Permit I� CITY OF TIGARD MECHANICAL PERMIT
I ' , COMMUNITY DEVELOPMENT Permit#: MEC2022-01123
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/7/2022
Parcel: 2S110BD05700
Jurisdiction: Tigard
Site address: 11872 SW VIEWCREST CT
Project: BURGUM Subdivision: ASPEN RIDGE
Lot: 24
Project Description: Relocating gas piping for range,capping gas line for fireplace,and installing venting for range hood.
Contractor: LUXURIOUS LIVING CO Owner: BURGUM, JIM A
5014 FOOTHILLS RD 11872 SW VIEWCREST CT
APT C TIGARD, OR 97224
LAKE OSWEGO, OR 97034
PHONE: 661-547-2199 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 12/07/2022 $33.39
Type of Use: SF Fuel Piping 12/07/2022 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 12/07/2022 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 12/07/2022 $42.46
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: —Po•mmaa Signature:
•
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
III City of Tigard RECReceived lBy: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 7
= Phone: 503.718.2439 Fax: 503.598.1960 eview Other Permit:
T i GA R D inspection Line: 503.639.4175 Pr-r 7 10 Date Ready/By: kris:
q2 dY yd ® See Page 2 for
Internet: www.tigard-or.gov 4. Notified/Method: Supplemental Information
N.1;_ IAl pry 'Pry
TYPE OF WORK . mtiRnink COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction (Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
{ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
u 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 1 % -7 a- s V,- V,6 (e 5 (.+ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: -t igt^f Of U Q.-- ci 7.9-)'41 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldgJapt.no.: Project name: 1r,,r p 1,,,,M Duct work 23.32
J
Cross street/directions to job site: StJ A 5 e A r ti aQ p r Hydronic hot water system 23.32
U J 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 fuel 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- C`0 Vt ,; ., ii�t�5 1;ok. fireplace 23.32 ,
I- A-- r A1(1Pr J'tfUVC (,.,,y2 Vtrr\)C- >. 1nQ lighter(gas) 23.32
Wood/pellet stove 33.39
- / of cl �Iks- 7t 7 Ver1-4.-c-e Wood fireplace/insert 23.32
1 f Chimney/liner/flue/vent 23.32
rl PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: ' \-=j ,t J�r.. Range hood/other kitchen r- I
l�' equipment 33.39
Address: k, c6-Z�< 5 IN V t��,u r_rs.5k- ra Clothes dryer exhaust 33.39
City/State/ZIP: 7 i lr rrfi V-, 37 d- .L1 Single-duct exhaust(bathrooms,
1 toilet compartments,utility rooms) 23.32
Phone:( ' ') -1 "F- Fax:( ) Attic/crawlspace fans 23.32
APPLICANT *CONTACT PERSON Other: 23.32
Business name: , Fuel piping:
�zy'\N rt<)`s`AS Vt\t� C O $14.15 for first four;S4.03 for each additional
Contact name: 6eocr9�.p I-t, P, (r\Qfcf 'Z Furnace,etc.
Address: / // Gas heat pump
O rC U O `r 11 5 C r Wall/suspended/unit heater
City/State/ZIP: GGa..\--e_ OSw�� U(k. q -76 j 14' Water heater
Phone:(c)(a.)�j(,7 \ O'9- Fireplace;( ) Fireplace 1
Range %
E-mail: J-4-Vv n s v \ 'v k(0) ..'2i ��' ' -U c r--. Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: I.M R.. .1---- Other:
MECHANICAL PERMIT FEES*
Address:
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: TOTAL PERMIT FEE
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: 3C) -t r tvo-nrte - Date: P---1 -)-2---
_
ItBuilding'1ermits1MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00 $69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and
$2.81 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and
$2.54 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and
$2.49 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first$100,000.00 and
$2.92 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
L:\Building\Permits\MEC_PermitApp_040113.doc 2