Permit CITY TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2006-00489
° '� I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/13/2006
PARCEL: 1 S133DD -17300
SITE ADDRESS: 11946 SW 128TH AVE ZONING: R -4.5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 5 LOT: 209 JURISDICTION: TIG
Project Description: Gas line to gas cooktop.
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:
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
JOHNSON, JERALD E + PEGGY C Description Date Amount
11946 SW 128TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 10/13/20C $72.50
[TAX] 8% State Surcha 10/13/20( $5.80
Total $78.30
Phone: 503 -590 -9631
Contractor:
HOLMES INSTALLATION SERVICE
33535 NW VADIS ROAD
CORNELIUS, OR 97113 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 267 -7974
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: kly`-g&Y
Call 503- 639 -4175 by 7:00 a.m. for inspections that businesQ 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 . Ica r ` '
Foli OFFICE USE ONLY
Received
City of Tigard Date/By I I, o b : i Permit No .. 06r- oo €71;
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 OCT 2006 Other Permit:
3 //Hi».F�i�•x� p' Date/By. .
Inspection Line: 503.639.4175 11 i y
__
Date Ready/By: tan ' ®See Page 2 for
Internet: www.ci.tigard.or.us k 1 Y or •
Li ',. a
X1 i.1 J Notified/Method: Supplemental Information
D IT1rarvsT ",-
`>
j� TYPE 'T OF WORK �/ ;
- ' COMMERCIAL FEE* SCHEDULE — USE CHECKLIST'
❑ New construction / Ly�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 ❑ Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ Multi - family ❑ Master builder 1:1 Other:
For special information use checklist.
Description Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
Job site address: I I i (( S w i z 7 ( Air conditioning or heat pump
l (requires site plan showing placement) 14.00
City /State /ZIP: f5 M✓ 4 0 v 1,42_, 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
` \, �t /-, 5 ...s. ,9 t ,O r /3 / {2 .4 C Flue vent for water heater or gas
44// 5 / J fireplace 10.00
Ca, ��V Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue/vent 10.00
ROPERTY OWNER ❑ TENANT '
Other: 10.00
Name: e,,,,v„ " ,/ m - c /-/ /_ ! a 4) Environmental exhaust and ventilation
Range hood/other kitchen
Address: / t q 4 yip/2 1i equipment 10.00
City /State /ZIP: 7 G I, 9 bW e._ Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (7°3 )SyO .— 9 b 3 ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ 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
Furnace, etc.
Address: –
Gas heat pump _
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range /
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: . I 1 AI3 j! 5-v2
Other:
Address: 3.53 p i t ,„) i5 MECHANICAL PERMIT FEES*
City /State /ZIP: CT fvt e /` � 0 g,� 9 7 "? Subtotal
Phone:') ) 2-1) 7 75 7 Y Fax: ( )
Minimum (25% fee r mit fee
Plan review (25% of permit fee)
CCB lic.: / 0 2. 'e 73 iO /7 / ® V State surcharge (8% of permit fee)
TOTAL PERMIT FEE 7 Is 30
•
Authorized signature This p ermit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: fa. rt.. ., z Date: / y3 L * Fee methodology set by Tri- County Building Industry Service Board
i:\ Building\Permits\MEC- knitApp.doc 2)03 44 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:\Building\Permits\MEC- PermitApp.doc 12/03 2
•
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: MEC200 &00489 •
13125 SW Hall Blvd., Tigard, OR 97223
, 111 /
... DATE ISSUED: 10/1312006
Phone: (503) 639-4171. /tea Nln 14111
Inspection Requests (24 Hrs.): (503) 639- 4175� 'll�
INSPECTION WORKSHEET FOR DATE: 10/20/2006 TIME: 7 :01AM PAGE: 35
SITE ADDRESS: 11946 SW 128TH AVE CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 5 LOT #: 209 TYPE OF USE:
PROJECT NAME: JOHNSON
DESCRIPTION: ;as line to gas cooktop.
OWNER: JOHNSON, JERALD E + PEGGY C, PHONE #: 503 - 590.9631
CONTRACTOR: HOLMES INSTALLATION SERVICE PHONE #: 503 - 267 - 7974 •
Inspection Request Scheduled For: Date: 10/20/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Mr -
610 Gas ling 038582 -01 503-590-9631
Corrections/ omments /Instructions: / ry C-. isio.7/
it, PASS I I PARTIAL APPROVAL I CANCEL ❑ NO ACCESS
II A IL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: r P Date: io• ° 06 Phone #: (503) 718 - zeziy
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: MEC2006 -00489 REQUIRED ON GREEN INSPECTION CARD.
✓ Code Inspection Description PASS Date By ✓ Code Inspection Description PASS Date By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG- Structure grading/footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post/beam structural 150 Hot tub /spa/pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors 199 Electrical final
240 Exterior sheathin •
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry _ 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG Structure set-up MEC - Mechanical Permit
280 Insulation 605 Post/beam mechanical
285 Drywall nailing _X 610 Gas line
287 Suspended ceiling X 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
X 699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in 305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test 315 Post/beam plumbing
995 Misc. inspection: 320 Plumbing rough -in
998 Alarm final 322 Shower pan
. 999 Sprinkler final 330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert/catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing ' 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 _ Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection 599 Final inspection
I: \Building \Inspection Cards \Forms\AOP - InspCard- Blank.doc 12/09/2005
CITY TIGARD • MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 -00489
�,� Ij , 7 DATE ISSUED: 10/13/2006
� !"- -- i. 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S133DD-17300
SITE ADDRESS: 11946 SW 128TH AVE ZONING: R -4.5
1 SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 5 LOT: 209 JURISDICTION: TIG
Project Description: Gas line to gas cooktop.
411 ISWIIMIIIII
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: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner:
FEES
JOHNSON, JERALD E + PEGGY C Description Date Amount
11946 SW 128TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 10/13/20C $72.50
[TAX] 8% State Surcha 10/13/20( $5.80
Total $78.30
Phone: 503- 590 -9631
3
Contractor:
HOLMES INSTALLATION SERVICE
33535 NW VADIS ROAD
CORNELIUS, OR 97113 - \ QUIRED ITEMS AND REPORTS
. . _
Contact #: PRI 503- 267 -7974 OQUIRED
:.1`;717;1.:1F7 ` ' CY
Reg #: LIC 102473
t "14
C9
Al o tivi5 Gah L- .
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 y
Issued By: !�1 / f, ' _ 5 Permittee Signature: ,,,/t
Call 503 - 639 -4175 by 7:00 a.m. for inspections that busine 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.