Permit C ITY OF TIGARD MECHANICAL PERMIT
4I DEVELOPMENT SERVICES PERMIT #: MEC2006 -00431
1.
r 'I II • 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/5/2006
PARCEL: 1 S134CD -06000
SITE ADDRESS: 11695 SW SUMMER CREST DR ZONING: R-4.5
SUBDIVISION: BURLWOOD NO.3 LOT: 020 JURISDICTION: TIG
Project Description: Install pellet stove.
CLASS OF WORK: OTR 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:
OTH 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: 1
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
•
RICHARD D. KOPF Description Date Amount
11695 SW SUMMERCREST DR
TIGARD, OR 97223 [MECH] Permit Fee 9/5/2006 $72.50
[TAX] 8% State Surcha 9/5/2006 $5.80
Total $78.30
Phone: 503 -590 -3000
Contractor:
PELLET STOVES EAST
21553 HIGHWAY 213
OREGON CITY, OR 97045 -9171 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 632 -7674
Reg #: LIC 46433
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.
sued By: k Permittee Signature: ra,4,i�,e9 /4 .
Call 503- 639 -4175 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.
Mecl:ani l Permit Application FOR OFFICE USE ONLY
• • City of Tigard eBy ®o a,
° 13125 SW Hall Blvd., Tigard, OR 97223 • .,
Plan Review
0 ' Phone: 503.639.4171 Fax: 503.598.1960 Date/By Other Permit:
T I G A It D Inspection Line: 503.639 Date Ready/By. PJ See Page 2 for
Internet: www.tigard or.gov Notified/Method Supplemental Information
• 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.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling •
Job site address: / / f 5 lc/ slth'1,)7 � ,Q4Qzsi / Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State/ZIP: T iO,,J_ d o A' 99°Z2? Furnace 100,000 BTU (ducts/vents) 14.00
/ � 0 f 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 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
I 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
l Gas fireplace 10.00
I tp� -r(�) ..A____ ELL� �. aro d ei 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
❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue/vent 10.00
Other: 10.00
Name: /SSA/14-d D r Environmental exhaust and ventilation
Address: / /if 915 S2-e./ 5k3y�ir,e .EOV7 Range hood/other kitchen
equipment 10.00
City /State/ZIP: i / g 4, 4. al i.-4,e 02,2,2 Clothes dryer exhaust 10.00
r / Single -duct exhaust (bathrooms,
Phone: ( .0' .) q9 3p ' 4 0 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: ( ) I Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: �C LL�i" 4 €fi5� Other:
Address: a/ 55 K 1 ll t o A y a i 3 MECHANICAL PERMIT FEES'
City /State/ZIP: bp_i Opt3 Lt-r/ bp, 9-76z/6-"9i7/ Subtotal 7 , .5T)
�1 / 7 t Minimum permit fee ($72.50)
Phone: ( 5 0 3 ) l o 3s — 71`7 I Fax: ( )
Plan review (25% of permit fee) fj . gO
CCB lic.: l 3 State surcharge (8% of permit fee)
^ TOTAL PERMIT FEE 78 r 30
Authorized signature: r / . This permit application expires if a permit is not obtained within 180 ' .,....10.,.. days after it has been accepted as complete.
Print name: m c b #1 i o ti //2 I ate: 4 4 • Fee methodology set by Tri- County Building Industry Service Board
I:\ BuildingPermiuVMEC- PermitApp.doc 04/06/06 440-4617T(II /02/COM/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 12/30/05 2
CITY OF TIGARD.
BUILDING DIVISION o PERMIT #: M &02011&00431
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/5/2006
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/2912406 TIME: 7 :06AM PAGE: 28
SITE ADDRESS: 11695 SW SUMMER CREST DR CLASS OF WORK:
SUBDIVISION: BURLWOOD NO.3 LOT #: 020 TYPE OF USE:
PROJECT NAME: KOPF
DESCRIPTION: Install pellet stove.
OWNER: KOPF, RICHARD PHONE #: 503.590-3000
CONTRACTOR: PELLET STOVES EAST PHONE #: 503.632.7674
Inspection Request Scheduled For: Date: 9129/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
615 Mechanical rough -in 037402 -01 503-590-3000 N
94/ Meenioxiiedv--
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718 - _6-1