Permit (80) a CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2016-00085
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/03/2016
Parcel: 2S103CD00700
Jurisdiction: Tigard
Site address: 11555 SW FAIRVIEW LN
Project: SUNDANCE INVESTMENTS LLC Subdivision: HOLLYTREE Lot: 2
Project Description: Moving(1)water heater to garage and installing gas line for water heater. Moving return air duct and(1)heat
register in the kitchen.
Contractor: LEGACY HEATING AND COOLING Owner: SUNDANCE INVESTMENTS LLC
325 N 7TH AVE 17420 SW 110TH AVE
CORNELIUS, OR 97113 TUALATIN, OR 97062
PHONE: 503-367-4752 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Duct Work 02/03/2016 $46.64
Type of Use: SF FlueNent For Any of Above 02/03/2016 $69.96
Class of Work: ALT Type of Const: Water Heater 02/03/2016 $23.32
Occupancy Grp: Flue Vent for Water Heater or Gas 02/03/2016 $23.32
Stories: Fireplace
Fuel Piping 02/03/2016 $14.15
12%State Surcharge-Mechanical 02/03/2016 $25.29
Range Hood/Other Kitchen 02/03/2016 $33.39
Fuel
Fuel Types:
Gas Pressure:
Total $236.07
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires yK to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952- 1- 90. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: a 'ttee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application
Received
City of Tigard �, Permit No.:
_ DateB17
13125 SW Hall Blvd.,Tigard,OR 97223 + - ' y f
= Phone: 503.718.2439 Fax: 503.598.1960 e� Plan Review
`)�,`� Date/By: Other Permit:
Inspection Line: 503.639.4175 nJ
Internet: www.tigard-or.gov ^ k ite Ready/By: Jugs: S See Pagel for
grid/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/refit performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipmcnt: boroverhead,and profit.
Value:$ 0
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/RWTEMS FEES-
® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family ❑ Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditionin 46.75
Job site address:11555 SW FAIRVIEW LANE Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:TIGARD,OREGON 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat ump 61.06
Suite/bldg./apt.no.: Project name: Duct work 2 23.32 46.64
Cross street/directions to job site:SW 115TH AVE Hydronic hot waters stem 23.32
Residential boiler(radiator or
h dronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for anyof above 3 23.32 69.96
Subdivision: HOLLVTREE Lot no.:2 Other: 23.32
Other fuel appliances:
Tax map/parcel no.:2SI03CDO0700 Water heater 1 23.32 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
MOVING WATER HEATER TO GARAGE ADDING GAS LINE fireplace 1 23.32 23.32
MOVING RETURN AIR DUCT AND ONE HEAT REGISTER IN THE KITCHEN 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: 23.32
Environmental exhaust and ventilation:
Name:SUNDANCE INVESTMENTS LLC Range hood/otherkitchen
equipment 1 33.39 33.39
Address: 17420 SW 110TH AVE Clothes dryer exhaust 33.39
City/State/ZIP:TUALATIN,OREGON 97062 Single-duct exhaust(bathrooms,
toilet corn artments,utility rooms) 23.32
Phone:(503)9691233 Fax:( ) Attic/crawls ace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name:SUNDANCE INVESTMENTS LLC Fuelpiping:
$14.15 for first four;$4.03 for each additional y
Contact name:SCOTT Furnace,etc.
Address: 17420 SW I IOr"AVE Gas heat pump
WalUsus ended/unit heater
City/State/ZIP:TUALATIN,OREGON 97062 Water heater 1 14.15 14.15
Phone:(503)9691233 Fax: :( ) Fireplace
Range
E-mail:HMSROBBINS@COMCAST.NET Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:SCOTT ROBERT GRIFFIN&IANCE GRIFFIN Other:
MECHANICAL PERMIT FEES*
Address:325 N.7T"AVE Subtotal 210.78
City/State/ZIP:CORNELIUS,OR 97113 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)329 4623 Fax:( ) o
State surcharge(12%of permit fee) 25.29
CCB lic.:201916 3 f ( TOTAL PERMIT FEE 236.07
This permit application expires if a permit is not obtained within 180
a days after it has been accepted as complete.
Authorized signature: Fee methodology set by Tri-County Building Industry Service Board
Print name:SCOTT ROBBINS Date:
1:\Bui1ding\Permits\MEC_PermitApp_040113.doc 440-4617T(I /02/COM/WEB)