Permit CITY OF TIGARD MECHANICAL PERMIT
;'�1 • COMMUNITY DEVELOPMENT Permit #: MEC2013 00776
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/31/2013
Parcel: 1 S134BD03000
Jurisdiction: Tigard
Site address: 12025 SW SPRINGWOOD DR
Project: DAVIES Subdivision: ENGLEWOOD NO.2 Lot: 119
Project Description: Gas fireplace insert with flue and fuel piping.
Contractor: OWNER Owner: DAVIES, BRIAN
11571 SW ELTON CT 12025 SW SPRINGWOOD DR
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 971 - 645 -0489 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 12/31/2013 $33.39
Type of Use: SF Chimney /Liner /FlueNent 12/31/2013 $23.32
Class of Work: ALT Type of Const: Fuel Piping 12/31/2013 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 12/31/2013 $10.80
Stories: Minimum Fee Adjustment - Mechanical 12/31/2013 $19 14
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 cgpy of the rules
or direct questions to OUNC by calling 503.232.1987 • . .
-
Issued By: i Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection da .
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.
Mechanical Permit Application FOR OFFICE L SE o`L'
City of Tigard � v '� DaR PermitNo.: 131SW Hall BlvdTigard, OR 972 Phone: 503.718.2439 Fax: 503598.1 Date /By: Other Permit:
Date/By:
I G A R D Inspection Line: 503.639.4175 DEC 31 201
Internet: www.ti and or. ov DE Date Ready /By: See Page 2 for
g g II�� " N ap � Supplemental Information
G ? O { , JSI i K>lJST
- a � 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.
a rY , Value $ $1,700.00
, i �. "Y4t t 11\U \� t S d�Y. ,, , t £ t
. .. ..,: 1081 " ,
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. Total
" "' I1 FQRi `I"I( ItI 'AND [ ' s Heating/cooling:
'
'" Air conditioning 46.75
Job site address: 12025 SW Springwood Dr Furnace 100,000 BTU (ducts/vents) 46.75
City/State /ZIP: Tigard, OR 97223 Furnace 100,000+ BTU ( ducts/vents) 54.91
Heat pump 61.06
Suite/bldg. /apt. no.: Project name au/ e.5 Duct work 23.32
Cross street/directions to job site: SW Springwood Dr at SW 121st 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: Englewood Lot no.: Other 23.32
Other fuel appliances:
Tax map /parcel no.: Water heater 23.32
i "a.,- ",,.IE1*lall,±a►wc - Gras fireplace /insert 1 33.39 3 3ti
" - Flue vent for water heater or gas
Install a new gas fireplace in the location of the existing wood burning fireplace 1 23.32 X3
fireplace using the gas line already installed in the area. Log lighter (gas) 23.32
/ Wood/pellet stove 33.39
1 ecv� rk, C� r 0 1 26 - 05 - 0 1 rLi L...) i) ow -er Wood fireplace/insert 23.32
Chimney /liner /flue /vent 23.32
23. 2
st er 3
Environmental exhaust and ventilation:
Name: Brian Davies Range hood/other kitchen
equipment 33.39
Address: 11571 Sw Elton Ct Clothes dryer exhaust 33.39
City/State /ZIP: Tigard, OR 97223 Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
Phone: (971)645 -0489 Fax: ( ) Attic /crawlspace fans 23.32
;' i : 13 - APPL'xll�Irl'l' 4,1 "':1,+151rAGC`""PEtSpri'Md Other.
23.32
Business name: Fuel piping:
$14.15 for first four; $4.03 for each additional
Contact name: Brian Davies Furnace, etc. r P'1.15
Address: 11571 SW Elton Ct Gas heat pump
Wall/suspended/unit heater
City/State /ZIP: Tigard, OR 97223 Water heater
Phone: (971) 645 -0489 Fax: : ( ) Fireplace
Range
E -mail: bdaviesl @outlook.com Barbecue
' 'COKI A.tu")l'OR ,± . . Clothes dryer (gas)
Business name: none Other:
MECHANICAL PERMIT FEE..-; .:
5 *
Address: _ Subtotal _ _ —
City/State /ZIP: Minimum permit fee ($90.00) 4Q.
Plan review (25% of permit fee)
Phone: ( ) Fax: ( ) State surcharge (12% of permit fee) /p . Se
CCB lie.: -----2 TOTAL PERMIT FEE , icd. SO
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: e . t a U LP wc Date: i Z/ 3( 201 3
L`: BuildinePerrai ts=MEC_PennitApp_040113.doc 440 -161 Tr (1 1,02 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:\ Building \Permits\MEC_PermitApp_040I 13 .doc 2
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
li with the Construction Contractors Board.
� or
�
I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Print Name of P- it Applicant
i73( 201
,Signatui i t Date
Permit #: In/ Y?oI 3 —U0`1 Ice
f ,20) -5 fc.�) .lru� �r _ • ` f ' • r
Address: •�;�� <' .: r'�
ff y"".
Issued by _ e -% • Date: /;2/3%/
This Copy for Permit Offices
CITY OF TIGARD • ,...---._, .....
BUILDING DIVISION A #: ine.G4 c1.5.- °C)7>..6'
f
, 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Inspection Requests (24•Hrs.): (503) 639-4175 ...._•, ---
INSPECTION WORKSHEET FOR DATE: /- 7-11( 1.:; TIME: 9-,3q,064-7 PAGE: /
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SITE ADDRESS: 1 el 0 ..5 C 14, sep./.),(5-cuov-ii z:r — CLASS OF WORK:
SUBDIVISION: ; LOT#: TYPE OF USE:
'PROJECT NAME: a
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DESCRIPTION: ,./
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OWNER: PAoc N f ,,.„ , PHONE #:
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CONTRACTOR: -” PHONE #:
Inspection Request Scheduled For: ' . Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
6 JO 64i. L /2)£ 4,
Corrections/Comments/Instructions:
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50 414.-.7.c>A)E (,4-,c) Eir /40/N i e.
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la.PASS Eji PARTIAL APPROVAL 'n CANCEL ACCESS
El CALL FOR S' otsioN-----.. El ADDITIONAL FEES ASSESSED
Inspector: ._., __ •,-.--7: . , .... Date: 7-7-/y Phone #: (503) 718- -2 V.
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12025 SW SPRINGWOOD DR, TIGARD, OR,
97223
Residential - Mechanical
699 Mechanical final
2014-01-08 00:00:00
MEC2013-00776
PASS - No C of O
Violation Summary:
Inspector Contractor