Permit CITY OF TIGARD MECHANICAL PERMIT
• • COMMUNITY DEVELOPMENT Permit#: MEC2020-00221
Date Issued: 04/27/2020
T f G A R 0 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S110BA08600
Jurisdiction: Tigard
Site address: 14260 SW 116TH TER
Project: Schumock Subdivision: EVERGREEN SPRINGS Lot: 11
Project Description: Adding(1)fuel piping for future fire pit and gas grill.
Contractor: OWNER Owner: SCHUMOCK, RANDY C
RANDY SCHUMOCK 14260 SW 116TH TER
14260 SW 116 TIGARD, OR 97224
TIGARD, OR 97223
PHONE: 503-781-9409 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 04/24/2020 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 04/24/2020 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 04/24/2020 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 5?3.232.1987 or 1.800.332.2344.
Issued By: ermittee Signature: ( /(� 7C
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
4(2312v
Mechanical Permit ApplOKF rqED FOR OFFICE USE ONI.)
I City of Tigard R 2 3 2., Received .
Deceive:
u 13125 SW Hall Blvd.,Tigard,OR 9/ L ` �'',� � ���
Phone: 503.718.2439 Fax: 503.598.1960 WLMI
Plan Review
Dan R Other Permit:
TIGARD Inspection Line: 503.639.4175 Clrr U6= i jU1�RD Date Ready/By: lams IO See Page 2 for
Internet: www.tlgard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
jr. Mechanical permit fees*are based on the value of the work
New construction . '7^4ddition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
Demolition 1❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
t and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
` /' Air conditioning
Job site address: ,LI� j.� /r (requires site plan showing placement) 46.75Ci /State/ZIP: �1- / Fumace 100,000 BTU(ducts/vents) 46.75
ty Q.�(I i Lj Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: 4 C Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
�1-4 I_ Hydronic hot water system 23.32
(4•�^C� l // /141 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
` .�3 Other: 23.32
Tax map/parcel no.: Z 0 !/ 10 ,S Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
1. 1 _ Gas fireplace 33.39
t, 1 h c I if'.r JI(`'" {2, aS (l// Ili i (,, zit r 06 s Flue vent for water heater or gas
i V I. • l _ j jos �' a, Log fireplace 23.32
'�''� Log lighter(gas) 23.32
' �/ ir(wood/pellett stove 33.39
o.. ueplace/insert 23.32
(JL� t i n 'l P}7P �0 JA2��[0�/9-Oos-
OPERTY Lrn6L
ht 0 tier: liner/flue/vent 23.32
Other: 23.32
Name: 'lickr
V et Environmental exhaust and ventilation:
Address: ..-cj/f �( rare p p/fig tl� Range hood other kitchen
G�irrr�'rr 111 ( f Y/a I w ca ( ss 4,4 equipment 33.39
City/State/ZIP: , .6}� t Clothes dryer exhaust 33.39
v Single-duct exhaust(bathrooms,
Phone:(s�3) gtl/'��f Fax:( ) toilet compartments,utility rooms) 23.32
0 APPLICANT / 0 CONTACT PERSON Attic/crawlspace fans 23.32
Business name: Other: 23.32
Fuel piping:
Contact name: $14.15 for first four;54.03 for each additional
Address: Furnace,etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone:( ) Fax: : ( ) Water heater
Fireplace
E-mail:
Range
CONTRACTOR Barbecue
Business name: Clothes dryer(gas)
��� � Other:
Address: MECIIANICAI,PERMIT FEES*
City/State/ZIP: Subtotal
Minimum permit fee($90.00)
Phone:( ) Fax:( )
Plan review(25%of permit fee)
CCB tic.: State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Authorized si u+• t e: This permit application expires if a permit is not obtained within 180
y days after it has been accepted as complete.
Print name: 7 / Date: 2 /lv/ * Fee methodology set by Tri-County Building Industry Service Board
hl8uilding\Per its I'C-Permit .doe /09/10 4 41617r(II 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$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:\Building\Permits\MEC-PermitApp.doc 09/09/10 2
APR 2 2 2020
! i n_ieal Permit Application CITY OF TIGAR
INCity of Tigard BUILDING DIVISI .•eceivea F-FOR OFFI 1 SF:0N1 1
• 13125 SW Hall Blvd.,Tigard,OR 97223 Dato/By: f/ Ar !ry J , r -_
Phone: 503.718.2439 Fax: 503598.1960 Plan Review "�� t•
T t C. .
A R D Inspection Line: 503.639.4175 Dat Re Other Permit:
Internet: www igardor.gov Date adylDy:
Notified/Method: turn S See Page 2 for
Supplemen ml Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE-USE CHECKLIST
C New construction Mechanical permit fees*are based on the value of the work
dition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition
Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
l-and 2-family dwelling ❑Commercial industrial ❑Accessory building RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
Multi-familyFor special information err checklist
0 Master builder ❑Other: Description I Qty. I Ea_ r Total
JOB/� SITE INFORMATION AND/LOCATION Heating/cooling:
Job site address: (— 2,j,/1 1 ,q // j _jt] 7 ' Air conditioning
_1- �u=V vd'(,l1 ( '/](J/f'l 4( (requires site plan showing placement) 46.75
City/State/ZIP: ( rn� (4).,(/<� Furnace 100,000 BTU(ducts/vents) 46.75
YI��� "" '--" '�{f v Furnace 100,000+gam(duets/vents) 54.91
Suite/bldg./apt.no.: \vv----JJJ t ?- ,4, r —
(Project name: Heat pump
Cross street/directions to job site: (requires site plan showing placement) 61.06
'nQDuct work 23.32
"�� 7 R n t hot water system 23.32 _
Residential
ential 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
Tax map/parcel no.: Other: 23.32
--- _ Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
rim A _ j ' _ Gas fireplace 33.39
��(� � -( {1� � (I�,/ OF Flue vent for water heater or gas
re rS� 7�( fireplace 23.32
�- � Loglighter
•
retage / /�} gh (gas) 23.32
� //'� — (�. ( � �i'� Wood/pellet stove 33.39
2;a4
L / /t 1 L�, -`>7 l( 1 Wood ey/lin ceflue/v 23.32
ROPER Y• J v( R " 0 TENANT Chimney/liner/flue/vent 23.32
Name: Q ail
Other 23.32
��l/ Environmental exhaust and ventilation:
�� : .42L // /Z/ � Range hood/other kitchen
Address: t( �J7LT ,/.1 equipment 33.39
City/State/ZIP: /' , r;,- Clothes dryer exhaust 33.39
Phone:(�� } `7 r Single-duct
omp exhartmeut(bathrooms,
w"�/!! Fax:( ) toilet compartments,utility rooms)Attic/ 23.32
0 APPLICANT
❑ CONTACT PERSON Other.rawlspace fans - 23.32
— - Other: 23.32
Business name: -..-- Fuel piping:
Contact name: $14.15 for first four,$4.03 for each additional
Furnace,etc.
Afidress: Gas heat pump
City/State/ZIP: _ _ _-- Waended/unit heater _
-- Waterter heater
Phone:( ) Fax: :( ) -
_ Fireplace _
E-mail: —
CONTRACTOR Barbecue
Clothes dryer(gas)
Business name: !llil L�_ ---- Other
MECHANICAL PERMIT FEES*
Address: _ Subtotal
:'i[y/SlalelZlP' ___--- Minimum permit fee($90.00)
Fax:( ) _ Plan review(25%of permit fee)
'hone:( State surcharge(12%of permit fee)
TOTAL PERMIT FEE
•
$lie:
This permit application expires if a permit isnot obroioed within 180
e: i
days after it has been accepted as complete.
i ULhOTIZe'd st Date: 2 " Fee methodology set by Tri-County Building Industry.Service Board
f1111 name' ,oq/lo. �46I1i(I 1021COM/WI:B)
rout. dx
u..adini J" Is IfC-P •