Permit (30) ;II CITY OF TIGARD MECHANICAL PERMIT
: . : COMMUNITY DEVELOPMENT Permit#: MEC2016 00098
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/11/2016
Parcel: 2S110DD05700
Jurisdiction: Tigard
Site address: 10660 SW HIGHLAND DR
Project: Fletcher Subdivision: SUMMERFIELD NO.4 Lot: 157
Project Description: Installation of gas line for new gas fireplace. Fireplace install by others.
Contractor: J & M CONTRACTOR SERVICES INC Owner: FLETCHER FAMILY REVOCABLE TRUST
15604 NE RUID RD BY FLETCHER, GILBERT J&ARLENE F T
AMBOY, WA 98601 10660 SW HIGHLAND DR
TIGARD, OR 97224
PHONE: 503-680-0195 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 02/11/2016 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 02/11/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 02/11/2016 $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 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 ions to UNC by calling 503.232.1987 or 1.800.332.2344. /
Issued B /4 Permittee Signature: W , .
x
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 FOIL(H.—Fitt: I SI:O\I.,
CI of TigardNI DECEIVED Received �����
PiN
13125 SW Hal Blvd.,Tigard,OR Date/By: �o/lp C
Other Permit:
INS Plan Review
Phone: 503.718.2439 Fax: 503.598.196097 Date/By: Permit
1 1 t A I,1, Inspection Line: 503.639.4175 FEB 1 1 2016 Date Ready/By: tura: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY •FTI 1
4a f q;,u 4t s t iWy'ri.° se's .ait�. itt t s. 1" " <; U+.�' 4 " ' i li �`: '
b� '�, � � ss 'ab,' t s�" I �` �r ts:wt 'r � � a �>^ �"�
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Mechanical permit fees*are based on the value of the work
❑New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition Other: mechanical materials,equipment,labor,overhead,and profit.
Value $
{ _ ;». ...-. : ', ..r ,� ,. ..- 1 4-4-,-,4,44.—WW�..,. ,s,-.,,.. o ;t ,4.<, ,. 1. P ,). s st ,^ 1 ,� ,:,i14;* �.. r a.)''DL. .�' '.
� ;a .� "s.�rr,s.� ;.. a�,of > .-.. , .. :,
jai-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑ Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
x r, filiirie :, ,• Heating/cooling:
,r ,., '"a� .... g.....,t w t c rA F... Air conditioning 46.75
Job site address:l(./ b, S t X l l
�� l G', Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: "----7-;,f.60,--e(/
; a / 91?.,24:2 ti Fun 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:F/P 7--`,t o Duct work 23.32
•
Cross street/directions to job site: ` Hydronic hot water system 23.32
Residential boiler(radiator or
Sk ril y,.......-- ll Dr, • L.j Crre e„,..S hydronic) 23.32
�-,` IA.,-1 Unit heaters(fuel-type,not electric),
G'e�.Lsr.� _ ----h 4 �/f ` in-wall,in-duct,suspended,etc. 46.75
174f
Flue/vent for any of above 23.32
�&t Lot no.: Other: 23.32
Subdivision:
_Cu_tri i' " Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESiCRIP1`iON-O WORK Gas fireplace/insert 33.39 . -1
a 111 q _ �i flue vent for water heater or gas
%h�`�
' �� V �sfireplaceL23.32
Log lighter(gas) 23.32
- � 6(47y- r (7 az I),s-2-(A-1- Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
., Other: 23.32
`a {' ^,_ .. a"' �; A. ,i Environmental exhaust and ventilation:
Name: 6,2;/ E A�/ ,'/61C i -- Range hood/other kitchen
/066/7 �� ) /tw X/ , Clothes t 33.39
Address: V S(/1/ r Clothes dryer exhaust 33.39
City/State/ZIP: ']—/`1 .-„/ "" q / `� Single-ductpexhaust(bathrooms,
/ J toilet compartments,utilityrooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
'11 AM4r u r toot v-.r apty V444 :' 'cox Other: 23.32
Business name: j / c > t! / Fuel piping:
'� .f if�/' � l�� 1--- $14.15 for first four;$4.03 for each additional
Contact name: Jam'tri
/^ J'�tI� ay eh` I) / (�v�-r Furnace,etc.
JJJJ���-���� 11�� hie!/ v v`��U / �' Gas heat pump
Address: g"27- ` ',/ �/ aye ,
L Wall/suspended/unit heater
City/State/ZIP: �� q i or q 7 a Water heater y
Phone:LQJ) b ff.�d (Bob I :su >X—f-7/,j�7�%, Fireplace
7 �) / Range
E-mail:# .f 11 B'Z/�9 i- ��� l 1 C2 '/.C�becue
'' tiF..)Si: r , =: �z xe v.t if ` ; 'fc 7.S
�� =4 f� ( Clothes dryer(gas)
Tor M�x� .b'" �.-:'�. R. �... ., .�*:'�e� ���n
Business name: 3'q" I - t Other:
Y n� � /Y v. C �`f N'� m ,,t r� �`
Address: /5/j L{ ,'J I��-:.J �. , r,� „J.;. .,#'-',0:,,0“,,,:, -4:-.;47-74W
Subtotal
City/State/ZIP: l m._ /t Minimum permit fee($90.00) (?&•65°�/ Plan review(25%of permit fee) ��-
Phone:,'7 ) &So”- /(2/5--/- Fax:( ) State surcharge(12%of permit fee) /Q(..cq,)
CCB lie.: /Sg5q, TOTAL PERMIT FEE /On.
dkr)
This permit application expires if a permit is not obtained wt inYt3
days after it has been accepted as complete.
Authorized signapo,,,-,
ture: r 6 6/al / 4 * Fee methodology set by Tri-County Building IndustryService Board
Print name: w(/ L f Date:���; `l J c )/6FBuilding PermitsMEC_PermitApp_040113.doc J 440-4617T(1I 02 COM WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Famil Fee Schedule:
$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\Pennits\MEC_PennitApp_040113.doc 2