Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2013-00618
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/15/2013
Parcel: 2S111CC10100
Jurisdiction: Tigard
Site address: 15790 SW GREENS WAY
Project: BAER Subdivision: SUMMERFIELD NO.2 Lot: 128
Project Description: Gas line to dryer.
Contractor: WATTS HEATING&COOLING INC Owner: BAER REVOCABLE INTERVIVOS TRUST
580 PORTLAND AVE. BY BAER, ROBERT G TR
GLADSTONE,OR 97027 PO BOX 9065
SO LAKE TAHOE,CA 96158
PHONE: 503-786-2858 PHONE:
FAX: 503-786-2807
FEES
Specifics: Description Date Amount
Fuel Piping 10/15/2013 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 10/15/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 10/15/2013 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
7Q
4)114.07,..0„:
Issued By: / aelso1111 ermittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Oct. 14. 2013,1 9:53A 1.4—Azil„1 -NT ,Nt"' rcllt(Irr•lc'E No, 5416 P. 2
1
■
City of Tigard i 1 �� Received PermiINo.: 1 — ,1'
0 13125 SW Hall Blvd.,Tigard.OR 972�` L `�
t n. Phone: 503.718.209 Fax: 503.598.1Y60 20 3 Date/By:Review Other Permit:
Date/By:
Inspection Line: 503.639.4175 {l rods, see��
T 1 Ci A It 17 p Date Ready/By: Page 2 for
Internet: tt�vmv.tigard•or.gov city or U uu�Y�� Notified/Method: ). Supplemental Information
CI TYPE OF WORK COMMERCIAL FEE" SCHEDULE- USE CHECKLIST
Mechanical permit fees"arc based on the value of the work
❑New construction NI Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS PEES'
[ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special Ltfor,,ra/lon use checklist.
❑Multi-family ❑Master builder ❑Other: Description __ I Qty. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Healing/cooling:
Air conditioning 46,75
Job site address; .1 '7• - - . E at-- Furnace 100,000 BTU(duds/years) 46,75
City/Slate/ZIP: `n/�J a rct G{•1 ZZ 4 Furnace 100,0004-flU(duets/vents) 54,91
Heat pump 61.06
Suile/bldgJapt.no.: I Project name:
Duct work 23.32
Cross streeVdirections 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 2332
Other. 23.32
Subdivision: Lot no.;
Other fuel aliplianccs:
Tax map/parcel no.: Water heater 2132
DESCRIPTION OF WORK Gas fireplace/insert 3139
Flue vent for water heater or gas
CI 0- Line --ii_ d�c r fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood lircplace/insen 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER , ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: f the rt (' c r Range hood/other kitchen
equipment 33.39
Address: f 5'7 90 6 rec n s '�aLf Clothes dryer exhaust 33.39
City/Slate/ZIP: ••1 i�r l 9 1•2:21-1 toild comp rtments(bathrooms,ty too
toilci compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspacc fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
( � � Fuel piping:
Lo
BusineSS nanme: aFb +I -r,nr] q rf�I I� S14.15 for first four;S-l.03 for each additional
Contact name: LI SR. `� Furnace,etc.
5U0 1Qr�2 �,J Gas heat pump
Address: U I ILf , I(.[ Wall/suspended/unit heater
City/State/ZIP: `-7 1.0L--I JIU lt ei 07'7 Water healer
Phone: 862, 2858 1 Fotc::( 03 //7.36,:,..210,-/ Fireplace
'! Range
I/1
E-mail: Lis.a e ia1- kha h ro . coy) Barbecue
CONTRACTOR (J Clothes dryer(gas) 1
, ' 1 Other:
Business name: W a �$ -4` ��ryr o} , fled MECHANICAL PERMIT FEES`
Address: 5 20 ..1)01- /./.r--� 'j f 'TVI Subtotal
City/State/ZIP: I3A 54 y-' 9-RD Z7 Minimum permit fee($90.00) ef Q•00
Plan review(25%of permit fee)
Phone:( '3) 726. 2252 F"..(613 7&0- 2ay-7 State surcharge(12%of-permit fee) Ita•so
CCB lie.: 1'54 (002. TOTAL PERMIT FEE_,_ ;:)13.9_,Q
This permit application expires Ira permit is not obtained within 180
days after II has been accepted as complete.
Authorized signature: V l � • Fee methodology eel by Tri-County Building Industry Service Board
Print rtarne: L UY`jQ r slate; 10'/'4°,3
l:mnuitdiog\PermilatEC_Perm1iApp_040113.doe 440.4617T(1I101/COM INED)