Permit t r: 1- .. I CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00002
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/2/2008
PARCEL: 1S134CB
SITE ADDRESS: 12207 SW MILLVIEW CT ZONING: R-4.5
SUBDIVISION: MILLVIEW LOT: 017 JURISDICTION: TIG
PROJECT: KENYON
Project Description: Install gas piping for gas 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:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
LARRY KENYON Description Date Amount
12207 SW MILL VIEW CT
TIGARD, OR 97223 [MECH] Permit Fee 1/2/2008 $72.50
[TAX] 12% State Surch 1/2/2008 $8.70
Phone: 503-590-3113
Total $81.20
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.
Issued I Permittee Signature: fr � -7 2 )a
Call 503.639.4175 by 7:00 a.m. for inspections that siness 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 Applicatioq , _ _ o FOR OFFICE USE ONLY
Received IN City of Tigard
Date/By: / /� 0 O Permit No.: J 2
• 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TI G A It D Inspection Line: 503.639 Date Ready/By: IBM El see Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK 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: $
1- and 2 -famil dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
2-family g ❑ Commercial/industrial ❑ Accessory building
M ulti -famil For special information use checklist.
y ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 12_2_ S w 1,,,,,,,c I • J.e v.l Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State /ZIP: / (y Ow J) k3 Y Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: 1 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
) +OL Q r---, �IV Gas fireplace 10.00
L I ,- 4 r i r, / z._ .14— C+y /� - � 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
5 A
Chimney/liner /flue /vent 10.00
PROPERTY OWNER / I ❑TENANT Other: 10.00
�,`
Name: t, ke•N Environmental exhaust and ventilation
17710 "' Range hood/other kitchen
Address: f e/1/ Mt, / `! 1/ P equipment 10.00
City /State /ZIP: <FLf oi./1) 0 ve.--- Clothes dryer exhaust 10.00
3 � 7 3/1
Single-duct exhaust (bathrooms,
Phone ) 7 a Fax: ( ) toilet t 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: [� 6H^ e S ! Sre_C. Serz_ Clothes dryer (gas) Other:
Address: 7 7 " / N W - j 7 4 lS 1 MECHANICAL PERMIT FEES"
City /State /ZIP: C 0 / 4e (cvt 6 r7 /( 5 Subtotal
7 Minimum permit fee ($72.50) /2.5 a
Phone: ( ) 2.137 7 � Fax: ( ) Plan review (25% of permit fee)
CCB lic.: / 0 2_1( 7 3 State surcharge (8% of permit fee) g.?U
i TOTAL PERMIT FEE (¢! Thi perm ap p lication expires if a permit is not obtained within 180
Authorized signature: 'ti days after it has been accepted as complete.
Print name: 114-y ( l cy..—p Date: / - ',/ • Fee methodology set by Tri- County Building Industry Service Board
I :\ Building \Permits\MEC•PermitApp.doc 01/19/07 440-4617T(11/07/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.
l:\ Building \Permits\MEC- PermitApp.doc 01/19/07 2
CITY OF TIGARD , r, N I , ; v-
BUILDING DIVISION Gy 4 PERMIT #: MEC2008 -00002
13125 SW Hall Blvd., Tigard, OR 97223 L fin"' DATE ISSUED: 1/7J2008
Phone: (503) 639 -4171 ..J111,. 1/
Inspection Requests (24 Hrs.): (503) 639 -4175 � AJ" `__ I
INSPECTION WORKSHEET FOR DATE: 1/3/2008 TIME: 7 :00AM PAGE: 13
SITE ADDRESS: 12207 SW MI LL VIEW CT CLASS OF WORK:
SUBDIVISION: MILLVIEW LOT #: 017 TYPE OF USE:
PROJECT NAME: KENYON
DESCRIPTION: Install gas piping for gas range.
OWNER: KENYON, LARRY PHONE #: 503-590-3113
CONTRACTOR: HOLMES INSTALLATION SERVICE PHONE #: 503-267-7674
Inspection Request Scheduled For: Date: 1/3/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
VO
610 Gas line 062502 -01 503-590-3113 N O • ,Z`"
Corrections /Comments /Instructions:
V
l� t, I.
ail (egg , t 1 P tcpw .
I,
•
g, PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Ins ector: Date: 'I' Phone #: (503) 718 -
P )