Permit ,� CITY OF TIGARD MECHANICAL PERMIT
1111111 2 COMMUNITY DEVELOPMENT Permit#: MEC2014-00662
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/09/2014
Parcel: 25111 DB00100
Jurisdiction: Tigard
Site address: 15200 SW ALDERBROOK DR
Project: FLECK Subdivision: SUMMERFIELD NO.8 Lot: 429
Project Description: Gas piping for range.
Contractor: HOLMES INSTALLATION SERVICE Owner: FLECK, ROBERT S
33535 NW VADIS RD 15200 SW ALDERBROOK DR
CORNELIUS,OR 97005 TIGARD, OR 97224
PHONE: 503-647-9320 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 12/09/2014 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 12/09/2014 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 12/09/2014 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1190. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: iiiat
Call 503.639.4175 by 7:00 a.m.for the next available inspection te.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application �r t OR OIII( I I ',I O\I 1
City of Tigard ��‘ rVl Date/By:
;II • 13125 SW Hall Blvd.,Tigard,OR y 11 II Phone: 503.718.2439 Fax: 503.5 Plan Review
DateBy: Other Permit:
I I c :�I:I) Inspection Line: 503.639.4175 %1° Date Ready/By: See Page 2 for
Internet: www.tigard-or.gov [-C1 �� Notified/Method: P Supplemental Information
��
TYPE OF VON v�rr��tv0 0� COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
V Mechanical permit fees*are based on the value of the work
❑New construction Addition/alte cement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
-and 2-family dwelling ❑Commercial/industrial El Accessory building For special information use checklist.
Multi-family El Master builder El Other: Description Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
r Air conditioning 46.75
Job site address: 00 r 2W yl� ijjy1� ` Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: T15 c✓Q O V 9 7 Z 7 y Furnace 100,000+BTU(ducts/vents) 54.91
t / Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: 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
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
r, Flue vent for water heater or gas
.--/kA-VG-\\/•./5 G S t, , Mr A- CA-51 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 ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:_A G vl e- ` - Range hood/other kitchen
r� equipment 33.39
Address: tc QJ � � � 1k.)� V� Clothes dryer exhaust 33.39
City/State/ZIP: a'V 1� J, -� Single-duct exhaust(bathrooms,
` toilet compartments,utility rooms) 23.32
Phone .7 —(„7._0 2 i Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional_
Contact name: Furnace,etc. _
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) _Fireplace
-r
Range /y/
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: ���+,t�.,eS \N 5\uNM( $i.,�
Other: MECHANICAL PERMIT FEES*
Address:-3 7535 /�/u t,J, Jot..',(5 �� Subtotal l y/y
City/State/ZIP: Co ` _ t C os—� -71 f 3 Minimum permit fee($90.00) Gi)_ire)
�th� ♦v ! !
Phone:(o) �L,'1 7S 7 ii Fax:( ) Plsn surcharge(25%of permit fee)
� State surcharge(12/o of permit fee) 1 U, !)
CCB lie.: l• Zv 7 3 i,,,_ -'I it 4 TOTAL PERMIT FEE AUd•
This permit application expires if a permit is not obtained within 180
/2 .„, days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: f a us re Is L Date: •
1:\Building\Permin\MEC_' mitApp_040113.doe 441 .61 I1/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
L\Building\Permits\MEC_PermitApp_040113.doc 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15200 SW ALDERBROOK DR, TIGARD, OR,
97224
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2014-00662
George Heimos
Violation Summary:
Inspector Contractor