Permit « -
C ITY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2005 -00373
;�i� DEVELOPMENT SERVICES DATE ISSUED: 6/22/2005
y" 13125 SW Hall Blvd., Tigard, OR 97223 503 - 6394171
PARCEL: 2S 102AC -01704
SITE ADDRESS: 12720 SW PACIFIC HWY ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Run 12' of piping for new gas meter.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: UNK 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
SPRINGER, JERRY C Description Date Amount
7400 SW FAIRWAY DR
WILSONVILLE, OR 97070 [MECH] Permit Fee 6/22/200f. $72.50
[TAX] 8% State Surcha 6/22/200f. $5.80
Total $78.30
Phone:
Contractor:
MURRAYHILL PLUMBING
11675 SW NICOLI PL
TIGARD, OR 97224 REQUIRED ITEMS AND REPORTS
Phone: 503- 469 -1231
Reg #: LIC 155238
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: Permittee Signature: c4ag( <,x,
Call 503 - 6394175 by 7:00 a.m. for inspections that business 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.
r
- Mechanical Permit Aar FOR OFFICE I SE ()NIX
City of Tigard � � Received -O Permit No.� `_ a) 6zi -73 • 13125 SW Hall Blvd., Tigard, OR 9722 plan 17atcJBy Review
Phone: 503.639.4171 Fax: 503.598.1960 ;,; ; Date/By. Permit:
Inspection Line: 503.639.4175 w,',,.
Internet: www.ci.ti ard.o r.us JUN , L , 2 4 1,E . - 'II L Date e d/Met y. S See Page 2 for
g Notified/Method Supplemental Information
rk t6 l T9C
T IC)
Q�IS`IC1f�N COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
• ❑ New construction 14 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 OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling 'Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family 0 Master builder
❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: / 2 7 2 0 c D�1 Air conditioning or heat pump
r J . r 1 A-cd liC 1I w y (requires site plan showing placement) 14.00
City / State/ZIP: 7 dv A g D 0 IAQ0 o&) .1'722. 3 Furnace 100,000 BTU (ducts/vents) 14.00
V Furnace 100,000+ BTU ( ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Lee 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
R V N I Z OF. 3/ 1 I (3Li a- 42 0 /3
Gas fireplace
water heater or gas
e 10.00
Flue vent fo
P u Fp R �- W 6- I} 5 M- 2.-1 -Q I''
fireplace 10.00
h Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
[PROPERTY OWNER I 0 TENANT ChChimney/liner/flue/vent 10.00
Other: 10.00
Name: SA. Jo p iV,4 j -e-e_ 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: (5 03) 38o-- (p � $5 ---- Fax: ( ) toilet compartments, utility rooms) 6.80
APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
MV k- v4 y 11 R . t �,.t hiA/
Other: 10.00
Business name:
Fuel piping
Contact name: / k $5.40 for first four; $1.00 for each a dditional
Furnace, etc.
Address: 1' ( r) . fir sr W. »✓L of Ir pi_
Gas heat pump
City /State/ZIP: 7;19A r � op-6 j C,t 7 2-2 9 Wall/suspended/unit heater
Phone: ( OZ) (,I (c 4 _ 12. r3 i - Fax::: ( ) 7 Water heater
J Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: 54 i"I' f 4 36 Other: dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
. City /State/ZIP: Subtotal
Phone: ( ) I Fax: ( ) Minimum permit fee ($72.50) 7.130
Plan review (25% of permit fee)
CCB lic.: 1 5 5 '2 3? State surcharge (8% of permit fee) s_1)
TOTAL PERMIT FEE 71., 3 6
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: fry, t2. K Ate Is, I Date: 6, — Z2, — _ • Fee methodology set by Tri- County Building Industry Service Board
i:\Building\Permits \NEC- PeanitApp.doc 12/03 440-4617T ( I 1/02/COM/WEB)
11
Mechanical Permit Application - City of Tigard b.4
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 12/03 2
•
CITY OF TIGARD . -
BUILDING DIVISION • ' . PERMIT #: MEC2005 -00373
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/2712005
Phone: (503) 639 -4171 �� +e�j�l��
Inspection Requests (24 Hrs.): (503) 639 -4175 _..' ` __..
INSPECTION WORKSHEET FOR DATE: 6/23/2005 TIME: 7:10AM PAGE: 10
SITE ADDRESS: 12720 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: LEE
DESCRIPTION: Run 12' of piping for new gas meter.
OWNER: SPRINGER, JERRY C, PHONE #:
CONTRACTOR: MURRAYHILL PLUMBING PHONE #: 503- 469 -1231
Inspection Request Scheduled For: Date: 6/23 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
610 Gas line 010005.01 503-469 -1231 N
Corrections/Comments/Instructions:
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ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: " Date: L [ l( Phone #: (503) 718- •