Permit CITY OF TIGARD ' MECHANICAL PERMIT
COMMUNITY DEVELOPMENT �� , Permit#: MEC2013-00641
Date Issued: 10/23/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S1 3/2013 600
Jurisdiction: Tigard
Site address: 11285 SW FOREST LN
Project: HOME INVESTMENT SERVICES Subdivision: 2008-038 PARTITION PLAT Lot: 1
Project Description: Replacing furnace and gas piping for furnace,range and fireplace 11/20/11 reprinted to correct address from
11329 SW North Dakota 10 11285 SW Forest Ln. 1/21/14, reprinted to add ductwork, (1)gas fireplace. (1) range
hood&(4)vent fans
Contractor: SUPREME COMFORT HEATING Owner: HOME INVESTMENT SERVICES LLC
9425 SW COMMERCE CIRCLE#16 BY BRADEN, JOHN N
WILSONVILLE, OR 97070 1102 N SPRINGBROOK RD, STE 113
NEWBERG, OR 97132
PHONE 503-682-1985 PHONE
FAX 503-682-1018
FEES
Specifics: Description Date Amount
Furnaces< 100K BTU 01/21/2014 $46.75
Type of Use: SF Duct Work 01/23/2014 $23.32
Class of Work: ALT Type of Const: Gas Fireplace 01/23/2014 $33.39
Occupancy Grp: Range Hood/Other Kitchen 01/23/2014 $33.39
Stories: Single Duct Exhaust(Bathrooms.Toilet. 01/23/2014 $69.96
Utility Rooms)
Fuel Piping 01/21/2014 $14.15
12%State Surcharge-Mechanical 01/23/2014 $26.52
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $247 48
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 qu -0 NC by calling 503 232 1987 or 1 800 332.2344.
•
Ise ed By: /71,�,‘, p ;, Permittee Signature: ��7
Call 503.639.4175 by 7:00 a.m.for the next available inspec- date. 1
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.
u CITY OF TIGARD MECHANICAL PERMIT
m, COMMUNITY DEVELOPMENT / Permit#: MEC2013-00641
Date Issued: 10/23/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1
1S134DB 2600
Jurisdiction: Tigard
Site address: 11285 SW FOREST LN
Project: HOME INVESTMENT SERVICES Subdivision: 2008-038 PARTITION PLAT Lot: 1
Project Description: Replacing furnace and gas piping for furnace,range and fireplace. 11/20/13,reprinted to correct address from
11329 SW North Dakota to 11285 SW Forest Ln.
Contractor: SUPREME COMFORT HEATING Owner: HOME INVESTMENT SERVICES LLC
9425 SW COMMERCE CIRCLE#16 BY BRADEN,JOHN N
WILSONVILLE, OR 97070 1102 N SPRINGBROOK RD, STE 113
NEWBERG,OR 97132
PHONE: 503-682-1985 PHONE:
FAX: 503-682-1018
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 10/23/2013 $46.75
Type of Use: SF Fuel Piping 10/23/2013 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 10/23/2013 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 10/23/2013 $29.10
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 Notifi - •- --nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direc .uestions to O C b -fling 503.232.1987 or 1.800.332.2344.
Issue' By: -.Art `r,/ Permittee S s nature:
-.Art ' s`
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.
CITY OF TIGARD MECHANICAL PERMIT
1,1
a. COMMUNITY DEVELOPMENT Permit#: MEC2013-00641
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/23/2013
Parcel: 1S134 DB12600
Jurisdiction: Tigard
Site address: 11329 SW NORTH DAKOTA ST
Project: HOME INVESTMENT SERVICES Subdivision: 2008-038 PARTITION PLAT Lot: 1
Project Description: Replacing furnace and gas piping for furnace,range and fireplace
Contractor: SUPREME COMFORT HEATING Owner: HOME INVESTMENT SERVICES LLC
9425 SW COMMERCE CIRCLE#16 BY BRADEN,JOHN N
WILSONVILLE, OR 97070 1102 N SPRINGBROOK RD, STE 113
NEWBERG,OR 97132
PHONE: 503-682-1985 PHONE.
FAX 503-682-1018
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 10/23/2013 $46 75
Type of Use: SF Fuel Piping 10/23/2013 $14 15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 10/23/2013 $10 80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 10/23/2013 $29 10
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 Notif - • enter. 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: estions to • N • calling 503.232.1987 or 1.800.332.2344.
Issued By: , - .1 • ' j Permittee Signatu
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.
10/22/2013 14:52 503-582-I ECEIVED SUPREME COMFORT INC PAGE 01
Mechanical Permit Application �Y WR (Il it I. i;." ()NI:1 . .
•
City of Tigalyd OCT 2 2 2013 permit No.: EQ 11_
13125 SW Hall Blvd.,Tigard.OR 97223 �.�/
Phone: 503.7182434 Fax 503.598.1960 Plan Review
-1 I r.,`n 11 Inspection Line: 503 639.4175 CITY T Y OF`f Date Ry
Internet- www.tigard-or.gov
TIGARD Date Ready/By Jurie' See page 2 for
BUILDING DIVISION Nottfied/Method. �tc. Supplemental Information
TYPE OF WORK - COMMERCIAL FEE* SCHEDULE--USE CHECKLIST
❑New construction Mechanical permit fees*are based-on the value of the work
®Addititm/alt�vation/replacement performed Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead.and profit
$
CATEGORY OF CONSTRUCTION Value.
RESIDENTIAL EQUIPMENT/SYSTEMS FEES"
® I-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For apedallgfnrmarlon sae dmeklit
[I Multi-family ❑Master builder ❑Other: Description 1 Qty.1 Ea, 1., Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address:11329 SW North Dakota Air Conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 1 46.75 46.75
City/State/ZIP:Tigard, OR 97223 _Furnace 100.000+BTU(dam/yenta) , 54,91
Suite/bldg./apt.no.: Project name: q ,,,�� C Heat pump _ 61.06
r r-` ' "LNt ie c -+4/�J Duct work 23.32
Cross street/directions 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,su ended,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
Replace Furnace vent for water heater or gas
fireplace 23.32 piping to furnace,range and gas fireplace
Loy lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fineplace/nsert 23.32
Chimney/liner/flue/vent _ 23.32
_ Other: 23.32
❑ PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:
Name: Range hand/other kitchen
Address: euilrment 33.39
Clothes dryer exhaust 33 39
City/State/ZIP: Single-duct exhaust(bathrooms.
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) ,Attic/erawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
_Fac�iping:
Business name:same as contractor $14.15 fir flrst four;S4.03 for each additional
Contact name: Furnace,etc, I 4,71
Gas heat pump
Address: -.
--- Wnll/suspcnded/unit heater
City/State/ZIP: Water heater
4.72 Fireplace " 1 ne:( ) Fax::( ) _
Pho
_ _Range 1 - 4.72
E-mail: _Barbecue
CONTRACTOR Clothes d r
Other:
Business name:Supreme Comfort Inc. _ PERMIT FEES*
MECHANICAL Address:9425 SW Commerce Cir.#16 Subtotal ' 60 90
City/State/ZIP:Wilsonville, OR 97070 Minimum permit fee($90,00) 90.00
Plan review(2,5%of permit Ice)
Phcmc:(503)602-1985 Fax:(503)682-1015 - State surcharge(12%of permit fee) 10.80
CCB tic.:211892 TOTAL PERMIT FEE 100.80
- This permit apprrca f;on expires if a permit h not obtained within 130
tiara nher it hm been accepted as complete,
Authnrired signature: • Fee momodotogy set by'fri-County building Industry Service Board
Print name:Randal Lapp Datc:10/22/13
r nuudrnp\rcrn,;t3\nru(:_rermaapp 0001 IS doe 440.46171'(I rro70-(1 Wwsy)
Mechanical Permit Applic 'EIVEI) FOR OFFICE USE ONLY
Received ti ff f5
City of Tigard
Date/By: �� Permit No.: ot3Cv /
MI
13125 SW Hall Blvd.,Tigard,OR 972 }t 121 2014 Plan Review
Phone: 503.718.2439 Fax: 503.598.E Date/By: Other Permit-
Inspection TIGARD Inspection Line: 503.639.4175 Date Ready/By: Sum 0 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notilied/Method. Supplemental Information
A> )o --- 14-C- illalibilstcliMSI ON
TYPE OF WORK _ COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
New construction ,Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
El 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special Information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. J Ea. I Total
JOB SITE INFORMATION D LOCATION Heating/cooling:
Air conditioning 46.75
Job site address /' g� � O2ti�j 0 Furnace 100,000 BTU(duets/vents) 46.75
City/State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: I Project name: 140H t /01)14,7-714f,2! ( Duct work _ i 23.32
Cross street/directions 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 _ 23.32
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no,: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert V 33.39
— `- QI2 3 H tot r 7- M (t41 Flue rep vent for water heater or gas
p 00 fireplace 23.32•
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
CI PROPERTY OWNER ❑ TENANT Other: _ 23.32
Environmental exhaust mad ventilation:
Name: Range hood/other kitchen
equipment 1 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) q 23.32
Phone:( ) Fax:( ) Attic/crawlspace Fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: _ 23.32
Business name: Fuel piping:
S14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc. •
Address:
Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue __
CONTRACTOR Clothes dryer(gas)
Business name: f r �- Other:
5• '� 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 tic.: TOTAL.PERMIT FEE !1,'44, 108
This permit application expires if a permit is not obtained within 180
1 days after it has been accepted as complete.
Authorized s' V attire. \ • Fee methodology set by Tri-County Building Industry Service Board
Illik
EMEMISNICIIIERITI „._ Date: -a h 1
I:1Building'Pennits\AtEC_PermitApp 040113 doe 440.4617r(II/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.
I:\Buildingwennits\MEC_PermitApp_040113.doc 2
CITY OF TIGARD FEE AND PAYMENT HISTORY
INS . 13125 SW Hat Blvd.. Tigard OR 97223
503.639.4171
TIGARD
MEC2013-00641 - 11285 SW FOREST LN, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due
Furnaces< 100K BTU 230-0000-43102 $46.75 $46.75 $46.75 1/21/14 Credit Card 194604 $0.00
Duct Work 230-0000-43102 $23.32 $23.32 $23.32
Gas Fireplace 230-0000-43102 $33.39 $33.39 $33.39
Range Hood/Other Kitchen 230-0000-43102 $33.39 $33.39 $33.39
Single Duct Exhaust(Bathrooms, Toilet, 230-0000-43102 $69.96 $69.96 $29.10 1/21/14 Credit Card 194604 $40.86
Utility Rooms)
Fuel Piping 230-0000-43102 $14.15 514.15 $14.15 1/21/14 Credit Card 194604 $0.00
12%State Surcharge-Mechanical 100-0000-24001 $26.52 $26.52 $10.80 1121114 Credit Card 194604 $15.72
Totals for Fees $247,48 $247.48 $100.80 $146.68
Receipt# Payment Method Check# Favor: Receipt Date Receipt Amount
193652 Credit Card F R Randal-Supreme 10/23/2013 $100.80
Comfort Inc
194602 Credit Card F R Randal-Supreme 01/21/2014 $100.80
Comfort Inc
194601 Credit Card F R Randal-Supreme 01/21/2014 $-201.60
Comfort Inc
194604 Credit Card 01/21/2014 $100.80
Total Payments: $100.80
Balance Due: $146 68
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11285 SW FOREST LN, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
FAIL
October 20, 2014 at 9:05:02
AM
MEC2013-00641
George Heimos
1. No one home, please provide access for inspection, no inspection made. Recall when
ready. 103.5.4
Left paper report
Violation Summary:
Inspector Contractor