Permit v CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2014 -00001
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/02/2014
Parcel: 1S135DB05300
Jurisdiction: Tigard
Site address: 11420 SW 94TH AVE
Project: JOHNSON Subdivision: MILLER Lot: 2
Project Description: Above - ground heating oil tank installation.
Contractor: SOIL SOLUTIONS Owner: DOUG JOHNSON ENTERPRISES LLC
3540 SE 28TH AVE 21860 SW 103RD CT
PORTLAND, OR 97202 TUALATIN, OR 97062
PHONE: 503 -234 -2118 PHONE:
FAX: 503 - 331 -7133
FEES
Specifics: Description Date Amount
Other, Heating /Cooling 01/02/2014 $23 32
Type of Use: SF 12% State Surcharge - Mechanical 01/02/2014 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 01/02/2014 $66 68
Occupancy Grp:
Stories:
Fuel
Fuel Types: Oil
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.
Issued By: • Permittee Signature:
i0 `
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.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard
ece ived
III / Permit No.:
�G� +ateBy: /I
d-/ pi ITT fY(�tlf) ��1
Phone: 503.718.2439 Fax: 503.598.1960
• 13125 SW Hall Blvd., Tigard, OR 97223 R \vE Plan Review
Other Permit:
Date/By:
TI G A R I) Inspection Line: 503.639.4175 Date ReadyBy: Juris ® See Page 2 for
Internet: www.tigard - or.gov i „lv 0 q 2 0\4 Notified/Method. Supplemental Information
TYPE OF WORK ' /1 '� f , ; f , 1 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
c 0 z it
ti 1)�� F: �' Mechanical permit fees* are based on the value of the work
® New construction ❑ Addition/alteration/rgp�ait �j performed. Indicate the value (rounded to the nearest dollar) of all
ID Demolition ❑ Other: L����'"� mechanical materials, equipment, labor, overhead, and profit.
Value. Ica ; s^....... —
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® l- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 11420 SW 94 Ave 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 z 46 ;- - :VSzvj 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, 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. Water heater 23.32
DESCRIPTION OF WORK Gas fireplace /insert 33.39
Flue vent for water heater or gas
Installing a new UL approved 275 gallon above - ground heating oil tank 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 ❑TENANT Other: h tech n' o find k I 23.32 z 3.32
Environmental exhaust and ventilation:
Name: Doug Johnson Range hood/other kitchen
equipment 33.39
Address: 11420 SW 94 Ave Clothes dryer exhaust 33.39
City /State /ZIP: Tigard, OR 97232 Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
Phone: (503)260 -4708 Fax: 1 51131331 -7133 Attic /crawlspace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name: Environmental Services DBA Soil Solutions
$14.15 for first four; $4.03 for each additional
Contact name: Aaron Siemers Furnace, etc.
Address: 3540 SE 28 Ave Gas heat pump
Wall /suspended /unit heater .
City /State /ZIP: Portland, OR 97202 Water heater
Phone: (503) 234 -2118 Fax: : (503) 331 -7133 Fireplace
- Range
E -mail: aaron@soilsolutionsenvironmental.co Barbecue
CONTRACTOR Clothes dryer (gas)
Business name: SAME AS APPLICANT Other
MECHANICAL PERMIT FEES*
Address: Subtotal 1 a.
3 �. ,
City /State /ZIP: Minimum permit fee ($90.00) 40 . csc
Plan review (25% of permit fee)
Phone: ( ) Fax: ( ) State surcharge (12% of permit fee) / n .yo
CCB lie.: i 3? 1 Li y iv / TOTAL PERMIT FEE I Vo.. lye)
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: A A r on S i C m L rS Date: 12/2 a/11
t.\ Building \Permits\MEC_PermitApp_040 I I 3 .doe 440 -4617T (I 1 /02 /COM/WEB)