Permit Support Document CITY OF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit#: MEC2022-00038
Date Issued: 1/19/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 � r/ ! Parcel: 2S112BC09000
Jurisdiction: Tigard
Site address: 14755 SW 80TH AVE
Project: Remodel Subdivision: RAZE MEADOWS Lot: 13
Project Description: Run gas line to new dual fuel range location-connect to existing gas meter and homerun a new line to the
range,2/2/22-Add 2 bath vent fans.
Contractor: LOCAL PLUMBING COMPANY Owner: ELLERMEIER FAMILY REVOCABLE TRUST
20833 SW OLDS PL 14755 SW 80TH AVE
SHERWOOD, OR 97140 TIGARD, OR 97224
PHONE: 503-642-2067 PHONE:
FAX: 503-642-5954
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 01/19/2022 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 01/19/2022 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 01/19/2022 $56.61
Occupancy Grp: Single Duct Exhaust(Bathrooms,Toilet, 02/03/2022 $46.64
Stories: Utility Rooms)
12%State Surcharge-Mechanical 02/03/2022 $5.60
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $153.04
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: Ectgo-roto- Permittee Signature: S
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applicatio FOR OFFICE USE ONLI
Cityof Tigard E�E E eeeivcd�.J /�'�
g Date/By 2 22- �/' Permit No.:/46(2622' e
11 • 13125 SW Hall Blvd.,Tigard,OR 97223 FEB 0 2 2022
Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready By: tort" ® See Page 2 for
Internet: www.tigard-or.gov CITY OFTIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK �\ COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
,.,_,/ Mechanical permit fees*arc based on the value of the work
❑New construction geddition/alteration/replacement �` ,,e4 performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other , '%� 640 mechanical matenals,equipment,labor,overhead,and profit.
/ryl Value:$
CATEGORY OF CONSTRUCTION ��� RESIDENTIAL.EQUIPMENT/SYSTEMS FEES*
[/-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family ❑Master builder ❑Other: Description Qty. Fa. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 1 l_ 7 S 5 S 3c)+h A ,,/ .. , Furnace 100,000 BTU U(ducts/vents) 46.75
I
City/Slate/ZIP: 1-.t,6..4/=., , 02.a I i.Z,2-4_ Furnace 100,0004 BTU(ducts/vents) 54.91
!Teat pump
Suite/bldg./apt.no.: Project name: e- 22
��'�"��'i Duct work 233.3.32
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
Subdivision: A-Z MEA.4o1c 0-)5. Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: 02 5 / ( e. 8c 0 O<la 0 a Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water healer or gas
R . ti b - 747t (Ji.oJT' F,Q,JS fireplace 23.32
50E Lir b se.9.49- -_GtrlO rye Log lighter(gas) 23.32
V �J Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
_
Name: �Q+OE i tG F--�l1�,(� R E Ja a 14 .yy S.0) Range hood/other kitchen t 33.39
Address: (4'7.5c 6 77(,,J d 44 4ji,�, (__ Clothes dryer exhaust 33.39
City/State/ZIP: 1" tip 6 �'1 12Z4" Single-duct exhaust(bathrooms,
1 i toilet compartments,utility rooms) a 23.32Dj 4ii
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
� ±� Other: 23.32
�Q APPLICANT f]� I.ONTACI' PERSON
Fuel piping:
Business name: L ,, E.J,A t1SS, "D$6 cA,d Gas,.,a t $14.15 for first four;$4.03 for each additional
Contact name: in A �' 4 A J 9 ` Furnace,etc.
Address: tic.O L, t�L �+� •T` Gas heat pump
/� Wall/suspended/unit heater
City/State/ZIP: I,e 4 .5i- L1 4I..i/ 6 R- • Water heater
Phone:(Sn3) 5051.-t f,..fel Fax::( ) Fireplace .
_ ► Range
E-mail: 6'4 05, D .�„m 6 4.4 7-v N�1 Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: /..., '026-tee Other:
+��"1ti {' � MECHANICAL PERMIT FEES"
I Address: V/ O a i.L (air .57F ^7 Q Subtotal
j L
City/State/Z1P: (,V Eg ^i(J 1j p /
0 P--• G 6`'v Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( 3) `319 G' ..- 1 3 tS Fax:( ) State surcharge(12%of permit fee)
CCH lie.: Fa Fib--5 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days alter it has been accepted as complete.
Authorized signature: ,,,,V,_ � * Fee methodology set by Tri-County Building Industry Service Board
Print name: IAA 4...k. ev,.AIJ It Date:
I'.\Building\Permits\MEC_PermitApp_040113.dor 440-4617T(I 1/02/COM/WEB)