Permit ' q CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2013-00631
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/21/2013
Parcel: 25111 CB01742
Jurisdiction: Tigard
. Site address: 10425 SW HOODVIEW DR
Project: KOPPES Subdivision: HOOD VIEW NO.2 Lot: 41
Project Description: Gas line for range with ductwork.
Contractor: CORNERSTONE BUILDERS INC Owner: OWEN DUKELOW&LAURA KOPPES
7849 SW CIRRUS DR 10425 SW HOODVIEW DR
BEAVERTON, OR 97008 TIGARD,OR 97224
PHONE: 503-671-9538 PHONE:
FAX: 503-671-9640
FEES
Specifics: Description Date Amount
Duct Work 10/21/2013 $23.32
Type of Use: SF Fuel Piping 10/21/2013 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 10/21/2013 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 10/21/2013 $52.53
Stories:
•
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090, You may tain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: 7
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
•
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FoR olI IC 1.1 USE ONLY
City of Tigard Received
Date/By: Permit No.:
iii 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review `
Phone: 503.718.2439 Fax: 503.5': )' :' -
Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 ^ `�O�1
Date ReadyBy: Juris: ® See Page 2 for
Internet: www.tigard-or.gov O( �j �±y� Notified/Method: ----, Supplemental Supplemental Information
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TYPE OF WO �0 k�r,i�\i�S�w • COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
'1S��0 Mechanical permit fees*are based on the value of the work -
❑New construction Addition/alteraria �placement performed.Indicate the value(rounded to the nearest dollar)of all
12 Demolition ❑Other: s� mechanical materials,equipment,labor,overhead,and profit.
Value:$
• CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
Er(- nd 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description 1 Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: An y Z5---- S(A) Mt,NI r''V" Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: (? ex-. 9722 y Furnace 100,000+BTU(ducts/vents) 54.91
r Heat pump 61.06
Suite/bldg./apt.no.: (Project name: h/ofp5 Duct work ' 23.32 (9.3..3).„
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32•• • • DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
V-Ctc /, "-lc / ,e_ dil/7A G2L.A fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
2OPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: /-�l"i k_019196-5 Range hood/other kitchen
` equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
I APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.'
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater _
Phone:( ) Fax::( ) Fireplace _
Range "/ //'/,15
E-mail: .Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name:
Ca tin t~-TLSrvnE (iq„,04 s• 4 cs MECHANICAL PERMIT FEES*
Address: 7y9 50/ G/)2)414& >12 Subtotal
City/State/ZIP: 6 w-yt i-vn on- 9 7,9v 7 Minimum permit fee($90.00) `-dAi
Phone: *o Fax: ?6 review(25%of permit fee)
3) (i7 f—9 S �' (S'd3 ) G7/— l G` State surcharge(12%of permit fee) ia., irz)
CCB tic.: 170.445y TOTAL PERMIT FEE _ fa,.F
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized stgnaturv� ' Fee methodology set by Tri-County Building Industry Service Board
Print name: 4 fI EN /iime K Z'�� Date:/o/Z//,/y
I:\Building\Pennits\MEC_PermitApp_040113.doc 440-46171•(11/02/COM/WEB) - - -
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
• fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
gS-. 38
I:\Building\Permits\MEC_PennitApp_040113.doc 2
CITY OF TIGARD
BUILDING DIVISION PERMIT#:AEG 62013-°°41
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
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INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
ll%,1��13 1�:3�
SITE ADDRESS: /04,Z.S.--( t/ j oOD[i! / CLASS OF WORK:
SUBDIVISION: LOT#: .. TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
•
OWNER: . PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections/Comments/Instructions:
`v6fi iZ r/ /0,01/ 1)
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO.ACCESS
• ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
'Inspector: Date: ii/e1/3 ' Phone #: (503) 718- P'P