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Permit CITY OF TIGARD MECHANICAL PERMIT 111 COMMUNITY DEVELOPMENT Permit #: MEC2011 00200 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/06/2011 Parcel: 2S103BB07901 Jurisdiction: Tigard Site address: 12350 SW 124TH AVE Project: Hinds Subdivision: LAKE TERRACE Lot: 8 Project Description: Gas line to water heater. Contractor: RAYBORN'S PLUMBING INC Owner: HINDS, TOM M & JUDY G 19990 SW CIPOLE RD 12350 SW 124TH AVE TUALATIN, OR 97062 TIGARD, OR 97223 PHONE: 503 - 692 -4139 PHONE: 503 - 590 -5295 FAX: 503 - 691 -2328 FEES Specifics: Description Date Amount Water Heater 05/06/2011 $23.32 Type of Use: SF Fuel Piping 05/06/2011 $14.15 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/06/2011 $52.53 Occupancy Grp: 12% State Surcharge - Mechanical 05/06/2011 $10.80 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. .4. Issued By: Permittee Signature: _tom Call 50 .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. .,.503 691 2328 Rayborns Plumbing 08:30:04 a.m. 05 -06 -2011 1 /2- — 1 Mechanical Permit Applicati© Ioa r rl( I. t Sl 0\1.1 City of Tigard !i t r V L. ® O Received DateBy: , C 11a •4 • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review '� Phone: 503.639.4171 Fax: 503.598. - 6 2011 Date /By: Other Permit: ,Gx„ge //' d6 ! 3 Inspection p g ction Line: 503.639 4175 Date Ready. By: Jur s: See Page 1 for Internet: www.ttigard- or.gor.- .. f D .... NotifiedtMethoda - - Sappieae+it CITY OF TIG at liifor.oAfiow TYPE OR G DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST E3 New construction 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 Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: S RESIDENTIAL EQUIPMENT / SYSTEMS FEES* tit I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special inJormalion use checklist. ❑ Multi - family ❑ Master builder El Other: Description I Qty. Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling - Job site address: p4 go / ,4 Air conditioning (requires S to plan ng showing pump ,7 V (requires site plan showing; placement) 14.00 ,-.... j City /State /ZIP: i l Q Furnace 100,000 BTU (ducts /vents) _ 14.00 6./._ ll . Furnace 100,000+ BTU (ducts, vents) 17.90 Suite/bldg./apt. no.: Project name: Gas heat pump 14.00 Cross street /directions to job site: Duct work 10.00 S ` �� Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) _ 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Flue/vent for any of above 6.80 Subdivision: Lot no.: Other: 10.00 _ Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 1 • 10.00 (. / / Gas fireplace 10.00 I� t . .11 Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.(X) Wood/pellet stove 10.0() ' Wood fireplace/insert 10.00 tg PROPERTY OWNER ❑ TENANT Chimney liner.flue /vent 10.1)0 Other. 10.00 Name: „ 1 Environmental exhaust and ventilation u / i �.y�g��^ �L Range hood/other kitchen Address: l 4. ,- t� gi-4 /e/I /A. ? equipment 10.00 City/State/ZIP: F 7,4,213 Ches dryer exhaust 10.00 Singngle -duct exhaust (bathrooms. Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Other. 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone :( ) j Fax:: ( ) Water heater 1 5 - S-4P Fire lace E-mail : Range CONTRA OR Barbecue i 1 t Clothes dryer (gas) Business name: �I NS ot, , .-... Other: Address: Al a Q d MECHANICAL PERMIT FEES* /s City /State /ZIP: N.-- Q6_ S ubtotal .A. ` Minimum permit fee (572.50) Phone. (S15-3) 6 �` /� 3` Fax: ( ) �/ Q( Pl re view ( of p ermit fee) d` I CCB lie.: gs State surcharge (12% of permit fee) i ffl g / YrT�V TOTAL PERMIT FEE �� 4 This permit application expires if a permit is not obta within 180 Authorized signature: days after it has been accepted as complete. Print name: I a ,�r L� / � Dat e: �, /' Fee methodology set by Tri- County Building htdustry Srrvice Board City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12350 SW 124TH AVE, TIGARD, OR, 97223 April 20, 2017 at 10:03:37 AM Record Type: Record ID: Residential - Mechanical MEC2011 -00200 Inspection Type: Inspector: 699 Mechanical final David Young Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor