Permit CITY OF TIGARD MECHANICAL PERMIT
3 COMMUNITY DEVELOPMENT Permit#: MEC2021-00222
Date Issued: 4/8/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S104AB06300
Jurisdiction: Tigard
Site address: 12162 SW 131ST AVE
Project: Roast Subdivision: MORNING HILL NO.4 Lot: 92
Project Description: Install Gas Fireplace
Contractor: OWNER Owner: ROAST REVOCABLE TRUST
12162 SW 131 ST AVE
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Water Heater 04/07/2021 $23.32
Type of Use: SF Gas Fireplace 04/07/2021 $33.39
Class of Work: ALT Type of Const: Flue Vent for Water Heater or Gas 04/07/2021 $23.32
Occupancy Grp: Fireplace
Stories: 12%State Surcharge-Mechanical 04/07/2021 $10.80
Minimum Fee Adjustment-Mechanical 04/07/2021 $9.97
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
\\\A •
Issued By: `1 jair\ L52 }? Permittee Signature: c)r\ GKA---3
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
or
Mechanical Permit Application FOROFFH 1 I SEONi ti
City of Tigard Re`e'"ed _
g EIVE' Datc,By: :�T�D���2 ' PermitNn:/4E 2/-�f(/2Cx_
rt 13125 SW Hall Blvd.,Tigatid,OR 97223 �C Milan Review
' Phone 503.718.2439 Fax 503,599,1960 C 4/?- Other Permit:
Inspection Line: 503.639.4175 Date/By. /
T I G ARD Date Ready/By: turn: RI See Page 2 for
Internet: www.tignrdl-or.gov Mpg 3 U 2021 Notified/Method: Supplemental Information
TYPE OF WORK �/� OF T GAc U COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
7-(tt1E -{# - Mechanical permit fees*are based on the value of the work
0 New construction ,Addition/alteration/[ hiCtf�`^ performed.Indicate the value(rounded to the nearest dollar)of all
D Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
_._ Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
0 nl
I-and 2-family dwelling ❑Comcrctul/tnd cs nstrial U Accaory budding - _.. For special information use checklist
Multi-Family ❑Master builder 0 Other: Description I Qty. La. Total
JOB SITE INFORMATION AND LOCATION Healinp/cooliag:
- Air conditioning 46.75
Job site:address: t I 6 2 s_5-C.tJ �3/.. C.� Furnace 100,000 BTU(duets/vents) 46.75
—
City/State/ZIP: , ! L7 t�( Gj—7 '� Furnace 100,000±BTU(duct/vents) 54.91
---_. -_ 1 ----(- --- -- - -- Heat pump 61.06
Suite/bldg./apt.no.: Project name: --
Duct work 23.32
Cross street/directions to job site: - Ilydronic hot water system 23.32
-s�GJ ,i d_ g-1" - 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
$ehdivtaton: / la IZ I NI t1 f l t L L qLai 4
, Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert ] 33.39 33,tom
Flue vent fur water heater or gas
Cr /z.- G (— 1 ( Z �� �r E fireplace 1 23.32 2�3-3 Z.
Log lighter(Vas) 23.32
- Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/Iirter/fllie/veot 23.32
Y PROPERTY OWNER ❑ TENAN Other: 123.5$
Environmental exhaust and ventilation
Name: , - Range hood/other kitchen -- _--
------.- txluipment 33,39
Address: 1 2 1 G 2 SG /[3 /' sT A,.(J j_ Clothes dryer exhaust 33.39
City/State/LH': -� �y4 Single-duct exhaust(bathrooms,
l G A •� l� ✓ toilet compartments,utility rooms) 23.32
i
Phone:( r.'3 "7 ' / _ 2�� Fax:( ) Atlic/crawlsptwc fans 23.32
Cl APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel plpl�:
g;
-.... _...__._-_. SI4.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater I --f•
Phone:( ) Fax::( ) Fireplace
Range
-
E-mail: ._ -_ _
tar-- eecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: c. ` �
__ � _ MECHANICAL PERMIT FEES*
Address: Subtotal 7 .S�
City/State/ZIP: Minimum permit fee($90.00) 9 n----
---------- Plan review(25%of permit fee)
Phone:( ) Fax: State surchargeIOTA 12%of permit fee) i p, �d Q
CCU 116.: L PERMIT FEE i ao.gb
- - --- ---- -- - - This permit application expires if a permit is not obtained within lab
days after it has been accepted as complete.
Authorized Sigtlp J * Fee methodology set by Tri-County Building Industry Service Board
Print name:�1Z.1�i.-> I P..... OW; 3•—. e -2 7
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