Permit CITY OF TIGARD
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00569
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/19/2008
PARCEL: 2S114BA - 10900
SITE ADDRESS: 16470 SW MEADOWOOD WAY ZONING: R - 4.5
SUBDIVISION: COPPER CREEK STAGE 2 LOT: 062 JURISDICTION: TIG
PROJECT: NYGUIST
Project Description: Gas piping installation to 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:
> 10000 cfm: GAS OUTLETS: 1
Owner: FEES
JEANNE NYGUIST Description Date Amount
16470 SW MEADOWWOOD WAY
TIGARD, OR 97224 [MECH] Permit Fee 11/19/20C $72.50
[TAX] 12% State Surch 11/19/20C $8.70
Total $81.20
Phone: 503- 476 -6520
Contractor:
FAST WATER HEATER COMPANY
12601 132ND AVE NE
KIRKLAND, WA 98034 REQUIRED ITEMS AND REPORTS
Contact #: PRI 425- 636 -7054
FAX 425- 636 -7055
Reg #: LIC 168049
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: I� G����
Call /.4175 by 7:00 a.m. for inspections that busines( 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.
From: • 11/18/2008 13:39 11774 P.002/003
......:.
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Mechanical Permit A licatioe 0 • FOR OFFICE USE ONLY " •
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City of Tigard fta,56 , .,,,, A Recei ew ved
• .13125 SW Hall Blvd., TigardNORj 9; .74.-47
• a . , .., 1 ck fp3v,, ,
• ,_ . . Phone: 503.639.4171 Fax: 503.598.1960 ( ... \\ I N. 0 111
/ 111
Plan Revi
t II, t Da & Other Permit
By:
Da / iffM1 :II Permit N°.: 0.)c__„_ r
:
Inspection Line: 503.639.4175 \*"\ kt ik.-7.. Date Ready/By: Agit: See Page 2 for
TIGARD El
Internet www,tigard gov - , ,,,:„.. "It NotifiedAvlethod: .12z- Supplemental Information
' " i : '.' " - -' ' ' • : '
TYPE OF W - " , -,'',-," .''• '... r •-•',,, •'':'', ,•: •: • • . ' . COMMERCIAL ' FEE" SCHEDULE :' USE CHECKLIST
. . ..
New construction LAddition/alteration/replacement
Mechanical permit fees* are based on the value of the work
0 R
performed. Indicate the value (rounded to the nearest dollai) of all
0 Demolition CI Other: mechanical materials, equipment, labor, overhead, and profit.
• .. • ::.- ..,. : .-' CATEGORY OF CONSTRUCTION • .: .''- .: ,,,;.,:.:.: .•,,, Value $
:.. . . ,
,: ; =; ,• RESIDENTIAL:EQUIPMENT,../. FEES'''.
X and 2 dwelling 0 Commercial/industrial 0 Accessory building
For special information use checklist.
0 Multi-family 0 Master builder 0 Other:
Description I Qty. _ Ea. Total . •
' • " ' .. . ," '. ''' ' - ,_
JOB SITE:INFORMATIONLANDf:E008.1ifON '.:. ''' ' '' ''• • - , Heating/cooling .
Air conditioning or heat pump
Job site address: \ t 0 E LA .) mt_a a• Lyi ( r.: i iii.s site plan showing placement) 14.00
City/State/ZIP: e 6 ) D (2. q '1,)...), 4- . rn Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: IQ 1 3 idtk s +_
. Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronie) 14.00
_)•.__t t._,&. - D / t
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 14.00
Flue/vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map/parcel no.: Other fuel appliances
. - . • . . D E S CRIPTI ON O ,.... 10.00 „,,.. :•H • , - , - .,: , • ..
Gas fireplace 10.00
Flue vent for water heater or gas
v\ sioL\ 6as f■?kr An RAIA.r._ fireplace
Log lighter (gas) 10.00
10.00
n
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
' : ".:.'': '' 0
4*0•47'W.:0**:;:;:,.:'..;::ii'"g:::N:44 Chimney/liner/flue/vent 10.00
Other: 10.00
Name: ------- 4 , „ t • L , • . U. si..•
Environmental exhaust and ventilation
Range hood/other kitchen
Address: \ t *I 5 , try ft (i 6 L0000 A ,...0
equipment 10.00
City/State/ZIP: 1 --
1'.) p..., el D,,_4 Clothes dger exhaust
Single-duct exhaust (bathrooms, 10.00
Phone: (563 ,- Lk 1 - ( Fax: ( ) toilet compartments, utility rooms) 6.80
APPLICANT Attic/crawlspace fans 10.00
Other: 10.00
Business name: W ikk_ ckit(?ckA---e....1( Fuel piping
Contact name: ( 4 c \ ' --- p N.0,y _ JA ‘.\ 55.40 for first four; 51.00 for each additional
Furnace, etc.
Address: N ( ,, c) . , .... ,: i t
Gas heat pump .
City/State/ZIP: ....,\, v -- \c \ a , )..) v\ 91)05 Wall/suspended/unit heater
Phone: 4„).5 -L., 73 .....--/ 0 s• . Fax: : ' , - , 6 -4 E-1 Water heater
Fireplace
E-mail: eata).\Kcc;) ..,rkss.\100,...,kr • , .. r, c (3 , ,, ----
Range I i "
: .'. '•::'."."' I : .; - 2'"': : ' : . ''
CONTRACTOR Barbecue
Business name: .." \ - -- c ; s .k... u o 0 ,k... ex - A.,.k._Qc_d_ex-- Clothes dryer (gas)
,, Other:
Address: V'a...CA k, ptife...31,vy_ ,i.,-!:-.,,,,:-;•-:::ii#0,t,,,,*;o:'..000fil*Es•-,--*.::_:,.••::'...:
City/State/ZIP: ' \\a rt_O G A-34-\ Cl Subtotal
.--, .. permit f
Phone: O ". 1 C.6 IN Fax:4- 3 ' ee
6 - (03‘:;S
Plan review (25% of permit fee)
CCB lie.: i t .6.._k ( A , State surcharge (12% of permit fee) q' 70
TOTAL PERMIT FEE R' i a C)
\ ,
This permit application expires if a permit is not obtained within 180 •
AuthorizedIature: Ck ii
days after it has been accepted as complete.
Print name. ce u,.. yy \ Date: 1 1 1/4 k $11A * Fee methodology set by Tri-County Building Industry Service Board
l:\BuildinPerniitn\M0C-PeimitApp.doc 01119/07 440-4617T (11/02/CONI/WEB)
CITY,- O.TIGARD
BUILDING DIVISION ' #
PERMIT hAFC200B -00569
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1•i /1r3/2008
Phone: (503) 639 -4171 441
Inspection Requests (24 Hrs.): (503) 639 -4175 J
INSPECTION WORKSHEET FOR DATE: 11/250008 TIME: 7:01AM PAGE: 35
SITE ADDRESS: 16470 SW MEADCWOOD WAY CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 LOT #: 061 TYPE OF USE:
PROJECT NAME: NY a11ST
DESCRIPTION: Gas piping installation to range.
OWNER: NYGUIST, ,fl"ANN PHONE #: 503- 476 -5521
CONTRACTOR: FAST WATER HEATER COMPANY PHONE #: 425 636 - 7054
Inspection Request Scheduled For: Date: 11/25/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 07646&Q2 503-476.6520 Y
Corrections /Comments /Instructions:
•V<SS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ii— Z-' a Phone #: (503) 718 - -"4-4-4—Y---
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BUILDING DIVISION
PERMIT #: MFC200a-0066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/190008
-Phone: (5U3)O3S'4171
Inspection Requests (24 Hrs.): (503) 639-4175 ~�� «���
INSPECTION WORKSHEET FOR DATE: 11/26/2OO8 TIME: TO1ouk4 PAGE: 36
SITE ADDRESS: 16470 SW MEADOWOOD WAY CLASS OF WORK:
SUBDIVISION: COPPER CREEK STAGE 2 LOT #: 062 TYPE OF USE:
PROJECT NAME: NYGUIST
DESCRIPTION: piping instHation to range.
OWNER: NYGUIST, JEANNE PHONE #: 603'476-6620
CONTRACTOR: FAST WATER HEATER COMPANY PHONE #: 42Er636'7U54
Inspection Request Scheduled For: Date: 11/26/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 07B465-01 503-47G'8520 Y
Corrections/Comments/Instructions:
.
•
.
.
.
PASS 0 PARTIAL APPROVA 0 CANCEL El NO ACCESS
7 FA|L LL FOR INSPECTION 0 AD0TlC�N FEES ASSESSED
AL
.
Inspector: ���� » Date: �� Phone (503) ~���c\`�
. � ` � �' ~-- - #: ` ' .
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