Permit Support Document CITY OF TIGARD
14 it,
�� Zc'io MECHANICAL PERMIT
Permit#: MEC2020-00001
COMMUNITY DEVELOPMENT i
TIG, R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/02/2020
Parcel: 2S108DB05400
Jurisdiction: Tigard
Site address: 15402 SW SEINE CT
Project: Mary Babicky Subdivision: POLYGON AT BULL MOUNTAIN Lot: 52
Project Description: Install new gas line to fire pit area. 1/17/2020: REPRINT permit to add gas line for barbecue.
Contractor: NORTHWEST CENTRAL PLUMBING CO INC Owner: BABICKY, JASON L&MARY L
2870 SE 75TH AVE#206 15402 SW SEINE CT
HILLSBORO, OR 97123 TIGARD, OR 97224
PHONE: 503-642-2067 PHONE:
FAX: 503-642-5954
FEES
Specifics: Description Date Amount
Log Lighter(Gas) 01/02/2020 $23.32
Type of Use: SF Fuel Piping 01/02/2020 $14.15
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 01/02/2020 $52.53
Occupancy Grp: 12%State Surcharge-Mechanical 01/02/2020 $10.80
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344,
Issued By: �G:'` c Permittee Signature: 61, ✓L/
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOit OFFICE USE ONLI
111114
City of Tigard RECEIVED ReceiRDat eiByved: ��ir .� .�
• 13125 SW Hall Blvd.,Tigard,OR. 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
I I t.A I:n Inspection Line: 503.639.4175 JAN 7 2020 Date/By
Date Ready/By: )iris: 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
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. Mechanical permit fees*are based on the value of the work
❑New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
❑ 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family ❑Master builder ❑ Oth{er: Description I Qty. I Ea. I Total
x - —toe, I0 — Heating/cooling: _
�/ i.4' '' Air conditioning 46.75
Job site address: 164O Z Slr - C� Furnace 100,000 Bill(ducts/vents) 46.75
City/State/ZIP: •p„cy ,/d , O /� Furnace 100,000 BTU(doers veers) 54.91
lL'l Q_ Heat pump 61.06
Suite/bldg./apt.no.: I Project name: CJ7t 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
Other. 23.32
Subdivision: I Lot no.: Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
^DESE urri-on OF 1VURK Gas fireplace/insert 33.39
r Flue vent for water heater or gas
kd f. -b s-k ?.. VUI.,I,'-- fireplace 23.32
j 1 L/l7 — 0O(DC ( Log lighter(gas) 23.32
W`(/ ` Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
1 gaf PROPERTY ; P e `P 1 , I ' n � "4 Other. 23.32
' '. , - a . ' -. "= :- Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( y" )_/,/ Fax ( ) Attic/crawlspace fans 23.32
r_ „1,;L�J APPLI s)�4.k ,2' t W _* " Other: 23.32
Fuel piping:
Business name: c-�1 ,p /�� �i ry/�iy Oa/ i4joi,,�
�' '"""`�� K ) `' f $I4.15 for first four;S4.03 for each additional
Contact name: 7j s„ __ _ ` Furnace,etc.
Address: �f�7 `���777��1 e�"Je+^ Gas heat pump
""��3 D a ,__- Wall/suspended/unitheater
City/State/ZIP: SL% _- ,0c1 ,.C€ G�-7 tc,1 v Water heater
Phone:( pi �jV 3-1 i-11f11 Fax::( ) Fireplace
E-mail: (n/l� Range
>`S Barbecue
�5 � ; fix' '�� >�. ..�" i ✓ �w�. ,. � Clothes dryer(gas)
.d.= x',�1�"'.,�1`sa;„ ar.. a..t�A�3}'T .1 w=x +, � . atv.., +n v4,
Business name: Other:
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lie.: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after ii has been accepted as complete.
Authorized signature: , /✓4./n,J 6--- VP . Fee methodology set by Tri-County Building Industry Service Board
Print name: Date:
h\Btiiding\PcrmitslydEC PcmutApp_040 113.doc 4404617r(11/02/COM/WEB)