Permit Support Document CITY OF TIGARD MECHANICAL PERMIT
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g COMMUNITY DEVELOPMENT Permit#: MEC2020-00452
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 t Ls I
Date Issued: 7/14/2020
Parcel: 2S109AA05100
r .)1J ) .. itii . Jurisdiction: Tigard
Site address: 14220 SW 128TH PL
Project: Ross//128th PI Subdivision: ELK HORN RIDGE ESTATES Lot: 17
Project Description: Vent water heater and run gas line to water heater location,vent dryer,re vent furnace fresh air and exhaust.
9/11/2020: REPRINT permit to add(1)bath fan.
Contractor: EVERGREEN GAS Owner: BROOKS, CLAYTON &STEPHANIE
16385 SW LANGER DR 14220 SW 128TH PL
SHERWOOD, OR 97140 TIGARD, OR 97224
PHONE: 503-407-9542 PHONE:
FAX: 503-344-6345
FEES
Specifics: Description Date Amount
FlueNent For Any of Above 07/14/2020 $23.32
Type of Use: SF Flue Vent for Water Heater or Gas 07/14/2020 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Clothes Dryer Exhaust 07/14/2020 $33.39
Stories: Fuel Piping 07/14/2020 $14.15
12%State Surcharge-Mechanical 07/14/2020 $11.30
Single Duct Exhaust(Bathrooms,Toilet, 09/28/2020 $23.32
Utility Rooms)
12%State Surcharge-Mechanical 09/28/2020 $2.80
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $131.60
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: L Permittee Signature: [A t
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Mechanical Permit APPlicatiRECEI>U I FOR OFFICE USE ONLY
City of Tigard EL Received / g1 /y �i n` 7 gj
.■ `J b nate/B 9/I11 �l1(� Pernik No.• IEt fit% o DD7�'
III
^ 13125 SW Hall Blvd.,Tigard,OR 97223 SEP 0 2 Z p �� Plan Review
_ Phone: 503.7182439 Fax: 503.598.1960
Date/By: Other Permit.
T I G A R U inspection Line: 503.639.4175 CITY OF TI GA R D Date Ready/By:q� /] Iuri la See Page 2 for
Internet: www.tigard-or.gov DIVISIC7� Nottfe Method•(/// '2,, 40 Supplemental Information
BUILDING4..j` P o Li.-
. M. ✓ `.gA�'fiJ'tAV-A Y oLiy�+ , '� b's ''em '.„
❑New construction [�Addition/alteration/r Addition/alteration/replacement Mechanical permit fees are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit
Value'$
[r1-and 2-family dwelling ElCommercial/industrial ` EQ .❑Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
� 4kMATION=AND'LOG ; " '-.,, Heating/cooling:
aiSt lug dr ,A., o s,M,., ,nf icUi=" Air conditioning 46.75
Job site address: I y Z2_ V U `'yS ' '1 ') ( Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 1 &r d , 0 `` (/-7 ZL[1 Furnace 100,000+BTU(ducts/vents) 54.91
Suitelbldg./apt.no.: 1 Project name: ( Heat
Duct w 61.06
SS 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: I Lot no.: Oth
er: 23.32
Tax map/parcel no.: Other fuel appliances:
Water heater 23.32
.5 DES,C}2IP7 a O i Ga s: f ` s fireplace/forinsert 33.39
/J Flue vent water heater or gas
T/ f. acla4,.GC (,1)(IS�117 P 1. fireplace 23.32
IA ct, 20 ,v - 00q5.2 J 4Log lighter(gas)Wood/pellet stove 23.32
33.39fel by` �"ti' '
Wood fireplacelinsert 23.32
Chimney/liner/flue/vent 23.32
s Other. 23.32
Eiiv a7 "� l'At t: o f tf�a ' „r t�kt Environments'ezhawtandvenHlatioa:
Name:
Range hood/other kitchen
Address: equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
Phone:( ) Fax toilet compartments,utility rooms) 23.32
( ) Attic/crawlspac fans 23.32
yt
�, ,.: 3 i Krt4r .' Other: l({(!� G1"' VN >4 23.32
Business name: evex- ree_� 005 Fuel piping:
f S14.15 for first four;$4.03 for each additional
Contact name: ( (` Furnace,etc.
Address: I (4,3 fail' S J I p}AN,.e� p� Gas heatpump
v �jj '�""'" Wall/suspended/unit heater
City/State/ZIP: glite.Y'Ll)0 oct, d g C 7 j(,i-L Water heater
Phone:(51Y3) 40/-- % -f Z Fax::( ) 3,14q ` ( .3q, Range- Fireplace
E-mail: - �eA/e4.' v-eeti1 C . rlrg( 7� Barbecue
_ b
` `' ' ' ,
a �14' .7*._ Clothes dryer(gas)
Business name: Eve.V-g vim bay
Other
Address. fVe 3(Ic `,vv Lai- IJ Ortlii :.. H , 1Y P Subtotal*Yes
d 23,3 L
City/State/ZIP:
/I/il 6 d!.� � 91114
-7 1 I t 0 Minimum permit fee(590.00)
Plan Phone:(�.3) U D-7 - 'WI 2- I Fax:( -)3l l l l CO3Lic surcharge
urch review(25%of permit fee)
CCB lic.: 1 6- Q, f� ( 7`l ll� f 7 State suroTOTeAL PERMIT FEE Z(
VVty r
This permit application expires If a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: l l ,(C( � , � Date: �(I2- 2 ()
1:\BuiWiegWecmitAMEC_Pern*App 040113.doe 61 (1 UOLco.tiwBB)
V
Mechanical Permit Application - City of Tigard
Page 2-Supplemental Information
Commercial &Multi-Family Fee Schedule:
Total Valuttiori:: 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:1BuildinglPennits\MEC_PermitApp_040113.doc 2