Permit IIICITY OF TIGARD MECHANICAL PERMIT
a
1 ' COMMUNITY DEVELOPMENT Permit#: MEC2015-00240
T E CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/28/2015
Parcel: 2S 114BD04000
Jurisdiction: Tigard
Site address: 16545 SW COPPER CREEK DR
Project: Castellano Subdivision: COPPER CREEK STAGE 3 Lot: 99
Project Description: Install gas piping for new range.
Contractor: HOLMES INSTALLATION SERVICE Owner: CASTELLANO, JOHN A&JUDY K
33535 NW VADIS RD 16545 SW COPPER CREEK DR
CORNELIUS, OR 97005 TIGARD, OR 97224
PHONE: 503-647-9320 PHONE: 503-639-4671
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 04/28/2015 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 04/28/2015 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 04/28/2015 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You ay obtain a copy of the rules
or dir- ---- ,• to OUNC by calling 503.232.1987 or 1.800.332.2344. ),,,,/
I.,ued By: , , ,,OF / Permittee Signature: I
Call 503.639.4175 by 7:00 a.m.for the next available inspection d
This permit card shall be kept in a conspicuous place on the job site until compl. on of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVED Received /ag s ,�, rife a��,/o
Date/By: / Permit No.: 7
11
• 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
APR 2 8 2015 DateBy:
I 1 i,\R u Inspection Line: 503.639.4175 Date Ready/By: 3urie: 1Z1 See Page 2 for
Internet: www.tigard-or.gov
CITY Notified/Method: Supplemental Information
BUILDING DINTS oN
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'PE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
! Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑ Master builder ❑Other: Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
J Air conditioning 46.75
Job site address: i 1,l s- S(fru cki G, C k-Pfk, `/� Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:j G py� (� Z Y Furnace 100,000+BTU(ducts/vents) , 54.91
1 111 /��" 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
.- Flue vent for water heater or gas
i( AA 5.?(,S+ 1 t A� t--U,, A— ) fireplace 23.32
`� / ) _J 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: 0 As --f` e L`,,e)i1J 0 Range hood/other kitchen
Address: / rb 1.w CO pp Q V-(.�ek- D Clothes dryer 33.39•
1 Clothes dryer exhaust 33.39
City/State/ZIP: i ` 0.1---) ( 7 Z Z Y Single-duct exhaust(bathrooms,
C, ^� toilet compartments,utility rooms) 23.32
Phone: 3) C, 9 / 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
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: (NS N )a , � Other: MECHANICAL PERMIT FEES*
Address:1)? 3 c!n4!%. , VA `S Subtotal
City/State/ZIP: \ 3 `/' e it v5 'O ✓ 7 r (a Minimum permit fee($90.00)
Phone:O�) d._6'7 7c 7 - Fax:( ) /
Plan surcharge(25%of permit fee)
State surchazge(12%of permit fee)
CCB lic.: (0 Z kis 3 TOTAL PERMIT FEE 1/.,go
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board
Print name: y jam/a .e(�S Date: 7 L Z O
1:\BuildingTermitaV�C_PermitApp_0401 t3.doe 440-461 (II/02/CO B)
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.
I`\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
16545 SW COPPER CREEK DR, TIGARD, OR,
97224
Residential - Mechanical
699 Mechanical final
PASS - No C of O
April 30, 2015 at 12:23:10 PM
MEC2015-00240
David Young
Appliance shut off installed at range location.
Violation Summary:
Inspector Contractor