Permit CITY OF TI MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00680
TtG 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/20/2007
PARCEL: 2S115AA - 07000
SITE ADDRESS: 16440 SW 108TH AVE ZONING: R - 4.5
SUBDIVISION: BERKLEY ESTATES LOT: 002 JURISDICTION: TIG
PROJECT: MALDONADO
Project Description: Install gas piping for gas range.
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:
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
MALDONADO, LAWRENCE + TANYA Description Date Amount
16440 SW 108TH AVE
TIGARD, OR 97224 [MECH] Permit Fee 11/20/20C $72.50
[TAX] 8% State Surcha 11/20/20C $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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: � - T Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for inspections that usiness 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.
Mechanical Permit Application �" "f ' 1�,� err -+�+�� S, ;xIR -' -4 ', ` ' , ry •
i';_r: iii Received / �7 /� /l
City of Tigard Date /By: f� 7 y; Permit No. �Fec 2 00/ — tO P
13125 SW Hall Blvd., Tigard, OR 97 3' Plan Review •
I:
EC EWED Permit:
,.. Ph one: 503.639.4171 Fax: 503.598.196Q: � � 2 0 � . �. Date/By:
T C n I- Ii Inspection Line: 503.639.4175 ICJ Lr Date Ready /By: Juris: 0 See Page 2 for
Internet: www.tigard- or.gov p CITY OF i I yyt U ,� M �+ D Notified/Method: rf Supplemental Information
ilov
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
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 ( Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS. FEES*
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
Multi- family ❑ Master builder ❑ Other: Description I Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 69 31W /0841. A Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State /ZIP: ( c,v8 ,e,..... c Z Furnace 100,000 BTU (ducts /vents) 14.00
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 10.00
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. 14.00
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
A t' �j� Gas fireplace 10.00
�► J�` v C� ie p (/t/O, Fi J � cc /f Flue vent for water heater or gas
t" / I' l fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
,�
KPROPERTY OWNER, ❑ TENANT • Other: 10.00
Name: 1"t A An ,A.1 D Environmental exhaust and ventilation
Address: '1p( ' s � 4 Range hood/other kitchen
1 equipment 10.00
City /State /ZIP r j c„.)4) Ogg 9 7z Z- if- Clothes dryer exhaust 10.00
l Single -duct exhaust (bathrooms,
Phone: (403) ,‘ ( ... 9,Jyc Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ 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
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CONTRACTOR Barbecue
Business name! 1_14, � N 3'-LQ. StL Clothes dryer (gas)
�/ Other:
Address: - 3 )S 3s ' Qv. v4 ) i S 4 h MECHANICAL PERMIT FEES*
City /State /ZIP: Co it f e I t OS one y 7//3 Subtotal
Minimum permit fee ($72.50) 7 ,50
Phone: (5t 3) Z 13,7 7 yl/ Fax: ( ) Plan review (25% of permit fee)
CCB tic.: % Z )_ y 7 3 State surcharge (8% of permit fee) ,5", ,F-O
TOTAL PERMIT FEE 7,, ',1
Authorized signature: R This permit application expires if a permit is not obtained within 180
g ;� .� days after it has been accepted as complete.
Print name: 72 C'Al h e J Date: i r Q7 * Fee methodology set by Tri- County Building industry Service B
1:\ Building \Permits\A1EC- PermitApp.doc 01/19/07 44 617T 1 /02 /COh1/N'EB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
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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 $23 1.50 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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1: \Building \Permits \MEC- PermitApp.doc 01/19/07 2
CITY OF TIGARD - ,
BUILDING DIVISION PERMIT #: MEC200 �. (
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/20/2007
Phone: (503) 639 -4171 �a'u'tm ii"
Inspection Requests (24 Hrs.): (503) 639 -4175 �..':J -1 1. ' ) E� �� ��
INSPECTION WORKSHEET FOR DATE: 11/21/2007 TIME: 7 :00AM PAGE: 5
SITE ADDRESS: 16440 SW 108TH AVE CLASS OF WORK:
SUBDIVISION: f3ERKLEY ESTATES LOT #: 002 TYPE OF USE:
PROJECT NAME: MALDONADO
DESCRIPTION: install gas piping for gas range. -
OWNER: MALDONADO, LAWRENCE •+. TANYA, PHONE #:
CONTRACTOR: HOLMES INSTALLATION SERVICE PHONE #: 503 -267 -7574
Inspection Request Scheduled For: Date: 11/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # . Message M 610 Gas line 06013 4 -01 503 -267 -7574
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Corrections /Comments/ Instructions:
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dlik PASS le - ' RTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL • CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _ L Date: 4/47 Phone #: (503) 718- .Z� • y �