Permit (209) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2016-00828
13125 SW Hall Blvd.,Ti Date Issued: 12/12/2016
T 4 f a'�4. and OR 97223 503.718.2439 9
Parcel: 2S111CC15400
Jurisdiction: Tigard
Site address: 10055 SW HIGHLAND DR
Project: CLOUSER Subdivision: SUMMERFIELD NO.4 Lot: 205
Project Description: Gas piping for range and fireplace.
Contractor: BUDGET HEATING Owner: CLOUSER, PENELOPE L
13885 SE 177TH CT 10055 SW HIGHLAND DR
DAMASCUS, OR 97089 TIGARD, OR 97224
PHONE: 503-233-3133 PHONE:
FAX: 503-558-9050
FEES
Specifics: Description Date Amount
Fuel Piping 12/12/2016 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 12/12/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 12/12/2016 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
frOP
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Issued By: 7 Permittee Signature: 411 jorr
APO
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE ISE 011.1
Received
City of Tigard PermitNo.:
♦ 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: I /(p �►j� M « R (�
oh
Plan Review
Date/By:
Phone: 503.718.2439 Fax: 503.598.196 Other Permit:
T I GA R D Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov ki Notified/Method: Supplemental Information
FIJI
COMMERCIAL FEE* SCHEDULE — USE CHEC •IST
E OF WORID� kW/
{� Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteratioffle 1N performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: 11'4 s"' mechanical materials,equipment,labor,overhead,and profit.
�(� Value:$
CATEGORY OF CON' A ➢.YTION
RESIDENTIAL EQUIPMENT I SY TEMS FEES*
I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
Heating/cooling:
JOB SITE INFORMATION AND L ATION
Job site address: /Q�C3- c� /n l c d/ conditioning 46.75
//Y«'� Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: /_)5fc(f( c-'/'t9. 72 2 Furnace 100,000+BTU(ducts/vents) 54.91
✓ Heat pump 61.06
Suite/bldg./apt.no.: Project name: 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
ti DRSCRIPTION OF " tt Gas fireplace/insert 33.39
. " " Flue vent for water heater or gas
fireplace 23.32
0tC,� /VqY Z D Jt- Log lighter(gas) 23.32
Wood/pellet stove 33.39
( ///CLV Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Q PROPERTY OWNER E 0*NANT': Other: 23.32
. ""_*�`` Environmental exhaust and ventilation:
Name: %A/e tom (-'/ Range hood/other kitchen
ff ( 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/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace / /1/..l5
Range /
E-mail: Barbecue
C7zogCTOR Clothes dryer(gas)
Other:
Business name: ea MECHANICAL PERMIT
Address: 7 �9
1 �� Subtotal
Jr1,(c"-
City/State/ZIP:
""
Ci /State/ZIP: 9<J �� Y?og7 Minimum permit fee($90.00) 1d,ec
Phone:( 3/2" .2.2(:/o() Fax:( ) Plan review(25%of permit fee)
/ G , State surcharge(12%of permit fee) as•f)
CCB lic.: /�/ 7 9�`� TOTAL PERMIT FEE J00
// ( !` "�� This permit application expires if a permit is not obtained within 180
7//far
e/(/ days after it has been accepted as complete.
Authorized signi re: c C 2. ` * Fee methodology set by Tri-County Building Industry Service Board
Print name , ‘ l/ Date: Z,,"dip
(
I:\Building\Po o CPermit 40,113.doc 440-4617T(11/02/COM/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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10055 SW HIGHLAND DR, TIGARD, OR, 97224 March 8, 2017 at 9:59:06 AM
Record Type: Record ID:
Residential - Mechanical MEC2016-00828
Inspection Type: Inspector:
699 Mechanical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor