Permit •
q CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00295
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/21/2007
PARCEL: 2S 103AA -03700
SITE ADDRESS: 12300 SW 106TH DR ZONING: R -4.5
SUBDIVISION: CLYDESDALE LOT: 017 JURISDICTION: TIG
PROJECT: NEWTON
Project Description: Gas line to range and barbeque. Approx. 22ft.
CLASS OF WORK: ADD 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: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 2
> 10000 cfm:
Owner: FEES
ELIZABETH A. NEWTON Description Date Amount
12300 SW 106TH DR
TIGARD, OR 97223 [MECH] Permit Fee 5/2112007 $72.50
[TAX] 8% State Surcha 5/21/200 $5.80
Total $78.30
Phone: 503- 579 -9276
Contractor:
HOLMES INSTALLATION SERVICE
PO BOX 0381
NORTH PLAINS, OR 97123 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 647 -9320
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.
Issued By:._ `� /' //_ ,.� Permittee Signature: lA /1* 04/1/
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 APP .tin ll ' " r FOR OFFICE ONLY '' ', ,
City of Tigard tiLIEIVE +,1 Received
DateBy: / ��
III
Plan Revie . Permit 6. ,, 9_00x95
a 13125 SW Hall Blvd., Tigard, OR 97223 v
Phone: 503.639.4171 Fax: 503.5g8)1960 , 7 Date/By : Other Permit:
I Li 503. 639 . 4175 f`rrl l � o o l
T G 'A` RD Date Ready /By• BE ® See Page 2 for
Internet www. tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
RUH_D!�!n DIVI'
TYPE OF WORK 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: $
1 - and 2-family dwelling • RESIDENTIAL EQUIPMENT / SYSTEMS FEES* •
/ } g ❑ Commercial /industrial ❑ Accessory building
❑ Multi - family ❑Master builder For special information use checklist.
❑ Other:
Description p Qty. Ea. Total
• JOB SITE INFORMATION AND LOCATION Heating/cooling
/ L �OO C V / 0 `_ +� J Air conditioning heat pump
f
Job site address: ((J � (requires site plan showing placement) 14.00
City /State /ZIP: ii 1, D - 5 7 z. z.2.— ?) Furnace 100,000 BTU (ducts /vents) 14.00
/ Fumace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project nam : Gas heat pump 14.00
Cross street/directions to job site: /0 ( / -- ,//�i 1 l I Duct work 14.00
5 1/ , ut %� yy Hydronic hot water system 14.00
�W 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
}� �� / , � l/ / Gas fireplace 10.00
f YI S I +U/ -Ga en / t la Y41 � i �y�1
i C C Flue vent for water heater or gas _
fireplace 10.00
CS iq CA/ , n Q 4/ Ira r U Log lighter (gas) 10.00
• P -a x 2-2..- Wood/pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
PROPERTY OWNER ❑ TENANT Other 10.00
Name: r c/I ` !/C/ 1 7 / ) Y I I/) V v-- 1 e4 A l Environmental exhaust and ventilation
Address: I 300 �(� / 0 0 l rl' l• li v I I Range hood/other kitchen
G U/ equipment 10.00
City /State /ZIP: TiArd / tj"I
. 97 L Z Clothes dryer exhaust 10.00
/ Single -duct exhaust (bathrooms,
Phone: (563) 5 9 C>. z 7 c, l/ Fax: ( ) toilet compartments, utility rooms) 6.80
APPLICANT /X CONTACT PERSON Attic /crawlspace fans 10.00
Business name:
Other: 10.00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Fumace, etc.
Gas heat pump
City /State /ZIP: WalUsuspended/unit heater
Phone: ( ) Fax :: ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue I
Business name: / l i° S j t- 5 �� � U., Clothes dryer (gas)
2 Other:
Address: 1 " ✓ 3 g l MECHANICAL PERMIT FEES*
City /State /ZIP: A / 0 1 4 / 1 , 1` 1 J ovcf cmi 57/2- 3 Subtotal
Phone:
(503) (p 4 - 7 .9 3 2 _6 Fax: ( ) Minimum permit fee ($72.5
Plan review (25% of permit fee)
)
CCB lic.: /6 z, +7 State surcharge (8% of permit fee) �
Authorized signature:, , TOTAL PERMIT FEE
��, V 1 Gal a/1441 / This permit application expires if a permit is not obtained within 180
+^_ � /r Y ,�^_ days after it has been accepted as complete.
Print name: L Y{K
a ,l n # Dater (t,' 2,/ �C7 • Fee methodology set by Tri- County Building Industry Service Board
I \ Building \Permits\MEC- PermitApp, doc 04/06/06 440- 4 (1 I /02 /C OM/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.
$1 00,000.01 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 12/30/05 2
CITY OF TIGARD,. n't ; 07
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639- 4171au
Inspection Requests (24 Hrs.):'(503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 1 30 c) (06: CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ,rV (_ to 1J
DESCRIPTION: 6., L lNL TD /&A - 6-G- t r3 .acz
OWNER: /UGWTOn!! Et /ZAAGTH PHONE #:
CONTRACTOR: HoLhES /N TQLLA j !Or/ Sc /LOCt;= PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
0 8937/ -
Corrections /Comments/ Instructions:
,q J l I 7719 05V/C_& NDi FUNT'i0' /tiG--
g c-c,9 LL FOIL. F /A 14 L
❑ PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: f3 /' ku 2 L 0 G K Date: S r —® Phone #: (503) 718- 2---v-e-/--3
CITY E�: 4 a ,D • 4 ,S.-
BUILDING DIVISION I PERMIT #:. EG2007 t 41
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/21/2ClCt , . _
Phone: (503) 639 -4171 w" ti " i .
Inspection Requests (24 Hrs.): (503) 639 -4175 4-..-44. Ail =----
INSPECTION WORKSHEET FOR DATE: .ii2:4/2007 TIME: ? 02 AM PAGE: `i'!
SITE ADDRESS: +JJOO SW 106 DR CLASS OF WORK:
SUBDIVISION: CLYDESDALE • LOT #: 017 TYPE OF USE:
PROJECT NAME: NEWTON . .
, ., . .
DESCRIPTION: Gas $inc� t ange a barbequ'. Approx 22ft. _ _.. .
- r:
OWNER: Nt:VVTON. ELIZABETH BET H PHONE #: 503
. CONTRACTOR: HOLMES INSTALLATION SERVICE PHONE #: 5 t1361 7 •'3320
Inspection Request Scheduled For: Date: 6/29/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610E is line 14917 -01 503 -742412 ¥
ti
Corrections /Comments /Instructions: N ,7
F 1 a +ff-
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N O, /
17.l PASS n PARTIAL APPROVAL H CANCEL n NO ACCESS
FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED 07 • Inspector: a -` s Date: 2 " P h one #: (503) 718- 4' 4� '--'
CITY OF TIGARI)
BUILDING DIVISION PERMIT #: MEC2007 -00295
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/21/2007
Phone: (503) 639 -4171 Are41Gig jll
Inspection Requests (24 Hrs.): (503) 639 -4175 =
INSPECTION WORKSHEET FOR DATE: 6/6/2007 TIME: 7:01AM PAGE:
SITE ADDRESS: 12300 SW 106TH DR CLASS OF WORK:
SUBDIVISION: CLYDESDALE LOT #: 017 TYPE OF USE:
PROJECT NAME: NEWTON
DESCRIPTION: Gas line to range and barbeque. Approx. 22ft.
OWNER: NEWTON, ELIZABETH PHONE #: 503 - 579 -9276
CONTRACTOR: HOLMES INSTALLATION SERVICE PHONE #: 503 - 617 -9320
Inspection Request Scheduled For: Date: 6/8 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 049890-01 503. 718.2412 N
Corrections /Comments /Instructions:
C 45L F11
(PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /3)/i1i Date: b Phone #: (503) 718- 7 #18)