Permit Aev`
IVP,(iLfthAmi;; °' CITY TIGARD CITY F MECHANICAL PERMIT
.,. PERMIT #: MEC2007-00376
COMMUNITY DEVELOPMENT DATE ISSUED: 6/21/2007
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 DB - 09800
SITE ADDRESS: 15515 SW OAKTREE LN ZONING: R -
SUBDIVISION: SUMMERFIELD NO.10 LOT: 586 JURISDICTION: TIG
PROJECT: SACCONAGHI
Project Description: Installing gas piping for a gas 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:
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:
GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
SANDRA SACCONAGHI Description Date Amount
15515 SW OAK TREE LN
TIGARD, OR 97224 [MECH] Permit Fee 6/21/2007 $72.50
[TAX] 8% State Surcha 6/21/200 $5.80
Total $78.30
Phone: 503- 620 -3520
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 /
Issued B � / / Permittee Signature: y
Call 503.639.4175 by 7:00 a.m. for inspections that b :sness 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.
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City of Tigard ` "�' ' '' @ C� e � FB 3tas ' Received ' l I� Permit No. �� �, /
Date/By: •
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.I960JUN 21 2007 g"r- go .A Date /By Other Permit:
Inspection Line: 503.639.4175 ;Y � Date Read B : 1a�g
ard.or.us -� y y H See Page 2 for
Internet: www.ci.ti
g C �"` tf 1] ' . 1'tU Rt ;1 , Notified/Method: ' 111 Supplemental Information
1 �JL 11 8, [ @ � ,� T'
�� � id Y�11 -' 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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
•
- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
❑ For special information use checklist.
❑ Multi family
❑ Master builder Other: Description Qty. Ea. Total
- - _ _ - • JOB;SITE.INFORMATION -AND LOCATION' _ - . _ - Heating/cooling
Job site address: i 5 / S 0 k'`r-0 ('e- L N Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State /ZIP: - i9Qr 4g. / 7 7 Furnace 100,000 BTU (ducts/vents) 14.00
/ / 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
Residential boiler (radiator or
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
5 -t„.. i f, Rs Q, -✓ �e /e Flue vent for water heater or gas
J / t fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
ROPERTY OWNER ❑ TENANT Chimney /liner /flue/vent 10.00
Other: R(}t,(>O1L 10.00 ‘0 . CID
Name: ONIVtA- s a cc a G I i Environmental exhaaust and ventilation
Address: / /� 'T-g P e L/ . Rane hood other kitchen
( equipgment 10.00
City /State /ZIP: , V G Re.- Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone' ) 6 Zo 757 D 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; 51.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -m Range 1 5 . ail)
. ' / CONTRACTOR Barbecue
Business name: ilo , me J e5' ^ / Cj 562... Clothes dryer (gas)
I / �` ] Other:
Address: V MECHANICAL PE RMIT FEES*
''.-3 5,5- �W -
City /State /ZIP: Co fZA 'e 1 ( v Ode, 9 #1/ 3 Subtotal 15 , 40
Minimum permit fee ($72.50) ',? .50
Phone: 23) Z , 7 7 Fax ( ) Plan review (25% of permit fee)
CCB lic.: f 02 11 7 State surcharge (8% of permit fee) . 0 ,4 Zl
` TOTAL pERMIT FEE ' 3O .
•
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: PAe / ----6. e!', , Date'. 6 z ,7 �7 ' Fee methodology set by Tri- County Building Industry Service Board
is \Building\Pennhl \MEC- PennttApp.doc 12/03 44 617T(II 02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
:!f••,
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 .
i:U 3uilding \Permits\MEC- PermitApp.doc 12/03 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2007 -00376
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/21/2007
Phone: (503) 639 -4171 ��u11� _
Inspection Requests (24 Hrs.): (503) 639 -4175 _�' ''!_I o Q 7 + O ®
INSPECTION WORKSHEET FOR DATE: 6/22/2007 TIME: 7:03AMVI PAGE: 23
SITE ADDRESS: 16615 SW OAKTREE. LN CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.10 LOT #: 586 TYPE OF USE:
PROJECT NAME: SACCONAGHI
DESCRIPTION: Installing gas piping for a gas range.
OWNER: SACCONAGHI, SANDRA PHONE #: 503 - 620.3520
CONTRACTOR: HOLMES INSTALLATION SERVICE PHONE #: 503- 267 -7574
Inspection Request Scheduled For: Date: 6/22/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 050776 -01 503 -620 -3620 N
Corrections /Comments /Instructions:
0
4
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f-
PASS ❑ PARTIAL APPROVAL I I CANCEL I NO ACCESS
FAIL CALL FOR INSPECTION ❑ .ADDITIONAL FEES ASSESSED
ir Inspector: Date: G - 2Y---e: Phone #: (503) 718 -