Permit ti CITY OF TIGARD MECHANICAL PERMIT
311 COMMUNITY DEVELOPMENT Permit#: MEC2015-00200
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/13/2015
Parcel: 1 S136DC03300
Jurisdiction: Tigard
Site address: 11750 SW 72ND AVE
Project: Cassinelli Subdivision: ELNOLA HEIGHTS Lot: 9
Project Description: Installation/repair of gas lines to existing furnace and water heater.
Contractor: OWNER Owner: CASSINELLI, RICHARD E
RICHARD CASSINELLI 11720 SW 72ND AVE
11720 SW 72ND AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-548-8217 PHONE: 503-548-8217
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 04/13/2015 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 04/13/2015 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 04/13/2015 $75.85
Occupancy Grp:
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
Utili otification . -nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
o direct questions to •. • .y .ailing 503.232.1987 or 1.800.332.2344. /
sued By: / /y�
` Its I ( Permittee Signature: 6. .d /!P
x
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.
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical,mechanical, and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
1 will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
RIF I will be performing work on property I own, a residence that I reside in, or a residence that I will
■ reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
T(//71•410 /- 7>tSCA.4Gt
Pint Name of Permit Applicant
/ii :; /
Signature of Permit Applicant 9 Pp Date
Permit#: HNC 9 /h-( .900
Address: 01750 &IAD 7� �v� �.;;,,,_, ;-.•�+
Issued by(uI Date: Oh S (44-
This Copy for Permit Offices
Mechanical Permit Applicatiti El CEIVEP 1.1111 01 1 ll I' (0,1 OM 1
City of Tigard Received Date/By:
° PermitNo.:Meola6--610;10D
. " 13125 SW Hall Blvd.,Tigard,OR 97223 Plum Review
Phone: 503.718.2439 Fax: 503.598.1960 APR 1 3 2 015 Other Permit:
Inspection Line: 503.639.4175 DateBe.
'I'I G A R U p f ,/ Date Ready/By: Awls: Si See Page 2 for
Internet: www.tigard-or.gov C1 TV I V 1►�, I IGARI) Notified/Method: Supplemental Information
'N` ITTvISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction dition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
a
- nd 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: // S-� Std 762641--A re_ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: /� I� Furnace 100,000+BTU(ducts/vents) 54.91
Yr�/vie I. Heat pump 61.06
Suite/bldg✓apt.no.: Project name: iii - if Duct work 23.32
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
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
,�IPROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:
J Name: //C�/ G gS,.'G Range hood/other kitchen
vvv equipment 33.39 _
Address: / t? Sa ,4174:_.
Y/ Clothes dryer exhaust 33.39
City/State/ZIP: 776, <d 4' 9 ZZ_.) Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32 _
Phone:(Js) .Slf -— 6 2./7 Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: _ 23.32
Fuel piping:
Business name: e,ri.,c_ ,,,s 601,..c $14.15 for first four;$4.113 for each additional
Contact name: Furnace,etc. /
Address: Gas heat pump > lyr/c
Wall/suspended/unit heater
City/State/ZIP: Water heater /
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: O, ii r^— MECHANICAL PERMIT FEES*
Address: Subtotal /4))
City/State/ZIP: Minimum permit fee($90.00) 4:r
Plan review(25%of permit fee) —
Phone:( ) Fax:( ) State surcharge(12%of permit fee) /� x
CCB lic.: TOTAL PERMIT FEE /(4 z/
-- This permit application expires if a permit is not obtained within 1S0
i days after it has been accepted as complete.
7 Authorized signature: * Fee methodology set by Tti-County Building Industry Service Board
) Print name: /((/ / r ss.,t,/may Date: Z// VT
I:U3uilding\Permit sMiC_PermitApp_040113.docc
440-4617T(11/02ICOMIWER)
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
11750 SW 72ND AVE, TIGARD, OR, 97223
Residential - Mechanical
610 Gas line
PASS
April 14, 2015 at 11:46:08 AM
MEC2015-00200
David Young
18 psi, 15 min.
Green tagged at meter.
Note: for final, seal all wall and ceiling penetrations.
Violation Summary:
Inspector Contractor