Permit Support Document CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT ' = ' Permit#: MEC2020-00240
`' Date Issued: 04/30/2020
T[S',i1 R.0 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 li s• 249
Parcel: 25104AD01800
Jurisdiction:
Site address: 12655 SW 128TH AVE
Project: Garrick 2020-095 Subdivision: BELLWOOD Lot: 45
Project Description: Gas Furnace Replacement. 5/15/2020: REPRINT permit to add A/C.
Contractor: THE HEATING SPECIALIST INC Owner: GARRICK, RYAN J
9300 NE HALSEY ST 12655 SW 128TH AVE
PORTLAND, OR 97220 TIGARD, OR 97223
PHONE: 503-257-7000 PHONE:
FAX: 503-257-7702
FEES
Specifics: Description Date Amount
Air Conditioning 05/15/2020 $46.75
Type of Use: SF Furnaces< 100K BTU 04/30/2020 $46.75
Class of Work: OTR Type of Const: Duct Work 04/30/2020 $23.32
Occupancy Grp: 12%State Surcharge-Mechanical 05/15/2020 $14.02
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $130.84
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: Permittee Signature: 4,c,/ e--740�e
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.
17 i, - Ad 6 Y Y1r1dr NIK20zz— DO 2-40
Mechanical Permit Applicatin E C E I VE D FOR OFFICE USE ONLY
Cl of Tigard
Received ) r� ](� •002.1.1.0
y g Date/By�_yi y2c1 .,, Permit No..M5C 020 a
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revi w
1 ° Phone: 503.718.2439 Fax: 503.598.1960 MAY 13 Zp20 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Dato ReedyBy: faro: See Pagel for
Internet: www.tigard-or.gov Notified/Method y/r'/2 �a Suppicmentai Information
BUILDING DIVISION
TYPE OF WORK �Y�f�COMKE CIAL FEE*.,r$4 DI/LE—USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION • RESmEN11AL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special Information use checklist.
❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
t/f f t�,., ( J ` l U Furnace
n ace 100,000
conditioning
46.75 �b,��
Job site address: ` //'_ f�W ((//j{.. A/A` Air con i coning BTU(ducts/vents) 46.75
City/State/ZIP�‘ A fl 1�Y (11 /) Furnace 100,000+BTU(ducts/vents) 54.91
U64 v� 1 /�33 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
DESC IPTION OF WORK ,- ' Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
lAi 04= _ e 7T g-)^ s n�PJ Log lighter(gas) 23.32
G!" C� Wood/pellet stove 23.32
/`672-ri/ Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ROPERTY R I
ENANT'.;
Other: 23.32
Y(l,^ tr y h } Environmental
ange d exhaust and ventilation:
Name: Y , f f`11 Range hood/other kitchen
equipment 33.39
Address: SS Clothes dryer exhaust 33.39
City/State/ZIP: v / Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
❑ PLIC r 0 CONTACT xi(
Other: 23.32
Business name: tam Y l� y 11 1 1 7�� Fuel piping:
JJJ ` V�+Vl CJ $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
Phone:( ) F ;:(( ) / , Fireplace
E-mail:
J1(t.tfEi16.05J aV�GvC� i1 f y�/IQIj W � �� * Range
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:
�� Other:
Address: MECRANICAL PERMIT FEES*
Subtotal 44.I.
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%ofpermit fee)
CCB tic.: 5�W aY , TOTAL PERMIT FEE liala
ll This permit application expires II'a permit is not obta' d within 180
days after It has been accepted as comp) e.
Authorized signature: * Fee methodology set by Tn-County Building Industry Service Board
Print name: 1 �r Date: �0 I�i � /]a Q e 9
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