Permit CITY TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00141
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/13/2007
PARCEL: 1 S133DD -01000
SITE ADDRESS: 11747 SW 129TH PL ZONING: R -4.5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 2 LOT: 049 JURISDICTION: TIG
PROJECT: BUNCH
Project Description: Install (2) gas fireplace insert with gas piping, 2 outlets.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 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:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 2
> 10000 cfm:
GAS OUTLETS: 2
Owner: FEES
PETER BUNCH Description Date Amount
117474 SW 129TH PL.
TIGARD, OR 97223 [MECH] Permit Fee 3/13/2007 $72.50
[TAX] 8% State Surcha 3/13/2007 $5.80
Total $78.30
Phone: 503- 228 -8878
Contractor:
R & D INSTALLATIONS
5246 SE 62ND
PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 774 -7142
Reg #: LIC 95236
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.
Issued By: 04 ,,,� Permittee Signature: aAAAJ L(.1:k
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 , - - ' . - FO O U SE ON ; Y ' °� r
•` City of Tigarc0 � Date /By: ,. / 0 / �, /' Permit 1 9 — 00
• 13125 SW Hall Blvd., Tigardd,tOR'�,9,73 Plan Revie • /
`' ' • 11 — Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
D' Inspection Line: 503.639.4175
T. P�p DateReadyBy: huts. la See Page 2 for
3 Internet: www.tigard or.gov I-•�f•tR 1 `, 2001 Notified/Method: Supplemental Information
COMMERCIAL FEE* SCHEDULE USE CHECKLIST
❑ New construction ®i tEri/al erat TT` ion/laceme rel `T ? Mechanical permit fees* are based on the value of the work
IX' performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other: mechanical materials, equipment, labor, overhead, and profit.
`.: r. ', ", .. CATEGORY OF CONSTRUCTION - ' • • • • Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES* - - .
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
❑ Multi- family ❑ Master builder ❑ Other: For special information use checklist.
Description Qty. Ea. I Total
- .- JOB SITE INFORMATION' " AND LOCATION Heating/cooling
Job site address: / / J / 7 7 5L--it- /2-6-P`'' b Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State /ZIP: t i .(i‘.-t C/( Gtr\'`-C, Fumace 100,000 BTU (ducts/vents) 14.00
Fumace 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 14.00
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. 10.00
Subdivision: Lot no.:
Flue /vent for any of above 10.00
Other: 10.00 _
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK - . -. ,- , Water heater 10.00
Gas fireplace 10.00
d" ` , vl ( A ( ( r) _ /�, /� (C G Flue vent for water heater or gas
( �J L/ l fireplace 10.00
/� 6 Log lighter (gas) 10.00
- (V 6!'�4S p�� Wood/pellet stove 10.00
r Wood fireplace /insert 10.00
❑ PROPERTY OWNER ❑ TENANT :. ' Chimney /liner /flue /vent 10.00
C ' I Ether: 10.00
t5L Name: Environmental exhaust and ventilation
r J / 2 4' / `"t PL Range hood/other kitchen
Address: ( 'T equipment 10.00
City /State /ZIP: � 0_ Clothes dryer exhaust 10.00
Phone: ( ) �� — Vs f - 5 Fax: Sing c duct r t ent (uathrooms,
(� ( ) toilet compartments, , utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
6 ` 4,,„, s 1 Other: 10.00
Business name: Fuel p i p in g
Contact name: Dv V— ) j (7 $5.40 for first four; $1.00 for each additional
/ Furnace, etc.
Address: 5 LC /6 L 60jit Gas heat pump
City /State /ZIP: C w- f ` � 0 - 7 b Wall /suspended/unit heater
�"
Phone: i3) 7 -7 C�._ - C CJ ' l Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR . Barbecue
CN Clothes dryer (gas)
Business name:
Other:
Address: 1.2 MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 1 2,3 State surcharge (8% of permit fee) 2 ,,
l TOTAL PERMIT FEE b O - ,71/
Authorized ature: This permit application expires if a permit is not obtained within 180
A J / - 7 days after it has been accepted as complete.
Print nam: r ' r , 'aI Date: ' Fee methodology set by Tri- County Building Industry Service Board
'A I mo ..∎ ��
1:\Building\Permits∎ C- PermitApp. doc 04 /06/06 440 -4617T (11/02 /CON B)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation:- . `4 Permit
$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 $231.50 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.
1:\ Building \Permits\MEC - PermitApp.doc 12/30/05 2
7 •,,
CITY OF TIGARD
BUILDING DIVISION .
PERMIT #: MEC2007-00141
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/13/2007
Phone: (503) 639-4171
„.....
Inspection Requests (24 Hrs.): (503) 639-4175 401 I L.
INSPECTION WORKSHEET FOR DATE: 3/14/2007 TIME: 7: 00AIVI PAGE: 12
SITE ADDRESS: 11747 SW 129TH PL CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 2 LOT #: 049 TYPE OF USE:
PROJECT NAME: BUNCH
DESCRIPTION: install (2) gas fireplace insert with gas piping, 2 outlets.
OWNER: BUNCH, PETER PHONE #: 503-228-8878
CONTRACTOR: R & D INSTALLATIONS PHONE #: 503-774-7142
Inspection Request Scheduled For: Date: 3/14/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 04481501 503-774-7142 N
Corrections /Comments/ Instructions:
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PASS _ PARTIAL APPROVAL 0 • CANCEL - NO ACCESS
I I FAIL 0 CALL FOR INSPECTION 0 ADDIT NAL EES ASSESSED
AID i
Inspector: II tr
./A Date: Phone #: (503) 718- -- - 2.--
........:
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