Permit •
C ITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00414
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/11/2007
PARCEL: 2S 114BD -00800
SITE ADDRESS: 09980 SW RIVERWOOD LN ZONING: R -4.5
SUBDIVISION: PICKS LANDING NO.2 LOT: 069 JURISDICTION: TIG
PROJECT: PETRUZELLI
Project Description: Installation of gas piping for bar- b -que.
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
STEPHEN & DOLORES PETRUZELLI Description Date Amount
9980 SW RIVERWOOD LN
TIGARD, OR 97223 [MECH] Permit Fee 7/11/2007 $72.50
[TAX] 8% State Surcha 7/11/2007 $5.80
Total $78.30
Phone:
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 •uestions to OUNC by calling 503.246.6699 or 1.800.332.2344.
n
Iss ed By: /„, ` �; ` !�L ` Permittee Signature: 61(4
Call 503.639.4175 by 7:00 a.m. for inspections that bu 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.
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Mechanical Perniit Application FOR.OIFFICE USE ONLY
City-of' Bard o e /Br 7 f/ o ' Permit No.: t , iD7 �p lad
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 1 Other Permit: Inspection Line: 503.639.4175 ■ ',�. Date / By Date Ready/By: plir 0 See Page 2 for
Internet: www.ci.tigard.or.us 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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
- and 2 - family dwelling Commercial/industrial ❑ Accessory building
M ultifamily ID Master builder ❑ Other: For special information use checklist.
Description I Qty. I Ea. I Total
- . .., JOB: SITE INFORMATION A ND LOCATION. . . - Heating /cooling
�° V �r J Air conditioning or heat pump
Job site address:
/ iq "' - a L J (requires site plan showing placement) 14.00
City /State /ZIP: Ti c A ore.. cq �7L L / Furnace 100,000 BTU (ducts/vents) 14.00
• 1 r 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 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.: Other: 10.00
Tax map /parcel no.: Other fuel appliances
. - `DESCRIPTION OF WORK . - - -` .. Water heater 10.00
�+�--�. e ' / Gas fireplace 10.00
J 1 e- Li �s rp 1 9,j j> (- 64 Flue vent for water heater or gas
1 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.
Other: 10.00
Name: S f Eji Jz_ e L ' 1 ( Environmental exhaust and ventilation
Address: q 4 0 �'� � v eV" QJ6 I , / Range hood/other kitchen
l ' ° p� equipment 10.00
City /State /ZIP: 1 `5C•„� arg Clothes dryer exhaust 10.00
r Single -duct exhaust (bathrooms,
Phone: 2�' �1 7 Fax: ( ) toilet compartments, utility rooms) 6.80
' .❑ LI
- APPCANT T -
❑ 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
�NTRACTOR Barbecue !
Business name: 01a.e5 I 7 - S� Clothes dryer (gas)
• --7 35 h , /i� Is Other
Address: 7 he. V IJ I d) `MECHANICAL,P.ERMITFEES*
City /State /ZIP:COYLVI t_ I 1713 Subtotal S-a
) 26'7 �` �� � Fax: ( ) Minimum permit fee ($72.50) 1a,
Phone �
Plan review (25% of permit fee) ! `,�
CCB lic.: /O 2_ State surcharge (8% of permit fee) (5 WO
ai-- TOTAL PERMIT FEE 7:70, 3v
Authorized signatur �P!-J} This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Al 012Ug , ■ a Date: AL"er * Fee methodology set by Tri- County Building Industry Service Board
i:\ Building \Permits\MEC- •ennitApp.doc 12/03 • I •617T(I1 /02/COM/WEB)
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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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is \Building\Permits\MEC- PermitApp.doc 12/03 r •.. 1
CITY OF TIGARD IF
BUILDING DIVISION PERMIT #: MEC2007- 170414
13125 SW Hall Blvd., Tigard, OR 97223 <..� DATE ISSUED: 7/11/2007
Phone: (503) 639- 4171jj °iii ' +�
Inspection Requests (24 Hrs.): (503) 639 -4175 'I.�..
INSPECTION WORKSHEET FOR DATE: 7/12/2007 TIME: 7:04AM PAGE: 33
SITE ADDRESS: 09980 SW RIVERWOOD LN CLASS OF WORK:
SUBDIVISION: PICKS LANDING NO.2 LOT #: 069 TYPE OF USE:
PROJECT NAME: PETRUZELLI
DESCRIPTION: Installation of gas piping for bar b
OWNER: PHONE #:
CONTRACTOR: HOLMES INSTALLATION SERVICE PHONE #: 503 -267 -7574
Inspection Request Scheduled For: Date: 7/12/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 051883 -01 503 -267 -7574 Y
Corrections /Comments /Instructions:
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►: -ASS n PARTIAL APPROVAL E CANCEL n NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: l 1 Date: 74)/c) Phone #: (503) 718-
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