Permit Support Document CITY OF TIGARD MECHANICAL PERMIT
IN •!,n COMMUNITY DEVELOPMENT .,a ' Permit#: MEC2020-00206
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Z7 .2e .041 Date Issued: 4/15/2020
Parcel: 2S111 DB14300
Jurisdiction: Tigard
Site address: 15150 SW 92ND AVE
Project: Arnett Subdivision: LAUNALYNDA PARK Lot: 30
Project Description: Install main gas line to Water Heater&Furnace&Range&Fireplace. 7/14/2020: REPRINT permit to add
installation of gas fireplace.
Contractor: ANDERSEN HEATING INC Owner: ARNETT, JOAN L&MICHAEL G TRS
16285 SW 85TH AVE STE 410 16995 SW ARBUTUS DR
TIGARD, OR 97224 BEAVERTON, OR 97007
PHONE: 503-992-6664 PHONE:
FAX: 503-536-6615
FEES
Specifics: Description Date Amount
Unit Heaters(Fuel-Type, Not Electric) 04/15/2020 $46.75
Type of Use: SF Water Heater 04/15/2020 $23.32
Class of Work: ALT Type of Const: Gas Fireplace 04/15/2020 $33.39
Occupancy Grp: Fuel Piping 04/15/2020 $14.15
Stories: 12%State Surcharge-Mechanical 04/15/2020 $14.11
Gas Fireplace 07/15/2020 $33.39
12%State Surcharge-Mechanical 07/15/2020 $4.01
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $169.12 1
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
1
Issued By: � y `.,L,/yt.L/� 1_- Permittee Signature: (JN /9-70/4L/ �'fj j7Q,
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
x-I 7L lrrral7
Mechanical Permit Applic tF NE D roll orrlcl:usE ONLY
City of Tigard eivedp o Y % /y/7ei �r Permit No• ,.,. 1141' G 4D
13125 SW Hall Blvd.,Tigard,OR 97223 J U L q 20 0 plan Review
Phone. 503.718.2439 Fax: 503.598.1960 Dam/By. Other Penait:M ` 1�
1 t c.:;;:n Inspection Line: 503.639.4175 C:Thu ;�° i'i D Dale Ready/By: heir la See Page 2 for
w Internet ww.tigardor.gov DIVISION Notified/Method:
BLIILC .� ( ,J! SPON Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE—USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New constriction 117 Addition/alteration/replacement performed.Indicate the value(retarded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEM FEES*
JJ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For'pedal InJbrwadoa use checklist.
0 Multi-family ❑Master builder ❑Other: Description I Qty. Es. , Total
JOBSITE INFORMATION AND LOCATION HeatiaPJeasllaCt
Air conditioning 46.75
Job site address: /5/50 . 1 42 ND &VF. Furnace 100,000 BTU(tha /v�ents) 46.75
City/State/ZIP: 9 7.21 3- I Furnace 100,000+Bi Waco/vents) 54.91
Heat pump 61.06
Stdte(bldgJ¢pt.no.: Project name.• �-me f 7` 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 far any of above 23.32
Other: 23.32
Subdivision: )A LinoI�f lrid Prey K Lot no.: 3 O
o` Other fuel appliances:
Tax.map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39 1
Flue vent for water heater or gas
fireplace 23.32 ,
(/) T i ' Log lighter(gas) 23.32
S 7trY fyttalJ 0J� Wood/pellet stove 33.39 _
I) It AsCl/f C •f`x. .tlSI �-rf Wood fireplace/insert 23.32
II II 1 G-c.s le l-r 17a.// Cbimneyllincr/Oudvent 23.32
!'4L6• 7e flare err „ unoerc Aif t2o4.62 Ao(p. Other 2332
® PROPERTY OWNER 0 TENANT G
Environmental exhaust and ventilation:
Nana: Arid Toth/ / &i m�, e l J 7'R s , Range band/other kitchen
4� � equipment 33.39
Address: I Clothes dr
yer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility moms) 23.32
Phone:( ) T Fax:( ) Attiderawlspace fans 23.32
0 APPLICANT j ❑ CONTACT PERSON Othr 23.32
{7 Fuel piping:
Business name: A I,4 ideiS ? !/l��// ,,L,/, 3.
SKIS far first Soar;$4,03 for each additional
Contact name: Ai). A:
!Q!/ �vSe Furnace me.
Address:
/6A �r1 ✓C _Gas heat pump
WalVsuspended/unit hater
City/State/ZIP: p 77«,rol 6 1-7 2 2 Y Water hater
Phone:(,0�) g,2 '-6G d / Fax::( ) Fireplace ,
E-mail: CelhtVTa 1) tarr,/-tyfn<r1//.'eC,�tcwf/Ck/ Jaw,/ ' Barbecue
CONTRACTOR)) L Clothes dryer(gas)
Oth
Business name: 21 1d eIc s1
//CQ 7T1 L • B
MECHANICAL PERMIT FEES*
Address: /4 Lg 5- Lt ✓e Subtotal 3,3. 3`7,
City/State/ZIP: )- rr yd p fa q7 2-2 + Minimum permit fee($90.00)
Phone:(ut'p'3 4 /r I Plan review(253 of permit fee)
/ `��t L� Fax:{ ) State surcharge(120/of permit fee) q el ,
CCB lic.: 1 / p c3'r 14� TOTAL PERMIT FEE 3 7 Q
Q� / This permit application aspires If a permit le act ehtailen within HS
days after It has been accepted u complete.
Authorized signature . • Fee methodology set by TdLoualy Building Industry Service Board
Print name: (PA /1404 Date: 7 5,—20
I11340dizerenaileV.tEC PeripitApp-0b110 doe 440.4617r(I A'JCOM.WEa)
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.
I:1Buildiug\Permits' MEC_PamitApp_040113.doc 2