Permit CITY OF TIGARD MECHANICAL PERMIT
_. COMMUNITY DEVELOPMENT Permit#: MEC2021-00365
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 f4 Date Issued: 5/26/2021
T I G A R T7 9 �Zf Parcel: 1 S 125DD03900
V Jurisdiction: Tigard
Site address: 9855 SW VENTURA CT
Project: Johnson Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 47
Project Description: HVAC ductwork addition and relocate.06/02/21 -add gas line for tankless water heater.em
Contractor: G THOMAS ENTERPRISES Owner: JOHNSON, MATTHEW&ANDREA
PO BOX 880 9855 SW VENTURA CT
NEWBERG, OR 97132 TIGARD, OR 97223
PHONE: 503-804-6333 PHONE:
FAX: 503-537-3021
FEES
Specifics: Description Date Amount •
Duct Work 05/26/2021 $23.32
Type of Use: SF 12%State Surcharge-Mechanical 05/26/2021 $10.80
Class of Work: ADD Type of Const: Minimum Fee Adjustment-Mechanical 05/26/2021 $66.68
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those les are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by c tag 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: ON Ale-/e/ 17-4-
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
jL , K.e A-o+� c c pda.- j' 2 _a o • —
Me anical Permit Application
City of Tigard Received
D° Permit No.: ifeczO24-00 3675
13125 SW Hail Blvd.,Tigard,OR 97223Plan
g Phone: 503.718.2439 Date/By:
Review
'Rem° Omen PernikPernikInspectionLine: 503.639.4175 Da 1 I G A It UDate Ready/By: hos: a See Page 2 for
Internet: www.tigard-or,gov Notified/Method: Supplemental Information
- - TYPE OF WORK
COMMERCIAL FEE*SCHEDULE-USE CHECKLIST
❑ New construction A Addition/alteration/replacement Mechanical permit fees°are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition 0 Other
._ mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
1-and 2-family dwelling El Commercial/industrial ❑Accessorybuilding RESIDENTIAL EQUIPMENT 1 SYSTEMS FEES*
El ❑ Master builder ❑Other: For special information use checklist.
Description_ _ I Qty�_ Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: c sou e,v fe, G� Air conditioning 46.75
City/State/ZIP:ddres r p, ^'�v -— Furnace 100,000 BTU(ducts/vents) 46.75
7 / a.,` q 7 22 3 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 2332
Hydronic hot water system 23.32
Residential boiler(radiator or
h1,h.n ic) 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
Tax map/parcel no.: Other fuel appliances:
Water heater lik 23.32
DESCRIPTION OF WORK - Gas fireplace/insert 3339
rU la Cl C f-e a/N,- r. A r ,fe L�„3S Flue vent for water heater or gas
l�T �'^' fireplace 23.32
CA)AriloWiHet/ _.. Log lighter(Ras) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 2332
jPROPERTY OWNER ❑ TENANT Other: 2332
Name: JblhN Saty J J fi-7-r ) de 4evziz T� Range hood/otherdntal a hauat and ventilation:
Range kitchen
Address: _ equipment 33.39
City/State/ZIP: S W /J e /7" ob Clothes dryerexhaust 33.39
Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( )
Attie/crawlspace fans 23.32
pfAPPLICANT 0 CONTACT PERSON
Other: 23.32
Business name: 6. t�an AS �tit1 p e i.0 Fuel piping:
Contact name: 6 'r I �aM S14.15 for first four;$4.03 for each additional
Addr;;as: PC5 BOX( fete)) Gurnace,pte.
rb *� Gus Leal pump
City/State/ZIP: pitimis f g7/.3z Water heater
heater
�,3 yogi- t'' 7 Waterheater j
Phone:( ) Fax::(�3) J3 f �.?02.4 Fireplace
E-mail: q- OMM$CNTer-pr'.c GC e s lv�e( e GQ 34^ Range .
J CONTRACTOR Barbecue
Clothes dryer(gas)
Business name:
Other:
Address: S r E HANI_3L P€�RAILT FRE S*
City/State/ZIP: _ 0rv�' Subtotal
Minimum permit fee($90.00) '..
Phone:( ) Fax.( ) Plan review(25%of permit fee)
CCB lie.: SIN t.'1 3' State surcharge(12%of permit fee)
TOTAL PERMIT FEE
- This permit application expires If a permit Is not obtained within 180
Authorized signature: days after it has been accepted as complete.
' Fee methodology set by Tri-Co,mry Building Industry Service Board
Print name:
G.194 14 Tlio r.1/9'( Date: (,/'Z-Z_!
F'Aail6m4'Penuin.MEC Penoiipp 010.520dec 440-4AI 77"(11,02/COM'WEB)