Permit CITY OF TIGARD MECHANICAL PERMIT
1111 COMMUNITY DEVELOPMENT Permit#: MEC2015 00032
T[G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/22/2015
Parcel: 251100692111
Jurisdiction: Tigard
Site address: 15485 SW FOUNTAINWOOD PL
Project: Siegel Subdivision:VTAINWOOD AT SUMMERFIELD A CO Lot: 11
Project Description: Installation of gas piping for gas range.
Contractor: HOLMES INSTALLATION SERVICE Owner: SUSAN SIEGEL
33535 NW VADIS RD 15485 SW FOUNTAINWOOD PL
CORNELIUS, OR 97005 TIGARD,OR 97224
PHONE: 503-647-9320 PHONE: 623-694-4910
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 01/22/2015 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 01/22/2015 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 01/22/2015 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uti 1otificatio -nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
direct questions to Ob C b .fling 503.232.1987 or 1.800.332.2344.
sued By: , / / "��. I Permittee Signature: \j
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit A l 4 FOR OFFI( I: l'SV 0\I.1 Received IIIIII City of Tigard Pp ��1 1�E Date/By: / �5 , II//yy,� Permit No.: 1
• 13125 SW Hall Blvd.,Tigard,OR 97223 ® Y��/ ��� ��QC�3�-
g Phone: 503.718.2439 Fax: 503.59E 1960
Plan review
Other Permit:
Inspection Line: 503.639.4175 • ' 2 2 2015 I G n R D Date Ready/By: orris:
® See Page 2 for
Internet: www.tigard-or.gov / Notified/Method: Supplemental Information
CHI I (1f MAIM
` IFDPOIN�I� COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
lYritr �'j���i Mechanical permit fees*are based on the value of the work
❑New construction %Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition El Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ ,
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
-and 2-family dwelling El Commercial/industrial El Accessory building For special information use checklist.
Multi-family El Master builder ❑Other: Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
c T� fyi Aiq conditioning
Job site address: X,�' .l� � (requires site plan showing placement) 46.75
City/State/ZIP: �(/� Furnace 100,000 BTU(ducts/vents) 46.75
`� Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Heat pump
(requires site plan showing placement) 61.06,
Cross street/directions to job site: Duct work 23.32
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
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
a t'I 4, 13 r, f .A- lecy Gas fireplace 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
C PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32
Other: _ 23.32
Nametj sm.Ai S/pqe e-- Environmental exhaust and ventilation:
Address:'c( C>5 i 1-71-)\/U)A N V,/ 4) f°/ (t e- Range hood/other kitchen
equipment 33.39
City/State/ZIP: (Q//i„O 0 y a- Clothes dryer exhaust 33.39
Single-duct exhaust(bathrooms,
Phone62.1) bq`f— 1.(5(0 Fax:( ) toilet compartments,utility rooms) 23.32 _
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name:
Other: 23.32
Fuel piping:
Contact name: $14.15 for first four;$4.03 for each additional
Address: Furnace,etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone:( ) Fax::( ) Water heater
Fireplace
E-mail: Range yr
CONTRACTOR Barbecue
Business name: J)W►Q 5 -i/\.I? `1 Clothes dryer(gas)
Other:
Address 3 N u IS I���(((��} MECHANICAL PERMIT FEES*
City/State/ZIP `J V" -e (,'S 0 7 7/ ( ? Subtotal Cy
Phone:933)t�b7—757 Fax:( ) Minimum permit fee($90.00) 7 U
Plan review(25%of permit fee) '"'—
CCB lic.: r 0 Z ti 7 3 State surcharge(12%of permit fee) /0.80
TOTAL PERMIT FEE /ze.
Authorized signature: This permit application expires if a permit is not obtained within 180
(((///___ /� days after it has been accepted as complete.
Print name: Q4%,/ j e, 14Lh) eti f Date: Z� J • Fee methodology set by Tri County Building Industry Service Board
1:\Building\Permita ermitApp.doc 09/09/10% 0461 (11/02lCOM/wEn)
r i
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.
•
1:\Building\Permits MEC-PennitApp.doc 09/09/10 2
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Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15485 SW FOUNTAINWOOD PL, TIGARD, OR,
97224
Residential - Mechanical
699 Mechanical final
FAIL
MEC2015-00032
David Young
Gas line installed and hooked up without gas line pressure test inspection.
Provide gas test inspection. G2417.1
Appliance shut off to be located in same room as appliance. G2420.5.1
Minor label for electrical ELS 450481
Violation Summary:
Inspector Contractor