Permit :,' CITY OF TIGARD
MECHANICAL PERMIT
11 DEVELOPMENT SERVICES PERMIT #: MEC2006 -00283
---• 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/22/2006
PARCEL: 2S105DA -16400
SITE ADDRESS: 14565 SW KLIPSAN LN ZONING: R -7
SUBDIVISION: PACIFIC CREST LOT: 052 JURISDICTION: TIG
Project Description: 60ft. of gas line and 1 outlet.
CLASS OF WORK: ADD 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:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
NICK WILSON Description Date Amount
14565 SW KLIPSAN LN.
TIGARD, OR 97223 [MECH] Permit Fee 6122/200€ $72.50
[TAX] 8% State Surcha 6122/200€ $5.80
Total $78.30
Phone: 503 -524 -6377
Contractor:
THE GASMAN
8940 SE CLINTON ST
PORTLAND, OR 97266 REQUIRED ITEMS AND REPORTS
Contact #: PRI 971 -570 -9722
Reg #: LIC 127089
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.
/ 4 #
Issued By: Permittee Signature: 441/7 efr. _
Call 503 - 639 -4175 by 7:00 a.m. for inspections that b ∎ siness day.
This permit card . shall be kept in a conspicuous place on the job site ntil completion of the project.
Approved plans are required on the job site at the time +f each inspection.
Mechanical Permit Applicati � • FOR OFFICE use oNL
Cit Of Ti 23 C 2006 ��
Permit N
��� N 1V /_w '� .,6 0 �Q
.. L. ' V c, ; 06 Date/By Receivec . 1 • t�J..o�C/ o�`3
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a 13125 SW Hall Blvd., Tigard, OR 97223 Plan By. w
C : Phone: 503.639.4171 Fax: 5b3:59 L960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.41 . (jt Date Ready/By: Jaris: - See Page 2 for
Internet: www.tigard - or.gov " r , -�,,,_ 4 -1 1 (L . , Notified/Method: Supplemental Information
Tr y g tr) Ta.
. . TYPE OF WORK • • , . - ` COMMERCIAL FEE *" SCHEDULE — USE CHECKLIST
El 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.
CATEGORY-'O F CONSTRUCTION Value: $
and 2-family dwelling RESIDENTIAL EQUIPMENT/ SYSTEMS FEES* , ,_,-
y g ❑ Commercial /industrial ❑ Ac cessory 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. 44565 , w K LI FS LN/ Air conditioning or heat pump
�+ ifl V (requires site plan showing placement) 14.00
City /State /ZIP: -- n 6 AGR+2 0 P..., '2-7 7 3 Furnace 100,000 BTU ( ducts/vents) 14.00
A Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name:
W L 7 Gas heat pump 14.00
Cross street /directions to job site: 5c (#c> 5 F ��r, fi(�' f /i Duct work 14.00
T RA-- > I./ (f / �_ V .�� ++ R eside n i hot water system 14.00
C.� _ T-, (��T Residential boiler (radiator or
t'il � 14 s „ r 6 - �r LI K Unit h ic) 14.00
- �-! / IL ` Unit heaters (fuel -type, not electric),
�f4� d NI �/ L ( P r-a� in -wall, in -duct, suspended, etc. 10.00
1 Flue /vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: 0 1 Other fuel appliances
" DESCRIPTION s OF WORK Water heater 10.00
Gas fireplace 10.00
A wl N 4 WA wgfri2 . 4 '317rt {-1E.pC t 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
U .;, ,.PROPERTY `OWNER _ ' ID' TENANT • .
Other: 10.00
Name: / A I) 0 L O wl J Environmental exhaust and ventilation
Address: I 6 5 SW K L.( vs ktJ Range hood/other kitchen
equipment 10.00
City /State /ZIP: 7 1 (j PCFjv7 O'_ '"7r) jZ Clothes dryer exhaust 10.00
"'v Singic -duct exhaust (bathrooms,
• Phone: (6 c'2.4 - (p 7 Fax: ( ) toilet compartments, utility rooms) 6.80
,` P.PLICANT - , - ❑ CONTACT "PERSON - , ' Attic/crawlspace fans 10.00
Other: 10.00
Business name: Fuel piping
Contact name: al/ N �i $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: /C.t.., e ATL. &3— LA. t fad Range
.. ` - ' CONTRACTOR - , , - Barbecue
Clothes dryer (gas)
Business name: — I oA5 myk N) l Other:
Address: �� 4d 5' C C f tJ" T b 1_ V - 'MECHANICAL PERMIT FEES* . '•` s ' •
City /State /ZIP: PO TLAs t4 p pg., 67 1M - 26 c Subtotal
Minimum permit fee ($72.50)
Phone: ( s - U ) A] Fax: ( )
— -- _ J I -�- l ✓ � _ � � Plan _review _(25 %_of_permit fee)—
CCB lic.: /
. State surcharge (8% of permit fee)
/ / TOTAL PERMIT FEE
Authorized signat_ �� � - T his permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: M fC / . ' 1/ &) Date: ‘-- 2-z— a 6 * Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Permits'MEC- PetmitApp.doc 04 /06/06 440 -4617T (1 1 /02/COM/W EB)
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.
1:\ Building \Permits\MEC - PermitApp.doc 12/30/05 _2 -
CITY OF TIGARD '' '
BUILDING DIVISION PERMIT #:Do0C 6 o2 8J
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 N ° ���I ,; i
Inspection Requests (24 Hrs.): (503) 639 -4175 A
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
f
SITE ADDRESS: I 4.fSlety Q a rV CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 6- Z e- D(0 Pour Time:
'fl HA-74 ic9=L
Code # Inspection Description Confirm # Contact # Message
6 I o (0 9 -k..f 332 -3 '
i. r r ecti. • - • mments /Instr . - . '
0 44-S � 1�+ -fi A.c 'l ..S__---S 74- S'- -rc_..
d /J JG , /
PASS_ _ -_I I _PARTIALA_ P_P_ROVAL _ Q_ CANCEL n_ NO_ ACCESS
_
I I FAIL I - CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: z' 7 Date: Phone #: (503) 718-