Permit C ITY OF TI C A i 0 MECHANICAL PERMIT
` ' ` COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00492
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/8/2007
PARCEL: 1S134CD
SITE ADDRESS: 11950 SW KATHERINE ST ZONING: R -4.5
SUBDIVISION: LERON HEIGHTS NO.3 LOT: 063 JURISDICTION: TIG
PROJECT: BACCELLIERI
Project Description: Installing gas piping for gas BBQ.
CLASS OF WORK: OTR 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: 1
> 10000 cfm:
Owner: FEES
FRANCES BACCELLIERI Description Date Amount
11950 SW KATHERINE
TIGARD, OR 97223 [MECH] Permit Fee 8/8/2007 $72.50
[TAX] 8% State Surcha 8/8/2007 $5.80
Total $78.30
Phone: 503 - 579 -2015
Contractor:
HOLMES INSTALLATION SERVICE
33535 NW VADIS RD
CORNELIUS, OR 97113 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -267 -7574
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.
Issue ✓. Permittee Signature. r -J YVX-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.
tMechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Fi EC El V E 1 Date /ByReceived : Permit No.: o _1fJ�/ 4r
II
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
_CJv i
=... Phone: 503.639.4171 Fax. 503.598.1960 Other Penult:
2007
Date/By:
Inspection Line 503.639.4175 AUG 0 Date Read /B lid See Page 2 for
TIGARD Re Internet: www.tigard- or.gov Notified/Method. Supplemental Information
CITY OF TIGARD
TYPE OF ALLUDING DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
111 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 Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
� RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
l�l 1- and 2- family dwelling ❑ Co mmercial /industrial ❑ Accessory building
Multi -family M aste r builder For special information use checklist.
❑ y ❑ ❑ O ther: Description Qty. Ea. Total
. JOB SITE INFORMA ON AND LOCATION Heating/cooling
Job site address: �� CT' Air conditioning or heat pump
� e , (requires site plan showing placement) 14.00
City /State /ZIP: rte/ CA../() 6K.-. Furnace 100,000 BTU (ducts /vents) 14.00
1 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 10.00
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. 14.00
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
-, /7 , i Gas fireplace _ 10.00
, J'g.145J1` t 4"5 X /J 101) / , /' / P-5 yL 4_ C S Ai) � Flue vent for water heater or gas
J/ l 1 _ 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
. , 7 t Other: 10.00
Name 6k p . c� I S ( +C ° 1e Environmental exhaust and ventilation
Address: VV �-, ` � Range hood /other kitchen
l(/ l�b`��e�,V`2. ) _ equipment 10.00
City /State /ZIP: . T1 c_ii 0 v �. Clothes dryer exhaust _ 10.00
Single -duct exhaust (bathrooms,
J
Phone:�'1Q3) 5 l; 2_ ( 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: ( ) I Fax: : ( )
Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue I C J . 40
' " lJ ! / �_ n Clothes dryer (gas)
Business name: I1. (+'J� Other: Address: 7? ly } too V (A-t 6"' / 1 MECHANICAL,PERMIT FEES* '
City /State /ZIP: ^,� A e 1 `v O t q -7u ) 2 7 Fax: ( ) Minimum permit fee ($72.50) W.50
Phone:
� 75-
Plan review (25% of permit fee)
CCB lie.: 1 �p Z v 7 7 State surcharge (8% of permit fee)
l 1 f TOTAL PERMIT FEE . 30
_D This permit application expires if a permit is not obtained within 180
Authorized si nature: +. -
' days after it has been accepted as complete.
Print naive: I y Y 2 Q Date: e - 46 ? / /02/COMEB) 0 7 ' Fee methodology set by Tri- County Building Industry Service Board
l: \Building\Permits \MEC- PermitApp doe 01/19/07 44 1
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.
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I: \Building \Permits \MEC- PermitApp.doc 01!19107 _ t
, I
CITY OF TIGARD f . •
BUILDING DIVISION
Ail
or, PERMIT #: MEC2007-00492
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/8/2007
Phone: (503) 639-4171 ,17,g,11
Inspection Requests (24 Hrs.): (503) 639-4175 ,-_„.111- _.!..
INSPECTION WORKSHEET FOR DATE: 8/10/2007 TIME: 7:00Atvi PAGE: 23
SITE ADDRESS: 11950 SW KATHERINE ST CLASS OF WORK:
_ . SUBDIVISION: LERON HEIGHTS 140.3 LOT #: 063 TYPE OF USE: •
PROJECT NAME: BACCELLIERI
• . DESCRIPTION: Installing gas piping for gas BBO.
OWNER: BACCELLIERI, FRANCES PHONE #: 503-579-2015
CONTRACTOR: HOLMES INSTALLATION SERVICE PHONE #: 503-267-7574
Inspection Request Scheduled For: Date: 8/1012007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 053800-01 503-579-2015 N
Corrections/Comments/Instructions:
(
/
PASS__ El_PARTIALAPPROVAL 0 CANCEL _ NO ACCESS
0 FAIL l] CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: l ci t--,
Date: '.
Phone #: (503) 718-