Permit CITY OF TIGARD MECHANICAL PERMIT
li ,
a ' COMMUNITY DEVELOPMENT Permit #: MEC2013 -00190
Tigard OR 97223 503.718.2439
1 3125 SW Hall Blvd., Ti Date Issued: 04/09/2013
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Parcel: 2S104CA07100
Jurisdiction: Tigard
Site address: 13443 SW HILLSHIRE DR
Project: Thielen Subdivision: HILLSHIRE Lot: 71
Project Description: Installation of gas piping for range and grill
Contractor: A 1 INSTALLATIONS NW LLC Owner: THIELEN, JOE C & PAULA J
15842 SW UPPER BOONES FERRY RD 13443 SW HILLSHIRE DR
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503 - 620 -5657 PHONE:
FAX: 503 - 620 -1696
FEES
Specifics: Description Date Amount
Fuel Piping 04/09/2013 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 04/09/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04 /09/2013 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Noti enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0090. You may obtain a copy of the rules
or dire questions to O b ■ C by . 14 503.232.1987 or 1.800.332.2344.
Issu =d By: . / / / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 of i 1( I: 151: ()NIA
City of Tigard Received l`�f�o? - /%b
3 W / Permit No.:
I II • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Date/By: 9 i
T I GA R D Inspection Line: 503.639 Date Ready/By: Juris HI See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 13443 SW HILLSHIRE DR (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP: TIGARD, OR 97223
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: GRIMES Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: MISTLETOE DR Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32 _
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
INSTALLING GAS PIPING FOR THE INSTALLATION OF A RANGE AND GRILL Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney /liner /flue /vent 23.32
❑ PROPERTY OWNER I 0 TENANT Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ® CONTACT PERSON Attic /crawlspace fans 23.32
Business name: A -1 INSTALLATIONS NW Other: 23.32
Fuel piping:
Contact name: ALAN NEWBY $14.15 for first four; $4.03 for each additional
Address: 15842 SW UPPER BOONES FERRY RD Furnace, etc.
Gas heat pump
City /State /ZIP: LAKE OSWEGO, OR 97035 Wall /suspended/unit heater
Phone: (503) 620 -5657 Fax: : (503) 620 -1696 Water heater
Fireplace
E -mail: alinstallations @gmail.com
Range 1 14.15 14.15
CONTRACTOR Barbecue 1 4.03 4.03
Business name: Al INSTALLATIONS NW Clothes dryer (gas)
Other:
Address: 15842 SW UPPER BOONES FERRY RD MEOIANICAL PERM3T FEES*
City /State /ZIP: LAKE OSWEGO, OR 97035 Subtotal 18.18
Minimum permit fee ($90.00) 90.00
Phone: (503) 620 -5657 Fax: (503) 620 -2696 Plan review (25% of permit fee)
CCB lic.: 186516 State surcharge (12% of permit fee) 10.80
TOTAL PERMIT FEE 100.80
Authorized signature: This permit application expires if a permit is not obtained within 180
g days after it has been accepted as complete.
Print name: ALAN NEWBY Date: 04/09/2013 • Fee methodology set by Tri- County Building Industry Service Board
I. \ Building 'Permits\MEC- PermitApp.doc 03/0 2 440-4617T (I 1/02 /COM/WEB)
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13443 SW HILLSHIRE DR, TIGARD, OR, 97223
Residential - Mechanical
610 Gas Line
04/10/2013 00:00
MEC2013-00190
PASS
Test10psi/15min
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13443 SW HILLSHIRE DR, TIGARD, OR, 97223
Residential - Mechanical
610 Gas Line
04/10/2013 00:00
MEC2013-00190
PASS
Test10psi/15min
Violation Summary:
Inspector Contractor