Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2016-00041
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/19/2016
Parcel: 2S 111 CA04500
Jurisdiction: Tigard
Site address: 9680 SW LAKESIDE DR
Project: CORBETT Subdivision: SUMMERFIELD NO.12 Lot: 665
Project Description: Installing gas fireplace,gas cooktop,and range hood.
Contractor: J3 BUILDERS Owner: CORBETT, COLLEEN J
4865 SOUTHSTAR CT NE 9680 SW LAKESIDE DR
SALEM, OR 97305 TIGARD, OR 97224
PHONE: 503-798-8140 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 01/19/2016 $33.39
Type of Use: SF Other,Fuel Appliances 01/19/2016 $23.32
Class of Work: ALT Type of Const: Range Hood/Other Kitchen 01/19/2016 $33.39
Occupancy Grp: 12%Stale Surcharge-Mechanical 01/19/2016 $10.81
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.91
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 may obtain a copy of the rules
or direct questions to CLINIC by calling 503.232.1987 or 1.800.332.2344.
Issued By: mittee Signatur
Call 503.639.4175 by 7:00 a.m.for the next available in pection ate.
This permit card shall be kept in a conspicuous place on thejob site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application
Received
City Tigard ED Permit No.:
Dale/6y:
al 13125 SW
W Hall Blvd.,Tigard,OR 97223 Plen Review
Phone: 503.718.2439 Fax: 503.598.19 EGE1 Other Permie
Inspection Line: 503.639.4175
P � 5T
Ins Datu By:
016 qty-�7
19 Dale Ready'By: or : ® ee Page 2 for
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'pN L Nolified'Melhod: Supplemental information
a.,y,... i :gt+ti JH ;r:v:.. r tsr ,II X11,
Mechanical permit fees"are based on the value of the work
El New construction [�Addition/aIterat� cement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
e . 70!!i
-, ,.u" , Value $
- ' ;`RP,S11 :N'i7AL;lQtiJiPMEdTf51`S'� Di1ffiFI §*.,,:' ..
.. . . ,a
I-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family ❑ Master builder ❑Other: Description Qty. I Ea. Total
``-",t:7 •1'Cf1'T R A9'[ON 1RNI7.i3OCATiON: Heating/cooling:
Air conditioning 46.75
Job site address: O 50 DA" Furnace 100,000 BTU(doers,euc) 46.75
City/State/ZIP: flt-, or q Furnace 100,000+BTU(doers,cut,) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: H dronic hot waters stem 23.32
Residential boiler(radiator or
h dronic) 23.32
Unit heaters(fuel-type,not electric).
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
`DESCRI 'I'tON OF YORK Gas fire lace/inser 1 33.39 e
Flue vent for water heater or gas
�j
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROkERTY ON?NFill-. ❑ TENANT Other p-(a 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
tri menl 33.39 3 °I
Address: K- Clothes dryer exhaust 33.39
City/State/ZIP: b Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:L6b� '?m 349—o(o Fax:( ) Attic/crawls ace fans 23.32
7 ��in �:� CONTAC"1' PERSpIy Other: 23.32
Business name: ."� 6 Fuelpiping:
11 $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: f ) ,\C Gas heat pump
'vL Wall/sus inded/unit heater
City/State/ZIP: bp, Water heater
Phone:( 7 ^�{�b Fax: :( ) Fireplace
Range
E-mail: rrn
Barbecue
Clothes dryer( as)
.yt ✓,s ' Olt_ ' „ ..
Business name: Other
' a �:..
kS
Address: $b �LN [ Q Subtotal , t
City/State/Z]P: Q 473 M inimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:
(�/'�) Fax:( ) State surcharge(12%of pennit fee) )O=
CCB lic.: G� TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signatur : w Fee methodology set by I ri-County Building Industry service Board
Print name: Date:
I naiddina'Per BBC_ aA, 01 - 440-4617f(It02 COM WFn)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-F mily Fee Schedule:
Total Valuations l?CI
$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:ABuildingAPeinits\MEC_PennitApp_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
9680 SW LAKESIDE DR, TIGARD, OR, 97224
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2016-00041
David Young
Violation Summary:
Inspector Contractor