Permit (264) CITY OF TIGARD MECHANICAL PERMIT
101 ' COMMUNITY DEVELOPMENT Permit#: MEC2017-00005
T[ ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/03/2017
Parcel: 2S 111 CD06600
Jurisdiction: Tigard
Site address: 9847 SW KIMBERLY DR
Project: Reed Subdivision: KERWOOD ESTATES Lot: 21
Project Description: Add gas line for cooktop,move(2)heat ducts,add new hood vent&add new bath fan.
Contractor: ROTH HEATING&COOLING Owner: REED, MICHAEL T&ANGELA L
PO BOX 1265 9847 SW KIMBERLY DR
CANBY, OR 97013 PORTLAND, OR 97224
PHONE: 503-266-1249 PHONE:
FAX: 503-266-3478
FEES
Specifics: Description Date Amount
Duct Work 01/03/2017
$23.32
Type of Use: SF Range Hood/Other Kitchen 01/03/2017 $33.39
Class of Work: ALT Type of Const: Single Duct Exhaust(Bathrooms,Toilet, 01/03/2017 $23.32
Occupancy Grp: Utility Rooms)
Stories: Fuel Piping 01/03/2017 $14.15
12%State Surcharge-Mechanical 01/03/2017 $11.30
Fuel
Fuel Types:
Gas Pressure:
Total $105.48
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or directqu •UNC by calling 503.232.1987 or 1.800.332.2344.
Issued !� / ��/�"��' Permittee Signature: X T 'V�
Call 503.639.4175 by 7:00 a.m.for the next available inspection(date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applicat' FOR OFFICE l SE ON El
City of Tigard V P Received
��� Permit No.: /I�
11111
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: � F /7-dee0
Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 ii-AN 20-1-7-
Date/By: Other Permit:
TI G A R U Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
Internet: www.ti and-or. ov
g g ���-�y �1' ;����'�� Notified/Method: Supplemental Information
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TYPE OF W(1fRK COMMERCIAL FEE* SCHEDULE- USE CHECKLIST
'` Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
. .. ., .
Value:$
CATEGORY O1 CONSTRUCTION} RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
0 1-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 rI.00A.TION
Air conditioning 46.75
Job site address: qgL f 7 yW �l.ytift,,I pt. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 77 6-440 Olt. et 71r7--4/ Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name:
Heat pump 61.06
Duct work 1 23.32 R3.31--
Cross street/directions to job site: Hydronic hot water system 23.32
p"` -(%'T/^ l v g 74
- 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
Subdivision: Lot no.: Oth23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
x DESCRIPTION OF WQ#R 's Gas fireplace/insert 33.39
-` fi- '.w Flue vent for water heater or gas
A__t7p4404/e- �'1 IA-I Pt, C,-,-irl fireplace 23.32
4' L S l)K G�,S Log lighter(gas) 23.32
4404/e- �// Wood/pellet stove 33.39
kW /071,JCIQBO Y Wood fireplace/insert 23.32
4p0 I ' pi. lr4`1 Chimney/liner/flue/vent 23.32
23.32xe L PROPETY OWNER 1£$ 0 N other:
x, Environmental exhaust and ventilation:
Name: JAII tr----- g ) Range hood/other kitchen
Address: -.1 g I/,7 Sl,,/ i' 3� �_ equipment 33.39 15*39
( ` Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms, l
G toilet compartments,utility rooms) + 23.32 t3 32
Phone:( d j) / sZ — b L'2,0 Fax:( ) Attic/crawlspace fans 23.32
Other: 23.32
91 APPLCAT 0 CONTACT PERSON ,'
Business name: ��f1 / ( ifr
Fuel piping:
a 6.-oa 7-44,..,6,r,6'� r ei"j� Jt. $14.15 for first four;$4.03 for each additional
Contact name: �,� j3. Furnace,etc.
Address: )5-7 c- 6,.J S q ex. Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: --7-11,44,-4,/,/ 1,,t-- 12 7.,"2-- Water heater
Phone:(Svs) y°7— G)ben Fax::( ) Fireplace
E-mail: 6.115,1; �
LotTM,i LT a ef` yy c t t . 4,43-r. Nei Range ! 17'/C—.
Barbecue
•
CONTRACTOR Clothes dryer(gas)
Business name: r2-01-44 01-1_, Other:
MECHANICAL PERMIT FEES*
a
Address: Subtotal /T
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) j 36CCB lic.: /Cob g TOTAL PERMIT FEE /06-,qc'
� This permit application expires if a permit is not obtained within 180
C days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: (15 rj Date: / /7 6,
I:\Building\Permits\MEC_PermitApp 040113.doc 440-46171(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
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
9847 SW KIMBERLY DR, TIGARD, OR, 97224
Record Type:
Residential - Mechanical
Inspection Type:
699 Mechanical final
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
MEC2017-00005
Inspector:
Jeff Grove
Contractor