Permit Support Document CITY OF TIGARD 1 { MECHANICAL PERMIT
COMMUNITY DEVELOPMENT itisIENPermit#: MEC2017-00112
T1( ;,R.1) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/10/2017
Parcel: 1 S 133AD 10300
Jurisdiction: Tigard
Site address: 10659 SW 127TH CT
Project: JACOBS Subdivision: AMART SUMMER LAKE NO.3 Lot: 159
Project Description: INSTALL FURNACE AND AIR CONDITIONING.3/2/17,REPRINTED to add gas piping.
Contractor: SKY HEATING&AIR CONDITIONING, INC Owner: JACOBS, GREGORY TODD&
1635 SE NEHALEM ST JULIE ELIZABETH
PORTLAND, OR 97202 10659 SW 127TH CT
TIGARD, OR 97223
PHONE: 503-235-9083 PHONE:
FAX: 503-235-0454
FEES
Specifics: Description Date Amount
Air Conditioning 02/10/2017 $46.75
Type of Use: SF Furnaces<100K BTU 02/10/2017 $46.75
Class of Work: ADD Type of Const: 12%State Surcharge-Mechanical 02/10/2017 $11.22
Occupancy Grp: Fuel Piping 03/02/2017 $14.15
Stories: Misc Administration Fee 03/02/2017 $45.00
12%State Surcharge-Mechanical 03/02/2017 $1.70
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $165.57
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notificati.• enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct•.-stions to • NC • calling 503.232.1987 or 1.800.332.2344.
Issuer By: / v
•
Permittee Signatur :
Call 503.639.4175 by 7:00 a.m.for the next available inspe tion date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Appli4 FOR OFF l: L sh,o1L1
City of Tigard a RDateeceiBy:ved
13125 SW Hall Blvd.,Tigard,OR 9 2�r,
111,1 ,Hamm permit No.: �17.E e6//,2.
Phone: 503.718.2439 Fax: 503.5980 '} m11 Plan Review Other Permit:
T 1 ,A P,D Inspection Line: 503.639.4175
Date/By:
Internet: www.tigard-or.gov Date Ready/By: Jurb: See Page 2 for
ti
1, ` Supplemental Notified Method: Supplemental luformation
•
,
❑New constructionAddition/alteration/replacement Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
1-and 2-family dwelling 0 Commercial/industrial
❑Accessory building For special information usee checec klist
❑Multi family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
:+,, i Heating/cooling:
Job site address:10659 SW 127TH CT Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:97223 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: I Project name: Heat pump 61.06
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
Subdivision: I Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater
23.32
Gas fireplace/insert 33.39
PLEASE ADD GAS PIPING TO EXISTING PERMIT MECH2O17-00112 r frup vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32• ' ��
�.,at" ,_ .�:, .,,a a ate,^' � .. ,� .�29 �'�„ Other:
23.32
` Environmental exhaust and ventilation:
Name:GREG AND JULIE JACOBS Range hood/other kitchen
Address:10659 SW 127TH CT. equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP:TIGARD,OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)419-8765 Fax:( )
Attic%raw pa ce fans 23.32
.Ak. a t • tw 2 ' Other: 23.32
Business name:SKY HEATING Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:SHANNON JONES Furnace,etc. 1
1
Address:19305 SW TETON Gas heat pump
City/State/ZIP:TUALATIN,ORE 97062 Wall/suspended/unit heater
Water heater
Phone:(503)235-9083 Fax::(971)224-5302 Fireplace
E-mail:INSTALL@SKYHEATING.COM Range
Barbecue
a: z '' O O Clothes dryer(gas)
Business name:SAME AS APPLICANT Other:
Address: n MECIIANIcM.PERMIT*EBSi:
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( )
State surcharge(12%of permit fee)
CCB lic.:
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signatu * Fee methodology set by Tri-County Building Industry Service Board
Print name:SHANNON JONES Date:3/2/2017
I:\BuildingPermits\lblEC PermitApp_0401 13.doc 440-4617T(11/02/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\Permits\MEC_PermitApp_040113.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10659 SW 127TH CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Mechanical MEC2017-00112
Inspection Type: Inspector:
699 Mechanical final Allyson Armstrong
Result:
PASS - NoCofO
Comments:
EL S574107
Violation Summary:
Inspector Contractor