Permit ii V
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2009 -00022
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/13/2009
PARCEL: 25111 CC -09601
SITE ADDRESS: 15740 SW GREENS WAY ZONING: R -12
SUBDIVISION: SUMMERFIELD NO.2 LOT: 123 JURISDICTION: TIG
PROJECT: LEIPZIG
Project Description: Installation of gas fireplace.
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: 1
FURN > =100K BTU: <= 10000 cfm:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
BOB LEIPZIG Description Date Amount
15740 SW GREENS WAY
TIGARD, OR 97224 [MECH] Permit Fee 1/13/200. $72.50
[TAX] 12% State Surch 1/13/2000 $8.70
Total $81.20
Phone: 503- 670 -4999
Contractor:
GAS PRO, INC.
7603 SE LOUNSBERRY LN
PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 775 -7020
FAX 503- 775 -7014
Reg #: LIC 167493
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: aea--04....416Permittee Signature: ��
k
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 Application . ,. FOR.OFFICE USE ONLY ,
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Reived AJ� dc�.
City of Tigard Received 2 1 2 D � Permit No.: l7 ��
III
- ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I G A RD Inspection Line: 503.639.4175 Date Ready /By. lulls' ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: 10 Supplemental Information
TYPE OF • WORK COMMERCIAL FEE* SCHEDULE - :USE CHECKLIST'
❑ New construction ddition /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 Rther: mechanical materials, equipment, labor, overhead, and profit.
Value: $
. CATEGORY OF CONSTRUCTION , •
�� RESIDENTIAL EQUIPMENT / FEES*
Tc - 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
�7 Air conditioning or heat pump
Job site address:
) S/ Y0 5 6 (.9 ee /f s /4r j (requires site plan showing placement) 14.00
City /State /ZIP: T ) 6 9x d 0'L q 72 2 Furnace 100,000 BTU (ducts /vents) 14.00
Y 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 1 0.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
1n -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
• , . " .DESCRIPTION „'OF WORK Water heater 10.00
Gas fireplace / 10.00
6A5 / /4 < Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
PROPERTY' OWNER ❑ TENANT ”
Other: 10.00
Name: j7 II) . p z 7
Environmental exhaust and ventilation
( Range hood /other kitchen
Address:
�ie90; equipment 10.00
City /State /ZIP: Clothes dryer exhaust , 10.00
� Single -duct exhaust (bathrooms,
Phone: ( c 3) lJ 7D_ 4/9 9 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
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( )
Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR-. Barbecue
Business name: Q 0 /� C- Clothes dryer (gas)
f Other:
Address: � ` x , f1 ���
MECHANICAL PERMIT,FEES*
City /State /ZIP: ( 0_4404 S / OA. , - 2�> � Subtotal
(((TTT v Fax: rC Minimum permit fee ($72.50) 7
Phone:
50'3) 275' 2 0_2 Fax: 3 3 7‘;,) y Plan review (25% of permit fee) e
CCB lic.: � ( ♦ / 7 State surcharge (12 %ofpemtit fee) y. 70
arr � / f TOTAL PERMIT FEE r , `n1
T his permit application expires if a permit is not obtained within 180
Authorized signature /
/ C. day s after it has been accepted as complete.
Print name: ( 97? ,i/ / f . e//,) Date: -/ - 4;1
!9 * Fee methodology set by Tri -County Building Industry Service Board
h\Building Permits EC- PermitApp.doc 01/19/07 440 -4617T (11 /02 /
\ \ M 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.
11:\Building\Permits\MEC-PermitApp.doc 01/19/07 2
CITY OF TIGARD ."
BUILDING DIVISION PERMIT #: MEC)0OCi-00022
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/13/2009
Phone: (503) 639 -4171
A �:, ...
Inspection Requests (24 Hrs.): (503) 639 -4175 __ '' 11.
INSPECTION WORKSHEET FOR DATE: 1/14/2009 TIME: 7:Q1AM PAGE: 1
SITE ADDRESS: 15740 SW GREENS WAY CLASS OF WORK:
SUBDIVISION: SUMMERFIELD N0.2 LOT #: 123 TYPE OF USE:
PROJECT NAME: LEIPZIG
DESCRIPTION: Installation of gas fireplace.
OWNER: LEIPZIG, 130F3 PHONE #: 503.670 -4999
•
CONTRACTOR: GAS PRO, INC PHONE #: 503- T75.7020
Inspection Request Scheduled For: Date: 1/14/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 079702 -02 503-670 N
Corrections/Comments/Instructions:
't! /_ -. _ . ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Iv ._. ~ _!P Date: L /
I 11/1 (�g Phone #: (503) 718 - �—C�
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BUILDING DIVISION PERMIT -
) ��"��""°~� �"°"�"~~"~ � �2C20O U002
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/132009
Phone: (503) 839-4171 Aso
Inspection Requests (24 Hrs.): (503) 639-4175 ~ "�-
INSPECTION WORKSHEET FOR DATE: 1/14/2009 TIME: 7 PAGE: 2
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SITE ADDRESS: 16740 SW GREENS WAY CLASS OF WORK:
SUBDIVISION: sUk1h4ERp|ELDN0� LOT 123 TYPE �
PROJECT NAME: LEIPZIG
DESCRIPTION: Installation of gas fireplace.
OWNER: LEIPZIG, BOB PHONE #: 603-670.4899
CONTRACTOR: GAS PRO, INC. PHONE #: 503-775-7O20
Inspection Request Scheduled For: Date: 1/14/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
816 Mechanical rough-in 079702'01 503-670-4999 A4
Corrections/Comments/Instructions: .
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�K PA -- F�RTALAPPR�VAL �� �AN�EL �� NOACCESS
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1111 - AIL CALL FOR INSPECTION ri ADDITIONAL FEES ASSESSED
Inspector: ' '���m�� Date: / 06 ' '/ � Phone #: (503) 718' �-�� / y
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