Permit .. ' iy
CITY TIGARD MECHANICAL PERMIT
1 � DEVELOPMENT SERVICES PERMIT #: MEC2006 -10001
' I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 1/17/2006
PARCEL: 2S1 10B D -08500
SITE ADDRESS: 11695 SW NICOLI PL ZONING: R -4.5
SUBDIVISION: EDWARDS PART. /MLP2000 -00010 LOT: 001 JURISDICTION: TIG
Project Description: Install woodburning fireplace with gas log lighter and gas line.
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:
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:
<= cfm: OTHER UNITS: 2
FURN > =100K BTU: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
CURT BULL Description Date Amount
11695 SW NICOLI PL [MECH] Permit Fee 1/12/200E $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 1/12/200E $5.80
Phone: 503- 639 -0153 Total $78.30
Contractor:
JEFF BENNETT CONSTRUCTION
602 HOLLY DRIVE REQUIRED ITEMS AND REPORTS
NEWBERG, OR 97132
•
Contact #: PRI 503- 235 -8465
FAX 503 -537 -5463
•
Reg #: LIC 143825
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 -
Iss -d By: I � ' � -% Permittee Sign . I i - 1
Call 503 - 639 -4175 by 7:00 a.m. for inspec • that business da 4
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 Received
OFFICE l Sl :ON'LY
City of Tigard Date/By. (/3 0 , a l Permit No.: ` ,.. / _ 000 /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 A D Other Permit:
1,
Inspection Line: 503.639.4175 J-. .1 l Date Ready/By: 3 ' 65 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: /O. Supplemental Information
E 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: $
nd 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
For special information use checklist.
❑ Multi - family
❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: l`(.��5 5 � 1' � Air conditioning or heat pump
!" Gp( t. 1' lf-CS. (requires site plan showing placement) 14.00
City /State/ZIP: - (L O((., 1'? 2,'L 4 Fumace 100,000 BTU (ducts/vents) 14.00
J Fumace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: g to ¢.3.-g �� W Duct work 14.00
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. 10.00
Flue /vent for any of above 10.00
Subdivision: Lot no.:
er: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
1).6ao (14-Z. ,-e_ Gas fireplace 10.00
Gua bc+^-^:- S ...L.) / � lC.t tst...„ Flue vent for water heater or gas
l C `J g..06/6% fireplace 10.00
S
3 � � j Log lighter (gas) / 10.00
C.1 Wood/pellet stove 10.00
Wood fireplace/insert ( 10.00
Chimney/liner /flue/vent 10.00
PROPERTY OWNER I TENANT Other: 10.00
Name: (,, 1 fA ,kgl Environmental exhaust and ventilation
` ' 1e Range hood/other kitchen
Address: (L( S Sw �.�4 <�x_ \ equipment 10.00
r
City /State/ZIP: ' - a- C Clothes dryer exhaust 10.00
3 Single - duct exhaust (bathrooms,
Phone: (w,) ) 61'1 - 015 3 Fax: ( ) toilet compartments, utility rooms) 6.80
- PLICANT QONTACT PERSON Attic/crawlspace fans 10.00
l Other: 10.00
�..1
Business name: _ R e_c..„.4e - C (.513.\, Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: c, kAOk-A Q �}� Furnace, etc.
U Gas heat pump
City / State/ZIP: O 1. C2. 7 ('3 Wall/suspended/unit heater
Phone: ( e?() - 3 S - ? ..44.=.5.-- Fax:: (to3) 531 5 AL3 Water heater
Fireplace
E-mail: Range
CONTRACTOR Barbecue
Business name: % - � 4 t",� 1.1.1 r Clothes dryer (gas)
Other:
Address: �c MECHANICAL PERMIT FEES*
City / State/ZIP: Sr C.t -,_....c. Subtotal
Minimum permit fee ($72.50) '7bAs S)
Phone: ( ) o- -- ( ) Plan review (25% of permit fee)
CCB lic.: ( 43 8 ZS- / 4' State surcharge (8% of permit fee) 5. 30
it TOTAL PERMIT FEE "7t 1
Authorized signature: _
""C.7.41 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print e: 'j...
e I Date: • Fee methodology set by Tri -County Building Industry Service Board
i:\Building ennitApp.doc 12/03 440.46I7T(II /02/COM/WF$)
•
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.
•
•
i:\ Building \PeamitsVvMEC- PermitApp.doc 12/03 2
CITY OF TIGARD
,
BUILDING DIVISION PERMIT #: kge 'g'c - moo/
13125 SW Hall Blvd., Tigard, OR 97 23 DATE ISSUED: 0
Phone: (503) 639 -4171 ir�petil
Inspection Requests (24 Hrs.): (503) 639 -4175 .._' -'I �..
INSPECTION WORKSHEET FOR DATE: ME: PAGE:
(Sc 2 1— c _NL(,
SITE ADDRESS: I l ID 9 5 dW i%- +CO S s L CLASS OF WORK: O
1 SUBDIVISION: LOT #: TYPE OF USE: .
PROJECT NAME: Fu1LL.
DESCRIPTION: tAgrow lt)ooa6ue43/1 A z- €PLAc.f.. WcrH 6 Loa, ) . C4 Qqs Log.
OWNER: CLQ.r flix.L.L. PHONE #: 5 - 4 6/53
CONTRACTOR: S£FG `a. lb c4tJET-- L�Dx.15I-Aken PHONE #:563 435'0476 --
Inspection Request Scheduled For: Date: ///7/
p q Pour T ime r -
Code # Inspection Description Confirm # Contact # Message ,,gyp,
(06- Heel{ . - P- N ocAc.rt - 1 h0 5D3- 35-$4105
/,,�� `
O 'rrections /Comments /Instructions:
0 1 11L., .... > 1 ' .77.---------)1./ .
PASS PARTIAL APPROVAL CANCEL // ❑ ANCE ❑ NO ACCESS
❑ FAIL • FALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/g ector: Date:
Inspector: Phone #: 503
P � ) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ;` ee Peale -
13125 SW Hall Blvd., Tigard, GJR,97223 DATE ISSUED: f /i3/01p
Phone: (503) 639 -4171 avd,m
Inspection Requests (24 Hrs.): (503) 639 -4175 jj,
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: (1(45 1,10 cc Z 1 P1. CLASS OF WORK: o�-
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: l?
DESCRIPTION: i*�5�"Hte Wan)/LQ.a Fi2'eAuY0._4, i,arrr} aft6 Le 04-5 4..10L-
OWNER: Cka-T PHONE #: 503 - 1x39 - 0153
CONTRACTOR: -xi ��� x rr eo,051 4„eTc,i PHONE #: 5'03 p s:- Sk45
Inspection Request Scheduled For: Date: f /17 )O (e Pour Time: gekil E5�
Code # iiiNt Inspection Description Confirm # Contact # Message 131-4 1134p
4/b 6 ? 35 - $ 465
Corrections /Comments /Instructions:
MAW
IN PASS /4 P. ' ' AL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL U LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-