Permit Ns.. . CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2009 -00023
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/13/2009
PARCEL: 25111 CC -01800
SITE ADDRESS: 10315 SW CENTURY OAK DR ZONING: R -7
SUBDIVISION: SUMMERFIELD LOT: 015 JURISDICTION: TIG
PROJECT: GALLIEN
Project Description: Installation of gas fireplace and gas line.
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:
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: 1
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
DICK GALLIEN Description Date Amount
10315 SW CENTURY OAK DR
TIGARD, OR 97224 [MECH] Permit Fee 1/13/200 $72.50
[TAX] 12% State Surch 1/13/20a $8.70
Phone:
Total $81.20
Contractor:
GAS PRO, INC.
7603 SE LOUNSBERRY LN
PORTLAND, OR 97206 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 775 -7020
FAX 503- 775 -7014
Reg #: LIC 167493
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 V - l / 1IQ! �,�(�L Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for inspections that b iness 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 FOR OFFICE USE ONLY
City of Tigard Received /� a, Pennit No.: MEeif -�A
N._ •',.: ° 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: �fi7
Plan Review
Phone: 503 639.4171 Fax: 503.598.1960 Date /By: Other Permit.
'TIGARD Inspection Line: 503 639 Date Read /B Ju ri
Internet: www.ti ard or.gov Ready /By: S See Page l for
g c Notified /Method: O2 Supplemental
. ., TYPE OF ,WORK' ..-..- - _. - COMMERCIAL FEE* - SCHEDULE.. —'USE CHECKLIST
❑ New construction Addition /alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
. CA _
CATEGORY OF CONSTRUCTION ' • . Value: $
dwelling RESIDENTIAL EQUIPMENT/ SYSTEMS.FEES* .
- and 2-family g ❑ 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
Job site address: J )? L `. LQ� 4 / ' L � Air conditioning or heat pump
4 c f V /� (requires site plan showing placement) 14.00
City /State /ZIP: �`' >�, 4R � 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
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other 10.00
Tax map /parcel no.: Other fuel appliances
. _ D ESCRIPT ION , OF', WORK_ . — Water heater 10.00
/ ,. Gas fireplace / 10.00
645 ) E�> C AC C Flue vent for water heater or gas
fireplace 10.00
6w5 /(P-7.5 Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
PROPERTY OWNER ❑ TENANT Other: 10.00
Name: D C l C G A //7�,,,/ Environmental exhaust and ventilation
Address: Range hood /other kitchen
equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) 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
C Barbecue
Business name: / /7,eO —7/7 G Clothes dryer (gas)
Other.
Address: 76 03 , ( C 4> 11 r l ' <Y. L � : _MECH A N ICAL PERMTT.'FEES *
City /State /ZIP: d 0 ' 1'z .. ci D7C 72c'7 Subtotal
n Minimum permit fee ($72.50) 7�
Phone. v l 7 — Fax: (, 7 7 — 2 Plan review (25% of permit fee)
CCB lie.: 76 ? ?3 / State sur (12% of permit fee) ' .10
Authorized signature: 10/ �� TOTAL PERMIT FEE g This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: /onw G r . '.....5' /---73
Date: ,a y " Fee methodology set by Tri- County Building Industry Service Board
\ \
1:\BuildingPermitsMEC- PermitApp.doc 01/19/07 / 440 -4617T (11/02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: . Permit;Fee ` _ °E
$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 01/19/07 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2009 00023
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: .inar1009
Phone: (503) 639-4171 &do,
..,..
Inspection Requests (24 Hrs.): (503) 639-4175 x, , .tb
INSPECTION WORKSHEET FOR DATE: 1/14/2009 TIME: 7:01AM PAGE: 3
SITE ADDRESS: 10316 SW CENTURY OAK DR CLASS. OF WORK:
SUBDIVISION: SUMMERFIELD LOT #: 015 TYPE OF USE:
PROJECT NAME: GALLIFN
DESCRIPTION: Installation of gas fireplace and gas line.
OWNER: GALLI EN , DICK PHONE #:
CONTRACTOR: GAS PRO, INC. PHONE #: 503-776-7020
Inspection Request Scheduled For: Date: 1/14/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 079701-03 603-624-7079 N
Corrections/Comments/Instructions:
_, ) /
If; PAS, /A PARTIAL APPROVAL fl CANCEL NO ACCESS
FAIL Ni CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
AMP L.-
Inspector: Aaills■—_ Date: 0 Phone #: (503) 718- 4___
—
' — — — —
CITY OF TIGARD
BUILDING DIVISION PERMIT #: t31 c:.Q00r0?3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1 /1 12009
Phone: (503) 639 -4171 4 ,1011141W '
Inspection Requests (24 Hrs.): (503) 639 -4175 `:_I :.
INSPECTION WORKSHEET FOR DATE: 1/14/2009 TIME: 7 :01AM PAGE: 4
SITE ADDRESS: 10315 SW CENTURY OAK DR CLASS OF WORK:
SUBDIVISION: SUMMMERFIELD LOT #: 0.ps TYPE OF USE:
PROJECT NAME: GALLIEN
DESCRIPTION: Installation of gas fireplace and gas line.
OWNER: GALLIEN, DICK PHONE #:
CONTRACTOR: GAS PRO, INC. PHONE #: 503.775 -7020
Inspection Request Scheduled For: Date: 1/14/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
615 M € chanical rough -in 079701 -02 503- 624 -7079 N
Corrections /Comments/ Instructions:
ill PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
IL /] CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: .� AMP Date: 1 t 1 ; Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: fVff CC103 0(3.13
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/13/2009
Phone: (503) 639 -4171 � A ���n� i A Inspection Requests (24 Hrs.): (503) 639 -4175 ' `'IL.
INSPECTION WORKSHEET FOR DATE: 11140009 TIME: 7:01 AM PAGE:
SITE ADDRESS: 10315 SW CENTURY OAK DR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD LOT #: 015 TYPE OF USE:
PROJECT NAME: GALLIEN
DESCRIPTION: Installation of gas fireplace and gas line.
OWNER: GALLIEN, DICK PHONE #:
CONTRACTOR: CAS PRO, INC PHONE #: 503775 -7O7Q
Inspection Request Scheduled For: Date: //1412009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 079701 -01 503 - 624 -7079 /if
Corrections /Comments/ Instructions:
III II PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL % OALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: /■_ , Date: / / 07 Phone #: (503) 718 (D