Permit ‚'
CITY O TI GARD MECHANICAL PERMIT
' ''I DEVELOPMENT SERVICES PERMIT #: MEC2006 -00120
�''l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 2/24/2006
PARCEL: 1 S 133DA -02700
SITE ADDRESS: 12825 SW GLACIER LILY CIR ZONING: R -
SUBDIVISION: AMART SUMMERLAKE LOT: 049 JURISDICTION: TIG
Project Description: Installation of gas to stove.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS WIO 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:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
KATHLEEN MEREDITH Description Date Amount
12825 SW GLACIER LILY CIR [MECH] Permit Fee 2/24/200€ $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 2/24/200€ $5.80
Phone: 503 - 524 - 9241 Total $78.30
Contractor:
RICHARD W RUEBER
17111 SE BIG TIMBER LN REQUIRED ITEMS AND REPORTS
CLACKAMAS, OR 97015 -7780
Contact #: PRI 503 - 658 - 6086
Reg #: LIC 19896
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: f fi / I) if F p*,
v `
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.
anical Permit A lication ,' , / j Foil
OFFICE ONLY `
I�' s �l R eceived n / `1 �O J z_.n ( - . _
i f Tigard I __ Date/By, Permit No l /S
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit 11
Phone: 503.639.4171 Fax 503.598 1. 6 / 41
60, 4 011 ; Date /By.
Inspection Line: 503.639.4175 __ 2006 -a+i Date Ready/By: NM ®See Page 2 for
Internet: www.ci.tigard.or.us Noufied/Method Supplemental Information
CITY OF TIGARD
BUILDIjt >17 I St K COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction gAddition/alteration /replacement 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 For special information use checklist.
❑ Master builder ❑ Other: Description Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
/� 8 ' // �` /� Air conditioning or heat pump
Job site address
(11. [4EJ -- 4-1 I (.I i C (requires site plan showing placement) 14.00
City /State /ZIP: I (evatitcA 1 O, q 701..)-.3 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
110-#.5 Hydronic hot water system 14.00
c X� Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc 10.00
Flue /vent for any of above 10.00
Subdivision: Lot no.:
Other 10.00
Tax map /parcel no. Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
'put cip ` j _ �{1 M qQ 5 � _,-� _� Flue vent for water heater or gas
�/ J . l[ fireplace 10.00
ID tD .1 V ( e vl $00-00 . - Log lighter (gas) 10.00
Wood /pellet stove 10 00
Wood fireplace /insert 10.00
❑ P OPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00
� Other 10.00
Name: '' /4 rl' �"ed l Environmental exhaust and ventilation
Range hood/other kitchen
Address: 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: 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
•
Business name. Z tC $ P� Clothes dryer (gas)
— Other
Address: MECHANICAL PERMIT FEES* .
City/State/ZIP Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: 61 9 y9( State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
i \Buildmg\Penn,ls\ME.C- PenmtApp doe 12/03 440 -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 $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
i.\ Building \Permits\MEC - PermitApp doc 12/03 2
CITY OF TIGARD
BUILDING DIVISION - PERMIT #:2,00 ,-06)
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 /vd/tivol •
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
ADDRESS: /02._ d �� e /d �\ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3—/ d - Pour Time:
Code # Inspection Description Confirm # Contact # Message
.
q-9d- 4 4 1
Corrections /Comments /Instructions:
•
•
PASS ( I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CAL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: r Date: Phone #: (503) 718- 2_19 e
CITY OF TIGARD .._.
BUILDING DIVISION PERMIT #: I�IiM�t:.t�iC3tlai 00i 20
13125 SW Hall Blvd., Tigard, OR 97223 . DATE ISSUED: 204/.006
Phone: (503) 639 -4171 �� u � �� dNvilti � i
Inspection Requests (24 Hrs.): (503) 639 -4175 !.+r
INSPECTION WORKSHEET FOR DATE: 2»/ -1300$ TIME: 7:01AM PAGE: 03
SITE ADDRESS: 12826 SW GLACIER LILY CIR CLASS OF WORK:
SUBDIVISION: AMART SUMMERLAKE LOT #: 049 TYPE OF USE:
PROJECT NAME: MEREDITH
DESCRIPTION: installation of gas to stove.
OWNER: MEREDITH, KATHLEEN PHONE #: 603..6'49241
CONTRACTOR: RICHA W RUEI3ER PHONE #: ,03.858 -E086
Inspection Request Scheduled For: Date: 2/270006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 027574 -01 503.524 -3241 N
l; ‘ ,'f'e 1 e- 4° j
Corrections /Comments /Instructions:
y 5 ? 5 l
i . .ed cd . / f roil l ./frii/- lia -ems
,Ve) /a : ree..0 . 6,31.4 7 e _ _ _, , i ../)44,
1
,e PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL l I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:
P 7.. / �VV Date: 2 47 i Phone #: (503) 718- 21,/
■