Permit CITY OF TIGARD MECHANICAL PERMIT
s. '- COMMUNITY DEVELOPMENT Permit#: MEC2016-00379
T I G A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/26/2016
Parcel: 2S 1038607500
Jurisdiction: Tigard
Site address: 12512 SW 123RD AVE
Project: Wylder Subdivision: LAKE TERRACE Lot: 3
Project Description: Replace tank water heater with tankless water heater and associated gas piping.
Contractor: SYNERGY PLUMBING Owner: WYLDER, RICHARD D
15183 SE BANNER CT 12512 SW 123RD AVE
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503-201-5038 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Water Heater 05/26/2016 $23.32
Type of Use: SF Fuel Piping 05/26/2016 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 05/26/2016 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 05/26/2016 $52.53
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-00•%. You may .• ain a copy of the rules
or direct• ' • OUNC by calling 503.232.1987 or 1.800.332.2344.
/Alie
Issued :y: - /‘ (12.. /(/a--4 Permittee Signature: /
ACe
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE O I v
FECEIVED Received /
City of Tigard Date/BY:
p1..6 6 I Permit No.: •
,111 11 13125 SW Hall Blvd.,Tigard,OR 9722 y" /�^�37
S Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
l I c.n l:I) Inspection Line: 503.639.4175 MAY 2 6 2016 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov �' Notified/Method: Supplemental Information
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M Mechanical permit fees*are based on the value of the work
❑New construction �Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
❑Demolition ❑Other:
Value:$
.,. ,_ `
.+• m,. �.�•� �'6 ... _ .�>��.�.m"?.,< +a.4'r'M.. k,:a a;;,qg' k?., `� e � �9/z k' US`' g$'� :k' �,�?n:V �" ''
Aii.�.. ,.x"a m.n.'. &'Ayw x k....:,.,,•,,,.. ....:'$s,..s �' fie^Y:5* «. .t...o
lill 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master ❑
builder Other: Description I Qty. I Ea. I Total
i 4.,;;17%,:,-;,,,v,.., Heating/cooling:r ; v 1 C'' 11if �N ($ ,-
Air conditioning 46.75
Job site address: 06(,), sw 1 irct ctiv.e_ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: ;LOR__ Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 6123 06
32
Suite/bldg./apt.no.: Project name: ajas/\
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 1 23.32
�j �Ojv ifF WORK ,. Gas fireplace/insert 33.39
-� �-- v P Flue vent for water heater or gas
# (Jc /112.4 �Y/I C tool 1-64-J2 _ fireplace 23.32
o Log lighter(gas) 23.32
L ` / • �"'`,n 6 j/' Wood/pellet stove 33.39
Wood fireplace/insert 23.32
[ Chimney/liner/flue/vent 23.32
4);"14R-
f) lbt I pri i I. _ , :,',1Z1*: Other: 23.32
M " `' Environmental exhaust and ventilation:
Name: D...:c t%2_ , '1' Range hood/other kitchen
Ir' equipment 33.39
f. aAddress: (. SL2 �w / �(,o4 /1 _ Clothes dryer exhaust 33.39
City/State/ZIP: •'_(- __ _ f �L'� Single-duct exhaust(bathrooms,
l �/V"{�"`� 97 toilet compartments,utility rooms) 23.32
Phone:( ) •Fax:( ) Attic/crawlspace fans 23.32
11C' s Other: 23.32
Business name: P� - Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: _a, ��0 J� Furnace,etc.
11L��t^�t/ ,� 1 Gas heat pump
Address: 157 f5 7 L V'
J Wall/suspended/unit heater
City/State/ZIP: rj m 4.70/`;--- Water heater
Phone:( ) 20 l --S?'3 Fax::( ) Fireplace
ja
Range
E-mail:
S lAt'r 'i V ilei bl v W`�Vl.
� ....� ��1 �z ` :, CBlaortbhecesude
rer(gas)t , ' " ;;� �; ; ft at 4, 4 * '1:"..2 "'!;'314:4'''''''''''''''''•';•"--
Business name:
Q Other.
Address: .a AM 1 �.�",a, �M r� 41r11;
�? `---������{{ Subtotal
.�vwt-� � �,a
Minimumpermit fee 90.00
($ ) QD
Cit /State/ZIP: ll •
y V� 1 1 Plan review(25%of permit fee) ��
Phone:(5-1)2) �I-C-3-03 E3 Fax:( ) State surcharge(12%of permit fee) l0•Se
CCB lic.: BOO L TOTAL PERMIT FEE lam, Q&
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signator52 * Fee methodology set by Tri-County Building Industry Service Board
Print name: Alv,ofre,,)J. `ic/64{V1 Date: e-3---0\L. -
440-46 VT(I I
I:'Building,.Permits MEC PermitApp_040113.doc 02XCOM�WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Famil Fee Schedule:
00 4"`1' i—: w4 -+..: ; :.
$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\MECPerrnitApp_0401 13.doc 2