Permit CITY OF TIGARD MECHANICAL PERMIT
_. , COMMUNITY DEVELOPMENT MECHANICAL
MEC2021-00381
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/9/2021
Parcel: 2S 102BC08000
Jurisdiction: Tigard
Site address: 12765 SW WATKINS AVE
Project: Motley Subdivision: 1999-007 PARTITION PLAT Lot: 1
Project Description: Existing gas line hookup to pool heater and meter
Contractor: OWNER Owner: MOTLEY, LAUREL S & BOYCE G
12765 SW WATKINS AVE
TIGARD, OR 97223
PHONE PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 06/07/2021 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 06/07/2021 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 06/07/2021 $75.85
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: Piro Vav,DPrWer,a Permittee Signature: OkVApp LOyt
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 Applical o ECEIVE I t>I: utl is 11 I u%l
City of Tigard Rat ed ``•, PertntNa:
13125 SW Hall Blvd.,Tigard,OR 97223 .01 Date/By: �D1�`'(,� !N 1�sw�Z�'�b3Ctt
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Other Permit.
1 I t;,1 it f1 Inspection Line: 503.639.4175 c,ITV OF TIGARD Date/ey
Date Ready/By: Anis: I ® See Page 2 for
Internet www.tigard-or.gov I llI NW 11Qir...Notified/Method: Simplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE-USE CHECKLIST
Mechanical permit fees are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all i
❑Demolition 0 Other mechanical materials,equipment,labor,overhead,and profit i.
Value:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES`
0-1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family 0 Master builder 0 Other: Description Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heati°g'coo0ng-
!ob site address: -'7 2!lG ,'r }y" p Air conditioning 46.75
� N V(l' I)")5 ptviL„ Furnace 100,000 BTU(duets/vents) 46.75
City/State/ZIP: ( 150, .-r, t CA Cr/Z23 Furnace IOO,000+BTU(ducWvents) 54.91
""s (JI1 I L- Heat pump 61.06
Suite/bldgJapt.no.: Project name: Thr I H'PCt.i--€-r Duct work 23.32
Cross street/directions to job site: 5ti I 1 I '1 i. j n(4 L ,5 _i- Hydronic hot water system 23.32
to H A t .t t ev 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: Lot no.:
Other. 23.32
Other feel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
t Li perm i t -Ci r ' —x(. is q5 fireplace 23.32
rp- tt"_jg) Log lighter(gas) 23.32
I (h-P ` ' 1 on i< up '�'7�`� pen n Q h-.1 Wood/pellet stove 33.39
arid_ Pr e—'f--t'— Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
W PROPERTY OWNER 0 TENANT Other 23.32
Environmental exhaust and ventilation:
Name: 1.Czurej c —rj� Te-I-e M o-H Range hood/other kitchen
equipment 33.39
Address: Z�&6 avj 1k ja±k. S ,9_ Clothes dryer exhaust 33.39
City/State/ZIP: -4 _ O� U� Single-duct exhaust(bathrooms, '..
7 toilet compartments,utility rooms) 23.32
Phone: ) /p Fax:( ) Attic/craw ace fans
gAPPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
514.15 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
Phone:( ) J Fax::( ) Fireplace
Range
E-mail: Barbecue ,
CONTRACTOR Clothes dryer(gas) A.
Business name: Other: I. �3, a 4
MECHANICAL PERMIT FEES*
Address:
Subtotal 1
City/State/ZIP: Minimum permit fee($90.00) qp,pt,
Phone:( ) Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB Iic.: TOTAL PERMIT FEE
( / ..�/'�//// This permit application expires if a permit is not obtained within 180
��tJ{ey�}t r A t e t eftt, days after It has been accepted as complete.
Authorized signature: I (w �J/��(�U( • Fee methodology set by Tril ounty Building Industry Service Bond,
I Print name Ct I4itCj M( Date: autp 1 ZQ�
I:UiuilduglPemuts MEC_PcrrneApp_040113.doe 4404617r 01/0 COM/WEH)