Permit (102) CITY OF TIGARD MECHANICAL PERMIT
2. COMMUNITY DEVELOPMENT
Permit#: MEC2017-00657
T€GAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/31/2017
Parcel: 2S104BD01400
Site address: 13665 SW FERN ST Jurisdiction: Tigard
Project: GIBSON Subdivision: OBRS HEIGHTS
Project Description: Furnace replacement. Lot: 1
Contractor: COST PLUS HEATING&AIR
Owner: GIBSON,ALEXIS&NATHANIEL
7132 N FESSENDEN ST 13665 SW FERN ST
PORTLAND, OR 97203 TIGARD, OR 97223
PHONE: 503-286-2009 PHONE:
FAX: 503-286-6552
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 08/31/2017 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 08/31/2017 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/31/2017
Occupancy Grp: $43.25
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �� Permittee Signature: 4.11,
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application
rox orrice lSl; o\l.1
City of Tigard Received _ .
111 0 a
13125 SW Hall Blvd.,Tigard,OR 97223 ^ " :‘ Date/By: `f�� Permit No.: _
Phone: 503.718.2439 Fax: 503.598 '.t Plan Review `
i-1 c A R I) Inspection Line: 503.639.4175 110Date/By: Other Permit:
Internet: www.tigard-or.gov t� 1-\\15,.1
0\t Date Ready/By: See Page 2 for
�t\� J Notified/Method: Supplemental Information
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❑New construction l Mechanical permit fees*are based on the value of the work
®Addition/altera cement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
® 1-and 2-family dwelling 0 Commercial/industrial _ � 1V1`l�,)U�I���5 ,�'I'�Al(�� -..
0 Accessorybuilding
❑Multi-family For special information use checklist
0 Master builder 0 Other: Description I Qty. I Ea. I Total
`i'ItN AviI Heating/cooling:
Job site address:13665 SW Fern Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 1 46.75 46.75
City/State/ZIP:Tigard or.97223 Furnace 100,000+BTU(ducts/vents) 54,91
Suite/bldg./apt.no.: I Project name: Heat pump 61.06
�t '� Duct work 23.32
Cross street/directions to job site:
Hydropic 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
Tax map/parcel no.: Other fuel appliances:
Water heater 23.32
�O kit. ' Gas fireplace/insert 33.39
Push pull furnacetxisting Vent,gas� ' Flue 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
... w ! Other: 23.320.'4 1 �. II
Name:Nathen Gibson Environmental exhaust and ventilation:
Range hood/other kitchen
Address:13665 SW Fern equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP:Tigard Or.97223 Single-duct exhaust(bathrooms,
Phone:(503)521 9302ax: toilet compartments,utility rooms) 23.32
F ( ) Attic/crawlspace fans 23.32
" P� :t.
Other: 23.32
Business name:Steven Sanderson Fuel piping:
Contact name: $14.15 for first four;$4.03 for each additional
Furnace,etc.
Address: Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
Phone:(503)781 9090 I Fax::( ) Fireplace
E-mail:stevecostplus@aol.com Range
Barbecue
` ,,...:':K.--2,:;,,:;:t. ' Clothes dryer(gas)
Business name:Cost Plus Heating @Air Other:
Address:7132 N Fessenden
Subtotal
City/State/ZIP:Portland Or.97203 Minimum permit fee($90.00) 90.00
Phone:(503)286 2009 I Fax:(503)286 6552 Plan review(25%of permit fee)
State surcharge(12%of permit fee) 10.80
CCB lie.:47978 S-1/0,1/pet TOTAL PERMIT FEE 100.80
This permit application expires if a permit is not obtained within 180
Authorized signature: ,jj -6.4.-( / days after it has been accepted as complete.
,� C O C Sc ti] * Fee methodology set by Tri-County Building Industry Service Board
Print name: S 4-cu, S A,A 3 0 r s J a✓ l Date:08/31/2017 l
I:\Building\Permits\MEC_PermitApp_040113.doc
440-4617T(l l/02/COMJWEl3)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13665 SW FERN ST, TIGARD, OR, 97223 September 12, 2017 at
2:13:50 PM
Record Type: Record ID:
Residential - Mechanical MEC2017-00657
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS - NoCofO
Comments:
Minor label # ELS 605133
Violation Summary:
Inspector Contractor