Permit Support Document �t CITY OF TIGARD L I T
IIII COMMUNITY DEVELOPMENT ' �(i�+ ( Permit#:MECHANICA MEC2020-0PERM 0442
T r G ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 1 ]� Date Issued: 7/10/2020
Parcel: 2S103AB00800
iI -/ 40.11 Jurisdiction: Tigard
Site address: 11345 SW WALNUT ST
Project: Winder Subdivision: None Lot: None
Project Description: Install furnace&supply ducts,zero clearance gas fireplace,gas line to fireplace,vent kitchen hood,vent dryer,vent
bath fan,vent laundry room fan. 7/20/20:REPRINTED to include A/C. Placement of NC unit must comply with
manufacturer's installation requirements.
Contractor: EVERGREEN GAS Owner: WINDER,SARAH THERESE
16385 SW LANGER DR WINDER, REX NORMAN
SHERWOOD,OR 97140 11345 SW WALNUT ST
TIGARD,OR 97223
PHONE: 503-407-9542 PHONE:
FAX: 503-344-6345
FEES
Specifics: Description Date Amount
Furnaces< 100K BTU 07/10/2020 $46.75
Type of Use: SF Gas Fireplace 07/10/2020 $33.39
Class of Work: ALT Type of Const: Range Hood/Other Kitchen 07/10/2020 $33.39
Occupancy Grp: Clothes Dryer Exhaust 07/10/2020 $33.39
Stories: Single Duct Exhaust(Bathrooms,Toilet, 07/10/2020 $46.64
Utility Rooms)
Fuel Piping 07/10/2020 $14.15
12%State Surcharge-Mechanical 07/10/2020 $24.93
Air Conditioning 07/21/2020 $46.75
Fuel 12%State Surcharge-Mechanical 07/21/2020 $5.61
Fuel Types: Gasoline
Gas Pressure:
Total $285.00
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained In the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ' L__ Permittee Signature: / �
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application _ FOR OFFICE USE ONLY
City of Tigard ��� Receives
nDatcJBy: Pemdl No.:�-� .•
t 13125 SW Hall Blvd.,Tigard,OR 97223 ,E,,- 20-CiC 119K0).
• r Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date By:
TIGARD Inspection Line: 503.639.4175 JUL 2 0 2020 Date Ready By: huh: ® See Paget for
Internet: www.tigazd-ot.gov Notified/Method: Supplemental Information
a r ., 1
�I O `1MlIO .*.2 }.'ti' ♦';'Is '(-)'{'� COMMERCIAL FEE* SCHEDULE-USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,Labor overhead,and profit
❑Demolition ❑Other:
Value:$ •
CATEGORY OF CONSTRUCTION
(.(1
RESIDENTIAL.EQUIPMENT/SYSTEMS FEES*
and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description P Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/coollmg:
Air conditioning ( 46.75
Job site address: I$ J L 6- SW t(\k I!V-7V�{- S'd- Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: ''�j7Qt Gl t L( !'Z23 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: `J Project name: V V 1 h car Heat pump 61.06
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
�C ( i / + Flue vent for water heater or gas
?( { 4 6 1 ( b\ cjt ex r`1 )it fireplace 23.32
1(�/il''11711 r .N- M 6 C L-0,2"0 - 0 0 y L121 Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY OWNER 0 TENANT Other 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
Address: equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
('APPLICANT 0 CONTACT PERSON Other
23.32
Business name: 9.4-/y Y ,`) baS Fuel piping:
1 J / $14.15 for first four;$4.03 for each additional
Contact name: 1V"'7 i I i 1 �(,L64v1 Furnace,etc.
Address: (� �� .�W �CRI r._ l Gas heat pump .
_.7 • "i WalUsuspended/unit heater
City/State/ZIP: S'/ ( 00 0 ` G771� Water heater
Phone:(bi?)II _iu--7 -C]l5`IZ- Fax::(. ))3) �qij - jq6 Fireplace
nge
E-mail: hi l\C C,t./eArel 5 .✓i.�f Barbe
'1V11 ���i� a, Barbecue
CONTRkTOR Clothes dryer(gas)
Business name: r Other:
QV GYU MECHANICAL PERMIT FEES*
Address: I(.02)U 1 l tS� G
�' � l 0�f/1� r,. Subtotal
City/State/ZIP: F 3 h�/Yw U JG( / u (,.Ir//;1 Minimum permit fee($90.00)
Phone:( H o l _ `-7,�/� Fax:(g3 ) Y U_(. 1 Plan review(25%of permit fee)
I �l �` State surcharge(12%of permit fee)
CCB lic.: 15l) o 3 I TOTAL PERMIT FEE
TM,permit application expires If a permit is not obtained within ISO
days after it has been accepted as complete.
Authorized signat re: • Fee methodology act by Tri.Cosmty Building Industry Service Board
Print name: "PA) FlxiceiliDate: 7/ O l 242
I:113uiIding\PermitA3.4EC_PemdtApp_040113.doc 440-4617T(I UV/COM/Waa)