Permit Support Document CITY OF TIGARD MECHANICAL PERMIT
2-0 a ' COMMUNITY DEVELOPMENT
® Permit#: MEC2021-00536
I[( Ag 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/20/2021
Parcel: 2S114BB08700
Jurisdiction: Tigard
Site address: 16288 SW 104TH AVE
Project: Morris Subdivision: SWANSON'S GLEN Lot: 28
Project Description: Install furnace and AC. 8/26/2021: REPRINT permit to add gas fireplace insert and gas piping.
Contractor: EVERGREEN GAS Owner: MORRIS FAMILY TRUST,THE
16385 SW LANGER DR 16288 SW 104TH AVE
SHERWOOD, OR 97140 TIGARD, OR 97224
PHONE: 503-407-9542 PHONE:
FAX: 503-344-6345
FEES
Specifics: Description Date Amount
Air Conditioning 07/20/2021 $46.75
Type of Use: SF Furnaces< 100K BTU 07/20/2021 $46.75
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 07/20/2021 $11.22
Occupancy Grp: Gas Fireplace 08/26/2021 $33.39
Stories: Fuel Piping 08/26/2021 $14.15
12%State Surcharge-Mechanical 08/26/2021 $5.70
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $157.96
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR, Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those
rules areset
forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: c aC4 Permittee Signature: (9N e-9-J-702/
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Apphcat o CEIVE ) FOR OFFICE USE ONLY
City of Tigard BUG 26 2021 Received
Dawsy: i:kA/ ,�?t► PemvtN fi7 22 Zr00S3�
III ° 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review L[r
C ' Phone: 503.718.2439 Fax: 503.598.1960 TIGARD Date/By; Other Permit:
Inspection Line: 503.639.4175 i�Y Q' n i Dak Read/B Axis: la See Page 2 for
TIGARD Internet: www.tigatd-or.gov f3 UILDINGDIVIS►G' ' NotifiedMiethod:d. :/� ,,&) L) Supplemental Information
'.TYPE OF"WORK `" 0 i- ;COMMERCIAL FEE* SCHEDULE-USE CII1sCKLIST
6 f 4/ Mechanical permit fees*are based on the value of the work
LlNew construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENT.,),".EQUIPMENT/SYSTEMS FEES*
1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building Far special information use checklist
Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/coolinR:
,) Air conditioning 46.75
Job site address: I �/ Q ( ‘09 1" �,e Furnace 100,000 BTU(duets/vents) 46.75
—V Furnace 100,000+BTU(ducts/vents) 54.91
City/State/ZIP: ( l0,4...c �� ZZ Heat pump 61.06
Suite/bldgJapt.no.: (Project name: i`vA l) rJI S Ductwork 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
Other. 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
`DESCRIPTION OF WORK ' Gas fireplace/insert i 33.39
' - i-" Flue vent for water heater or gas
A (r7 1.0 co- r.'" Cj, (t k! 1"ll i1/6yctiv/11- c2 fireplace 23.32
j S vi qJ I.�t/r ill/ f )`'1 C L b "V 6'J(F Log fighter(gas) 23.32
r J 1 Wood pellet stove 33.39
Wood fireplace/insert 23.32
ChimneyNner/flue/vent 23.32
Other. 23.32
0 PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 3339
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility moms) 23.32
Phone:( ) Fax:( ) Attic/cmwispace fans 23.32
si APPLICANT 0 CONTACT PERSON Other 23.32
E.
Y/ Fuel piping:
Business name: (./1,-gl .''ee An 6705 S14.15 for first four;$4.03 for each additional
Contact name: i Li J �p,(( Furnace,etc.
"'� Gas heat pump
Address: ((O'� (�� �� La,�G /' r Wall/suspended/unit heater
City/State/ZIP: // \^ ,(�� �wJ t-0 1 C)� 61 )�� / Water heater
Phone:(S18) LI )'7_ -f9l7 Fax::(c3 )3L.14 . (o3VS- RanpeFireplace 1
E-mail: ! �, fe (rC(►r��V Ls� .r U�1 Barbecue
-
COCTOR Clothes dryer(gas)
_._ Other:
Business name: EVZy QYe �a5 MECHANICALPERMITFEES*
Address: 1(1-2.,Q,SJcl4 LCL q ,V 17 Subtotal
City/State/ZIP: IVI-- , , ' f 4() an rev Minimum permit fee($90.00)
vIA/M'1J� i Plan review(25%of permit fee)
Phone:(51)3) Lib 1—9_0 2_ Fax:( 3) -04 _ c 3-/c State surcharge(12%of permit fee)
CCB lic.: I j Q 6 3 i TOTAL PERMIT FEE j , L v
This permit application expires if a permit b not obtained within 18
days after it has been accepted as complete.
Authorized signature: ..-�-"-----.1 • Fee methodology set by Tri-County Building Industry Service Board
Print name: l 1\ 7 ,(A'L Date: l�)Z(p/2)
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