Permit CITY OF TIGARD MECHANICAL PERMIT
!IN
COMMUNITY DEVELOPMENT Permit#: MEC2021-00254
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 5/13/2021
Parcel: 2S114AC01100
Jurisdiction: Tigard
Site address: 9118 SW WAVERLY DR
Project: Engen Subdivision: WAVERLY ESTATES Lot: 44
Project Description: Replacing gas fireplace
Contractor: OWNER Owner: ENGEN, MATTHEW P&JESSICA L
9118 SWWAVERLY DR
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 05/10/2021 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 05/10/2021 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 05/10/2021 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Van/De,W2ge Permittee Signature: Ovv 7,Ap .n
Rally
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. YY
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
/81-4 1 a
Mechanical Permit ApplicationF.,t1FFItI „sr.t,m.)
City of Tigard ECEIVE ReDacevee/ yf 2r 202/ 4 PrnmtNo.:AArECZ02i-W24,
IN . " 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 AP$ 1 9 202� �//Date/By: Other Permit:
T 1 c,n R I) Inspection Line: 503.639.4175 Date Read a Juris: gi Internet: www.tigard-or.gov CITY OF TIGARV y y2/2//�2� See Page 2 for
Notified/Meth 'Lion--
TYPE -n Supplemental Information
BUILDING DIVISION
OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
0 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:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: CM $ Sw (t,J kJ L'2Ly a2 Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 'T 16 ix.2 02 9 r) Z Z I! Furnace 100,000+BTU(duets/vents) 54.91
/ 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
St" 2"I-' A-.'u- 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
DESCRIPTION OF WORK Gas fireplace/insert i 33.39 33.Set
Flue vent for water heater or gas
RENtitd.4(r G r•S r1211:7)LAGt fireplace I 23.32 23.32
Log lighter(gas) I 23.32 _23• 3 2
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
® PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
Name: M P, E 4 G..L N Range hood/other kitchen
equipment 33.39
Address: co is
St..+ WAN/SZL' D 2 Clothes dryer exhaust 33.39
City/State/ZIP: -TI 6 fserz r O2 9 7 224 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503) 313 399 G. Fax:( ) Attic/crawlspace fans 23.32
V( APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
S14.15 for first four;$4.03 for each additional
Contact name: S//\ Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
, 1Range
E-mail: IAN&a`�1_ T O ry-e„z.. . on,. Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: 14//id Other:
MECHANICAL PERMIT FEES*
Address: Subtotal 530.03
City/State/ZIP: Minimum permit fee($90.00) 9 0. 00
Plan review(25%of permit fee) 2 2.s 0
Phone:( ) Fax:( ) State surcharge(12%of permit fee) J .
, Sf0
CCB lie.: TOTAL PERMIT FEE 123,30
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri•County Building Industry Service Board
Print name: M AI.- L 4 6*a NI Date: yJ i$i"LiId \Building\Permil&MEC_PermiLApp_0401 13.doe 440-4/617T(I I/02/COM/0/ED)