Permit _A-, L.
1111 1 C - TY OF TIGARD
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00269
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/29/2008
PARCEL: 2S 111 AB -06600
SITE ADDRESS: 09285 SW INEZ ST ZONING: R -4.5
SUBDIVISION: PENROSE TERRACE LOT: 011 JURISDICTION:' TIG
PROJECT: FIELDHOUSE
Project Description: Installation of 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:
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:
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
TOM & JANE FIELDHOUSE Description Date Amount
9285 SW INEZ ST
TIGARD, OR 97224 [MECH] Permit Fee 51291200E $72.50
[TAX] 12% State Surch 51291200E $8.70
Total $81.20
Phone: 503- 620 -5952
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.
Issued By. '; ! f / .10
, Permittee Signature: a fi..,„ / / /
Call 503.639.4175 by 7:00 a.m. for inspections that 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.
RECEIVE 1
,_ (Met'hanical Permit Application FOR OFFICE USE ONLY
Clt "of 'Tigard MAY 2 9 2008 Date/By: �' / / Permit No. I /f �� •
III 13125 SW Hall Blvd., Tigard, OR 97223
C :. Phone: 503.639.4171 Fax: 503.598.1960 _ . Other Permit:
Inspection Line. 503.639.4175 CITY OFTIGAR �'
TIGARD p e ..aReady /ey: Supplemental See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVIS !I ; hied /Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ddition /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
Multi- family ❑Master builder ❑Other: For special information use checklist.
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: &' ]] Air conditioning or heat pump
. ��� �" f`� N L (requires site plan showing placement) 14.00
City /State /ZIP: I v r a 0 q 7 Furnace 100,000 BTU (ducts /vents) 14.00
`� Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Pr ject 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
_ aC 1Q 1 � 5 f t/l 1 F0 0 4 /t FP Gas fireplace 10.00
� : (7 Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00 .
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
ROPERTY OWNER ❑ TENANT Other: 10.00
Name: - 1 - 6 _ 4 G `J t e 11 I40\f S Q `, Environmental exhaust and ventilation
i v J 3N Z.._ cr.- Range hood /other kitchen
Address: C
!!� JW e equipment 10.00
City /State /ZIP: I (C G. KO ow__ Clothes dryer exhaust 10.00
) / Fax: Single -duct exhaust (bathrooms,
Phone:
'4Z•0 S Z. ( ) 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 X
CONTRACTOR . Barbecue
� °� Clothes dryer (gas)
Business name: i wer 3.- , Stry
C" Other:
Address: 7751 / Ls, MECHANICAL PERMIT FEES *.
City /State /ZIP: Co RA e-4 v 13122- 9 7//3 Subtotal
1 Minimum permit fee ($72.50) 7. 3
Phone:) ) Z,(� 7 75-7 y+ Fax: ( )
Plan review (25% of permit fee) U
CCB lie.: (.0 2 Li 73 State surcharge (8% of permit fee) 6, 70
TOTAL PERMS FEE �f Wi[u
n
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
1 —
Print name: i es,--s Date: S vo not
Fee methodology set by Tri- County Building Industry Service Board
I: \Building \Permits \MEC- PermitApp.doc 01/19/07 40 -4 617T (I 1/02 /CON WEB)
Mechanical Permit Application - City of Tigard -
Page 2 - Supplemental Information
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 $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.
I: \Building \Permits \MEC- PermitApp.doc 01/19/07 2
CITY OF TIOARD
BUILDING DIVISION PERMIT #: MEC200B -00269
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/29/2008
Phone: (503) 639 -4171 /o/ I i
Inspection Requests (24 Hrs.): (503) 639 -4175 AL
INSPECTION WORKSHEET FOR DATE: 5130/2008 TIME: 7 ;01AM PAGE: 18
M C--Z 7 qZ
SITE ADDRESS: 09285 SW INEZ ST CLASS OF WORK:
SUBDIVISION: PENROSE TERRACE LOT #: 011 TYPE OF USE:
PROJECT NAME: FIELDHOUSE
DESCRIPTION: Installation of gas piping fos gas range.
OWNER: FIELDHOUSE, TOM & JANE PHONE #: 503.620 -5952 .
CONTRACTOR: HOI..MES INSTALLATION SERVICE PHONE #: 503 -7574
Inspection Request Scheduled For: Date: 5/30/2008 ' Pour Time:
Code # Inspection Description Confirm # Contact # Mess- • - ^
610 Gas line 070601 -01 503 -267 -7574 ... /�'
611 •1 4 .
Corrections /Comments /Instructions:
/ r-o 1C_.____ 1S .---- t i
i%rrl6q't .,TES - >
l ■ PAI a PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: , 3 718 - :Z.C____.r
Dated, Phone # : (50 )