Permit CITY OF TIGARD MECHANICAL PERMIT
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COMMUNITY DEVELOPMENT Permit#: MEC2015-00525
TI GAAD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/03/2015
Parcel: 2S110DD02800
Jurisdiction: Tigard
Site address: 10580 SW CENTURY OAK DR
Project: Olsen Subdivision: SUMMERFIELD Lot: 35
Project Description: Installing a gas fireplace insert with gas piping for range and clothes dryer.
Contractor: HOLMES INSTALLATION SERVICE Owner: OLSEN, BOB
33535 NW VADIS RD 10580 SW CENTURY OAK DR
CORNELIUS, OR 97005 TIGARD, OR 97224
PHONE: 503-647-9320 PHONE: 503-245-3923
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 08/03/2015 $33.39
Type of Use: SF Fuel Piping 08/03/2015 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 08/03/2015 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 08/03/2015 $42.46
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503. 2.198Zoc 1.800.332.2344.
Issued By: • ignature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE IISF.ONLY
City of Tigard �P� Received
�� `
Date/By: �y� `
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.5 Other Permit:
v Date/By:
T I G A R n Inspection Line: 503.639.4175 3 `1d1� Date Ready/By: 11E1 ® See Page 2 for
Internet: www.tigard-or.gov P\``G nO Notified/Method: Supplemental Information
TYPE OF W COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
`��^,fin`(\ — Mechanical permit fees'are based on the value of the work
❑New construction Addition/altetrtiJ111replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
Multi-family 0 Master builder 0 Other: Description I Qty. I Ea I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
5-L S%.0..4..., 4� o DR_ Air gconditioning
Job site address: 2 ((_ (requires site plan showing placement) 46.75
City/State/ZIP: n Furnace 100,000 BTU(ducts/vents) 46.75
I�Ja�"'/f 0 Y+C Furnace 100,000+BTU(ducts/vents) - 54.91
Suite/bldg./apt.no.: // Project name: 61 5 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
Gas fireplace `T�( 33.39 33 39
—L ira f 1%09 p,0,1 —5{- ap /r le Flue vent for water heater or gas
`�£ �r�lr5 A f/4, 1a c ii4 e w I ~ fireplace 23.32
C t , t.v�.� 7•-T L../JJ /� 11 vi Log lighter t stove 23.32
ZO � ,ff/1V/CC_.. l�tQ E�� Wood/pellet stove 33.39
J' Wood fireplace/insert 23.32
Name:
PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32
5 Other: 23.32
�f` Environmental exhaust and ventilation:
y Address: t 05170 S■•: y^—y O � 1 L )ft Range hood
/other kitchen
equipment
_ 33.39
City/State/ZIP: O V� � Y"nn. — Clothes d er exhaust 33.39
Phone:) lt( `31 Fax:( ) Single-duct exhaust(bathrooms,
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: WalUsuspended/unit heater
Phone:( ) Fax: :( ) Water heater
Fireplace
E-mail:
Range _
CONTRACTOR Barbecue /14,P7
�Q `t 9 I 1 Clothes dryer(gas)fkil.._Business name: Jv
Other:
Address:711 V M NS MECHANICAL PERMIT FEES*
City/State/ZIP: COY A e t 1uC O Ve T ( (3 Subtotal
Minimum permit fee($90.00) 40.000
Phone: ) 'Z S 7 9 Fax:( )
Plan review(25%of permit fee) _
CCB lic.: L tot -k77 3 State surcharge(12%of permit fee) id.8z)
TOTAL PERMIT FEE 'a) .
This permit application expires if a permit is not obtained within 180
AUIhOrIZed Signature: days after it has been accepted as complete.
J `
Print name: Y° r o 14 S) Q Date: 7 17a-q 2 O( Fee methodology set by Tri-County Building Industry Service Board
1:\Building\Permits\MEC-Permit p.doc 09/09/10 44 T(Il/0 OM/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.
I:\Building\Permits\MEC-PermitApp.doc 09/09/10 2
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
10580 SW CENTURY OAK DR, TIGARD, OR,
97224
Residential - Mechanical
699 Mechanical final
FAIL
MEC2015-00525
David Young
No access for inspection, no one home. 1159 am.
Called twice prior to inspection per contractors request.
Violation Summary:
Inspector Contractor
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
10580 SW CENTURY OAK DR, TIGARD, OR,
97224
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2015-00525
David Young
Corrections done.
Violation Summary:
Inspector Contractor