Permit CIT OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00484
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/3/2007
PARCEL: 2S 104CA -03000
SITE ADDRESS: 13552 SW LAUREN LN ZONING: R -7
SUBDIVISION: HILLSHIRE LOT: 030 JURISDICTION: TIG
PROJECT: JACKSON
Project Description: Gas line to 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:
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: 1
GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
GREG & ALISON JACKSON Description Date Amount
13552 SW LAUREN LN.
TIGARD, OR 97223 [MECH] Permit Fee 8/3/2007 $72.50
[TAX] 8% State Surcha 8/3/2007 $5.80
Total $78.30
Phone: 503- 970 -1475
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact #:
Reg #:
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 vs? _ , l?ermitteeSignature:— .WI!
Call 503.639.4175 by 7:00 a.m. for inspections t . busi ess 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
City of Tigard li` Date/By: I� 6' Permit No f _ 1 �oCZ
- ° 13125 SW Hall Blvd., Tigard, 11,• 1,4,, 1...,
Plan Review Other Permit:
503.639.4171 Fax: 503.598.1960 Other
T I G A R D Inspection Line: 503.639 AUG 2001 Date Ready /By. Juris: El See Page 2 for
Internet: www tigard Notified/Method: Supplemental Information
S COT( OF TIGAREI
TYPE`IlFQtRK DIVISION
COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ❑ 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: $
. RESIDENTIAL EQUIPMENT./ SYSTEMS FEES*
❑ 1- 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
Air conditioning or heat pump
Job site address: /355 54/
- t ur� IA) (requires site plan showing placement) 14.00
City /State /ZIP: 7:1 � 9722:3 Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: 164 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
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WOR Water heater 10.00
Gas fireplace / 10.00
/1 qq - re p) (e ) Flue vent for water heater or gas
` J fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00 _
Wood fireplace /insert 10.00
tU PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
)/ Name: A J 16 „k , Environmental exhaust and ventilation
( ? J t Range hood /other kitchen
Address:
/3 G.6 ,,te,a4et a \t equipment 10 00
City /State /ZIP: / ;,100 /57,22 3 10.00
Single -duct exhaust (bathrooms,
Phone: (5a3 ) 7 _ 75/ 7.5' 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
CONTRA OR , ' ' Barbecue
Business name:
D(.(_) e. Clothes dryer (gas)
Other:
Address: MECHANICAL' PERMIT FEES* '
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 7,A .50
_ Plan review (25% of permit fee)
CCB lie.: State surcharge (8% of permit fee) 5 • 8
O
4///-0---/ J r TOTAL PERMIT FEE 7 Q, 3 D
Authorized signature: r V ' ' / ,, This permit applicati expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: L`S / az, Date: .4._. J * Fee methodology set by Tri- County Building Industry Service Board
I.\Building \Permits \MEC- PermitApp doc 01/19107 440 -46t7T (It /02 /COM/WEB)
► v:
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 01/19/07 2
CITY OF TIGARD ..
BUILDING DIVISION PERMIT #: MEC2007-004184
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/3/2007
Phone: (503) 639 -4171 PInspection Requests (24 Hrs.): (503) 639 -4175 ' ..
INSPECTION WORKSHEET FOR DATE: 9/21/2007 TIME: 7:00AM PAGE: ' 4
SITE ADDRESS: 13552 SW LAUREN LN CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 030 TYPE OF USE:
PROJECT NAME: JACKSON
DESCRIPTION: Gas line to fireplace. ,
OWNER: JACKSON, GREG & ALISON PHONE #: 503 -910 -1475
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 056116.01 503.301 -1420 N
Corrections /Comments/ Instructions:
"41 . , • °.. /' Ju.t / 44- i rl-.1 �l- l
Li PASS I_L PAFITIALAPPROVAL I_I CANCEL —_NO ACCESS
AIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: Date: 9.---- ,g/- 7 Phone #: (503) 718- 1-511 7�
CITY OF,.TIGARD W ."
BUILDING DIVISION Lys PERMIT #: twLC[e707 O(fi34
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/3!.X307
Phone: (503) 639 -4171 ��Ni
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/10/2007 TIME: 7 : 01AM PAGE: 9
SITE ADDRESS: 13552 SW LAUREN LN CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 030 TYPE OF USE:
PROJECT NAME: JACKSON
DESCRIPTION: Gas line to fireplace.
OWNER: JACKSON, GREG & ALISON PHONE #: 503970.1475
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/10/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message V
610 Gas line 05734001 503 - 381 -1428 Y eV/ fl h:14*P
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FAIL CALL F R INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: 9 v / 6 Phone #: (503) 718- .
CITY OF.TIGARD ,
BUILDING DIVISION PERMIT #: Mf=C2007.004B4
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 813/2007
Phone: (503) 639 -4171 �r4j u� I�� 1 \
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/10/2007 TIME: 7:01Al PAGE: 8
SITE ADDRESS: 13552 SW LAUREN 1_N CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 030 TYPE OF USE:
PROJECT NAME: JACKSON
DESCRIPTION: Gas line to fireplace.
OWNER: JACKSON, GREG & ALISON PHONE #: 6103 -970-1476
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/10/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
615 Mechanical rough -in 057340.02 503 - 381.1428 N
Corrections /Comments /Instructions:
1 / ii
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'ASS PARTIAL APPROVAL I_ CANCEL W_ O_ACCESS
• L. Z CALL FOR INSPECTION I 1 ADDITIONAL FEES ASSESSED
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Inspector: qc.rA..„9 Date: '� I b D7 Phone #: (503) 718-
. it , ( . /
I4-' . _
CITY OFTIGARD
BUILDING DIVISION PERMIT #: MFG2007- 00484
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/3/2007
Phone: (503) 639 - 4171 °l
Inspection Requests (24 Hrs.): (503) 639 -4175 'I L.
INSPECTION WORKSHEET FOR DATE: 10/1212007 TIME: 7 :01AM PAGE: 9
SITE ADDRESS: 13552 SW LAUREN LN CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 030 TYPE OF USE:
PROJECT NAME: JACKSON
DESCRIPTION: Gas line to fireplace.
OWNER: JACKSON, GREG & ALISON PHONE #: 503970.1475
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 10/12/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
515 Mechanical rough -in 057547 -02 503-381-1428 V 1 A 1
Corrections /Comments /Instructions:
,X PASS I_J_PARTIALAP_PRO_VAL ❑CANCEL —_NO ACCESS
n FAIL ❑ CALL F R INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: J Date: L 1 Z 107 Phone #: (503) 718-
CITY OFTIGARD
BUILDING DIVISION PERMIT #: lvtEr2(1t17 -p 834
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 913 ;2007
Phone: (503) 639 -4171 N urdioii
Inspection Requests (24 Hrs.): (503) 639 -4175 J ' _L
INSPECTION WORKSHEET FOR DATE: 10/1211007 TIME: 7:81 Am PAGE: 10
SITE ADDRESS: 13552 SW LAUREN LN . CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 030 TYPE OF USE:
PROJECT NAME: JACKSON
DESCRIPTION: Gas line to fireplace.
OWNER: JACKSON, GREG & ALISON PHONE #: 503.970-1475
CONTRACTOR: ()INNER PHONE #:
Inspection Request Scheduled For: Date: 10/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 057547 -01 503 - 381 -142.8 Y
Corrections /Comments/ Instructions:
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I FAIL � r'4 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
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Inspector: Date: 7Phone #: (503) 718 -
•
CITY OF TIGARD
BUILDING ^ DIVISION PERMIT #: MfEC2007..00484
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/3/2007
Phone: (503) 639 -4171 A �
Inspection Requests (24 Hrs.): (503) 639 -4175 IY
INSPECTION WORKSHEET FOR DATE: 11/26/20 }07 TIME: 7 :00AM PAGE: 15
SITE ADDRESS: 13562 SW LAUREN LN CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 030 TYPE OF USE:
PROJECT NAME: JACKSON
DESCRIPTION: Gas line to fireplace.
OWNER: JACKSON, GREG & ALISON PHONE #: 503-970 -1475
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/26/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
:JB Motha ucal final 060215-02 503 - 381 -1428 Y
Corrections /Comments /Instructions:
•
PASS ❑ CANCEL ❑ _ NO ACCESS
n FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
G ��
Inspector: V Date: //-1-O � Phone #: (503) 718 -