Permit CITY OF TIGARD MECHANICAL PERMIT
: a COMMUNITY DEVELOPMENT Permit#: MEC2013 00545
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/09/2013
Parcel: 1 S135DB04200
Jurisdiction: Tigard
Site address: 11270 SW 92ND AVE
Project: Killion Subdivision: DOGWOOD RIDGE Lot: 16
Project Description: Installation of solar hot water drainback system.
Contractor: ONE ENERGY Owner: KILLION,JACK T JR&
10260 SW GREENBURG RD#400 BEVERLY
PORTLAND, OR 97223 11270 SW 92ND AVE
PORTLAND,OR 97223
PHONE: 602-889-8619 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Other,Heating/Cooling 10/09/2013 $23.32
Type of Use: SF 12%State Surcharge-Mechanical 10/09/2013 $10.80
Class of Work: ALT Type of Const: VB Minimum Fee Adjustment-Mechanical 10/09/2013 $66.68
Occupancy Grp: R-3
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.::5 2.2 .
Issued By: — Permittee Sig ure:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1,
Mechanical Permit Applic iii El V ED r�(m OlOI l:ICI: usi:():Ni v /���
City of Tigard Received 9mI� Permit No.: fJ,,9U! 3 51
NI q 13125 SW Hall Blvd.,Tigard,OR 972 r p
Date/By:
II (� 5 2 013 Plan By: �
Phone: 503.718.2439 Fax: 503.598.19 0- DateBy. FM Other Permit: ,
f I G n li 17 Inspection Line: 503.639.4175 Date Ready l a s: El See Page 2 for
Internet: www.tigardor.gov CITY OFTIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK • COMMERCIAL FEE* SCHEDULE— USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,andprofit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*.
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. 1 Total
' JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:11270 SW 92°d Ave Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Portland,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Killion Residence Duct work 23.32
Cross street/directions to job site:SW Greenburg Rd&SW 92°d Ave 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: Lot no.:
Other: 23.32
Other fuel appliances:
Tax map/parcel no.:R275954 Water heater 23.32 6)-2):3).,
• DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
Install of a solar hot water drainback system fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER I ❑ TENANT • Other: 23.32
Environmental exhaust and ventilation:
Name:Beverly&Jack Killion Range hood/other kitchen
equipment i-
33.39
Address:11270 SW 92°d Ave Clothes dryer exhaust 33.39
City/State/ZIP:Portland,OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)968-2307 Fax:( ) Attic/crawlspace fans , 23.32
' ®_APPLICANT ® CONTACT PERSON Other: 23.32
Business name:One Energy Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Megan Thomsen Furnace,etc.
Address:10260 SW Greenburg Rd#400 Gas heat pump -
Wall/suspended/unit heater
City/State/ZIP:Portland,OR 97223 Water heater
Phone:(602)889-8619 Fax::(602)4374739 Fireplace
Range
E-mail:megan.thomsen @beoneenergy.com Barbecue
' • CONTRACTOR Clothes dryer(gas)•
Business name:One Energy Other:
MECHANICAL PERMIT FEES* -
Address:10260 SW Greenburg Rd#400 Subtotal �3,'
City/State/ZIP:Portland,OR 97223 Minimum permit fee($90.00) 4:10.00
Plan review(25%of permit fee)
Phone:(602)889-8619 ff Fax:( ) State surcharge(12%of permit fee) (0,7!-)0 CCB lic.:200680 -//3//5"." TOTAL PERMIT FEE 100 TS-0(( 1 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:Megan Thomsen 1 Date:9/20/13 • La��/
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