D ATE 4
13125 SW Hall Blvd., Tigard, OR 97223 E ISSUED: 1/4/2007
Phone: (503) 639-4171 enoloi,t;
Inspection Requests (24 Hrs.): (503) 639-4175 .4.61r 1.11. iti 00 9 -e000 9
INSPECTION WORKSHEET FOR DATE: 1/5/2007 TIME: 7:00AM PAGE: 20
SITE ADDRESS: 14255 SW 125TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MILLER
DESCRIPTION: Install propane gas insert and line for tank.
OWNER: MILLER, DON PHONE #: 503-620-7261
CONTRACTOR: R & 0 INSTALLATIONS PHONE #: 503-7747142
Inspection Request Scheduled For: Date: 1/6/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 041845-01 503-250-4448 Y
Corrections/Comments/Instructions:
g - D QA-- --- P,..(' t ..t3,(-13 I A.4711-. 0 1 – ri 44..- . - th- -- • 041-d-
j 1■46c , ,■) e-.4k- / Aic,11-2.4-41-7 ty , v L 2.-C
' •
I PASS ARTIAL APPROVAL 0 CANCEL I I NO ACCESS
I I FAIL 1 CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
/f Inspector: Date: /— S ---0 – 7 Phone #: (503) 718- 2-4c-7