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Permit CITY OF TIGARD MECHANICAL PERMIT 11111 3, COMMUNITY DEVELOPMENT Permit#: MEC2015 00112 T[G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/03/2015 Parcel: 25101 DC05000 Jurisdiction: Tigard Site address: 13410 SW 76TH AVE Project: Albertina Kerr Centers Subdivision: PACIFIC RIDGE Lot: 2 Project Description: Gas piping for generator. Contractor: AGAPE GASWORKS LLC Owner: ALBERTINA KERR CENTERS 8940 SE CLINTON ST ATTN: JERALD A HOFFERT PORTLAND, OR 97266 424 NE 22ND PORTLAND,OR 97232 PHONE: 503-570-9722 PHONE: FAX: 503-775-1007 FEES Specifics: Description Date Amount Fuel Piping 03/03/2015 $14.15 Type of Use: SF 12%State Surcharge-Mechanical 03/03/2015 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 03/03/2015 $75.85 Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas Gas Pressure: Total $100.80 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to I low the rules a••pted b the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090' Yo: o•t. n a cop of the rules or direct questions to OUNC by calling 503.232.1987 or 1.8 '.332.23••. Issued By: Permutes Signature: --�� Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard 0RECE E D Received A 3/f� L]77 _ Permit No r, © i9- )OI1l IIII • 13125 SW Hall Blvd.,Tigard, 97223 G G �l G1.�Plan Review �T! 3 Phone: 503.718.2439 Fax: 503.598.196 Date/By: Other Permit: T I G A R D Inspection Line: 503.639.4175 3 20'5 Date Ready/By: lurk: ® See Page 2 for Internet: www.tigard-or.gov MAR Notified/Method: Supplemental Information rry OF TIGARC TYPE OF WO ILDING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work ❑New construction El Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* _ i-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: / 3 LI i U 5 w 7 ( i 1 ,'e Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 'j-j C Cs C- -) , )V3 Furnace 100,000+BTU(ducts/vents) 54.91 11 Heat pump 61.06 Suite/bldg./apt.no.: Projbct name: I<e v Duct work 23.32 Cross street/directions to job site: 1 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 I' Flue vent for water heater or gas ij'e C n 5 1 ,,p F r O'r- N f 1/1£ -,c,- J 9 / 3I c,CI< fireplace 23.32 1 1 r - it /i Q l r.+ t A-f- +b ( L4 1K t,.s C-7 Vte Ymtl D•( Log lighter(gas) 23.32 1 i Wood/pellet stove 33.39 5 1 ghaf c� C'e 5 St. I Y'e Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 -'PROPERTY OWNER 1 ❑ TENANT Other: 23.32 Environmental exhaust and ventilation: Name: A I k.e r 4- i r G Ke s( `r Range hood/other kitchen / equipment 33.39 Address: t 3 Li (6 1 w l , n.i t Clothes dryer exhaust 33.39 City/State/ZIP: --t- r,,c i a f-,, n1 a_a-3 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) , 23.32 Phone:(E0)) 3 ` a._41-3s -7 Fax:( ) Attic/crawlspace fans 23.32 _PLAPPLICANT ❑ CONTACT PERSON Other: 23.32 / Fuel piping: Business name: e \ .e_ (S l.�.l 0,r l�.S LIZ $14.15 for first four;$4.03 for each additional Contact name: V 1 scv� L Lk c 1',..-e n b r„ C ,l Furnace,etc. Address: L(,, 5 W Li s 4' Gas heat pump Wall/suspended/unit heater City/State/ZIP: IV Oak A eA.1 f , C.) }2 (10 O Q Water heater Phone:(c i I ')O• ( 7 ac2 Fax::( ) Fireplace Range E-mail: , 6j ,U� JJ( 1,� ,\.3 (G Y� Barbecue `•+ C NTRACTOR Clothes dryer(gas) Other: 1°rye c" t5( Business name: „�r,,,, r,-_.' A w`e 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 lic.: i`-) /4/..) I TOTAL PERMIT FEE /00.ab This permit application expires if a permit is not obtain within 180 days after it has been accepted as complete. Authorized sign c( ) n� * Fee methodology set by Tri-County Building Industry Service Board Print name:3 6, 5,,Q S L lk c lCe r b 01.(._\ Date: -3- I S 1:\Building\Permits\MEC_PemtitApp_040113.doc 440-4617T(I 1/07JCOM/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_040113.doc 2 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 13410 SW 76TH AVE, TIGARD, OR, 97223 Residential - Mechanical 699 Mechanical ﬁnal PASS - No C of O March 4, 2015 at 12:40:48 PM MEC2015-00112 David Young 18 psi, 15 min. Violation Summary: Inspector Contractor 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 13410 SW 76TH AVE, TIGARD, OR, 97223 Residential - Mechanical 699 Mechanical ﬁnal PASS - No C of O March 4, 2015 at 12:40:48 PM MEC2015-00112 David Young 18 psi, 15 min. Violation Summary: Inspector Contractor