Permit CITY OF TIGARD MECHANICAL PERMIT
1111 q
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00607
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/28/2011
Parcel: 2S101AD01400
Jurisdiction: Tigard
Site address: 12700 SW 68TH AVE
Project: Oregon Ki Society Subdivision: WEST PORTLAND HEIGHTS Lot: 31
Project Description: 50 ft. of gas piping from meter to water heater.
Contractor: FAST WATER HEATER COMPANY Owner: OREGON KI SOCIETY
12601 132ND AVE NE PO BOX 2143
KIRKLAND, WA 98034 LAKE OSWEGO, OR 97035
PHONE: 425 - 636 -7084 PHONE:
FAX: 425 - 636 -7055
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 12/28/2011 $142.74
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/28/2011 $17.13
Occupancy Grp: Occupancy Load:
Stories:
Project Valuation: $2,899.00
Fuel Air Handlers
Fuel Types: Natural Gas Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $159.87
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Hoods: Comm Incinerators:
Required Items and Reports (Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire /Smoke Dampers:
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 -.'. .
/ Issued By: L Permittee Signature:
Call 5' "' 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.
From: 12/28/2011 10:31 #859 P.002/003
Mechanical Permit Application ��S� F OR OFFICE USE ONLY
City of Tigard �" 1O\\ Re
Date/By: / 'O i , ��
I r • 13125 SW Hall Blvd., Tigard, OR 97 t
Plan Review
` . Phone: 503.718.2439 Fax: 503.598.1960 � � � Date/By: Permit:
TIGARD Inspection Line: 503.639 \-... : - GQR Q
a ate ReadyBy: Juris: 0 See Page 2 for
_ . Internet: www.tigard- or.gov _ ` ,5 1 Notified/Method: Supplemental Information
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TYT'F WO ,, ,COMbfERCIAL FEE°SCFIEDLII: - I ;SECHECiCLIST ;�,:
Q _ � 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.
CA'PEGoRY•_O CONST'RC ?GTIOV E ES *
, ,, ICES
Value: ' ,-""
r
I E QUIPMENT / SYS'1EwLS F. ...
❑ 1- and 2- family dwelling gi Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description l Qty. I Ea. I Total
JOB, SITE INFORMATION AND I;OC.ATION.' •;.. t.. Heating /cooling:
Air conditioning
Job site address:, T100 S', (o" -� A ve_ (requires site plan shoving placement) 46.75
Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP: `"--\ /,( a \
J Fl f , - � Furnace 100,000+ B'fU (duccs.'vents) 54.91
cx\ ` � t
Suite /bldg. /apt. no.: Project name: , J \ ` 5 7C e --V y Heat pump
(requires site plan showing placement) 61.06
5\ Cross street/directions to job site: � ( Duct work 23.32
- 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
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.:. Other fuel appliances:
I'r ; :DIESCRIPT`ION ; OF:WORl{ -.. . >- ..',,>>i .•. - „..,,';
Water heater 23.32
{ Gas fireplace 33.39
11 ?(1 ` 50 c C *0_5 \ CiL \ e y 1c\ 'ki��' v t� - Flue vent for water heater or gas
l^ � ( fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
::: , P :OWNEH ..,::...,... , ,❑. TENANT_.,......_',.:: Chimney /liner /flue /vent 23.32
/ ` ,:_' Other: 23.32
Name: D\( ' 5 o \ € / e( 0 k Environmental exhaust and ventilation:
Address: 1 t t 0 s Y V u% Range hood /other kitchen
equipment 33.39
City/State/ZIP:� I.cueCk. on a. ' Clothes dryer exhaust 33.39 ,
\ q Single -duct exhaust (bathrooms,
Phone: (j0 2 )) ( __. b's Fax: ( ) • toilet compartments, utility rooms) 23.32
APPUC4NT `•, { ,,: '` CONTACT PERSON . _(.;, Attic /crawlspace fans 23.32
Business name: V V 0,.. (_,C Other: 23.32
Fuel piping:
Contact name: 3—\.,L, \ t e. � ash t $14.15 for first four; $4.03 for each additional
Address: , at) 0, \ 2- l l V (J r,,..._ Furnace, etc.
^\ j � Gas heat pump
City /State /ZIP: '\t \ C t ,V v : N c:3D jl-\. Wall /suspended /unit heater
Phone: (141,,S) Ul 3 lip rgik Fax:: ( 5) (123(0-- 703G Water heater 1 $1441. �{ ` /� e l Fireplace
E -mail: Jv1\ e-C A L3� V , c 1 Range
CONTRACTOR:: Barbecue
Business name: -
ECL_ �" N OA-Cc k a Clothes dryer (gas)
2,A0 0, t3 Z Other:
Address: � , ......., - E. - . :. `,_i .. . i
1ECHA� I #L YERhII "P,:EEE `,, , . ,,, '` .
City /State /ZIP: C' (A.,11 CA 1 W .+ \ gC 23� Subtotal , 4
Phone: (4-2, (,5( . -7 0Sti Fax: ( i4$ 5C v s Minimum permit fee ($90.00) G (H )s
Plan review (25% of permit fee)
CCB lie.: I iS CH- State surcharge (12% of permit fee) j'7. i;
TOTAL PERMIT FEE \1p,{� v'7
This permit application expires if a permit is not obtati within 180 / T ' , D /
Authorized signature: days after it has been accepted as complete.
Print name: )2 Ii e , � Date: / 2. Z 3 7/ " Fee methodology set by Tri- County Building Industry Service Board
P',Building\Permit C- PermitApp.doe 09/09/10 440-46171" (I1 /027COM/WEB)
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