Permit (24) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2016-00246
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/11/2016
T I c;A I�C� 9 Parcel: 1S133DD12900
Jurisdiction: Tigard
Site address: 11849 SW 126TH PL
Project: COURSOLLE Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 166
Project Description: Gas fireplace installation with venting and gas piping.
Contractor: R&D INSTALLATIONS Owner: COURSOLLE, JEREMY M&NANCY B
5246 SE 62ND 11849 SW 126TH PL
PORTLAND, OR 97206 TIGARD, OR 97223
PHONE: 503-774-7142 PHONE:
FAX: 503-774-7142
FEES
Specifics: Description Date Amount
Gas Fireplace 04/11/2016 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 04/11/2016 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel Piping 04/11/2016 $14.15
Stories: 12%State Surcharge-Mechanical 04/11/2016 $10.80
Minimum Fee Adjustment-Mechanical 04/11/2016 $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 copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee 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 < :V� Folz 0111("1; t St: 0\I.1
City Of Tigard Date/By:Received i PermitNo.:
13125 SW Hall Blvd.,Tigard,OR 9722 G y �'� _610149 r
:� • 01" Plan Review
„ 111 Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Date/By:
Inspection Line: 503.639.4175
I I .; \I:I) p PQ f t Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Qp ¢y1 ��1" iliified/Method: Supplemental Information
" .�; ,..Y a ir,.�." ,,,,7�. �:„ I 47 i: \'� .`.-- �`� '`.7'7" ; t1 iiii* 7.n-•fr' g I.. +�' r v ',,'...a! wy:�,.,'�!'
. 7" t .;, "* It ` ' " " ` p Mechanical permit fees*are based on the value of the work
w construction 0 Addition/alteration p'l'acement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
t ,, C A Value:
+'„"r :::::;a:
'..",•%4',441'
�1t ' r :'A4. 17' x l i '-,4.4. .M., ... a .44.,' `• ,;:n ,, '':
K
,,,.,,.. mss,.,,, ., r�r... . . ',n� 1? t �,,,
]and 2-family dwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist.
Multi-family ❑ Master builder 0 Other: Description Qty. Ea. Total
:m. z r "� s t� a Heating/cooling:
1,y t...� sw,.'"x '..,.'M 1 -tin _ ! �,� �,. +CSC'+, , ..,„ .'.. s... .-
(//`/) Air conditioning 46.75
Job site address: // C/ V9 � 6 -‹ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: T� A,.1/ Furnace 100,000+BTU(ducts/vents) 54.91
v !N�t/ i Heat pump 61.06
Suite/bldg./apt.no.: Project name: CoLir- 0//e.� 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
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DES n"np r Gas fireplace/insert f 33.39 33,3i
' � " ' "''" " '" ''1 " " Flue vent for water heater or gas
Vt 5-4- J/�( _ e S, 3. fireplace 1. 23.32 )3.3,A
ykr_, _ � �� J Log lighte (gas) 23.32
>,/� Wood/pellet stove 33.39
Wood fireplace/insert 23.32
•
Chimney/liner/flue/vent 23.32
y Other: 23.32
`« PR11P; iT OWNER a] .mANT
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawispace fans 23.32
"'. CAN
I CON Act' P N Other: 23.32
�' " Fuel piping:
Business name:
$14.15 for first four;54.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace 1 /l(-ij'
Range
E-mail: Barbecue
5, r ,,,t,t,...'<'„ ,«. 4, '- , .'. ';._ .0 ,,u ,, ,1., ,. ', Clothes dryer(gas)
Business name: 1Z Ct i 3 L�/ / Other
Address: SL VC 5 61 214 ` - Subtotal
City/State/ZIP: (2(4 4 O4 9)-Q'� Minimum permit fee($90.0 .Ov
t' 1111 Plan review(25%of permit feee))
Phone:563 )77V----7/V2 Fax:( e...).(4(( 1-yej State surcharge(12%of permit fee) jU .ke
CCB lic.: 9S-Z3lD TOTAL PERMIT FEE /4)//// 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 Budding Industry Service Board
Date:
I:Building Permits MFC_PermitApp_040113.doc `---�/ 440-4617T(I I X02 COM WOO)
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 Permits MEC_PennitApp_040II3.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
11849 SW 126TH PL, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
April 18, 2016 at 11:01:31 AM
MEC2016-00246
Chip Barnett
Violation Summary:
Inspector Contractor