Permit (124) Mechanical Permit Application IOROIIR I 1 I ()\L \City of Tigard Received
,.„ 4,temy: to ,. AEWIIIIIIII.irjr iiii Permit No.: _ ,, ,ji, is-v
, .., 13125 SW Hall Blvd.,Tigard,OR 97223
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Phone: 503.718/439 Fax 503.598.1960 :'..i't i 4 ";.a-41 7 .;" • Other Permit „:714) .....i
Inspection Line: 503.639.4175
1 IL, NRi) Date Ready/By: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
',-))ri 2 2017
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Mechanical permit fees*are based on the value of the work
0 New construction 0 Addition/alteration/1*V performed.Indicate the value(rounded to the nearest dollar)of all
affrffl, , , 1 1,,i %,
AL; f,,_, t„ _,- - 4. .4%.,' • mechanical materials,equipment,labor,overhead,and profit
0 Demolition 0 Other:
Value:$2,000.0
CATEGORY OF 031"11t1Jen,1 ' - ' '-' Rystogroixt izamtgpriv liaTtui
ID 1-and 2-family dwelling [2]Commercial/industrial 0 Accessory building For special information use checklist
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
TOR SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:16650 SW 72'd Ave
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Portland,OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Johnstone Supply
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
OESCRTPTION OF WORK Gas
fireplace/insert 3339
Flue vent for water heater or gas
Modify existing duct work for new rooms fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
CI
PROPERTY OWNER
Other: 23.32 0 TENANT
Environmental exhaust and ventilation:
Name:PacTrust Range hood/other kitchen
equipment 33.39
Address:15350 SW Sequoia Parkway,Suite 300
Clothes dryer exhaust 33.39
City/State/ZIP:Portland,OR 97224 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)624-6300 Fax:( ) Attic/crawlspace fans 23.32
- ' - - -
QAnuc ,-4 - ' - — - - - 0 coNTA--r PERSON Other: 23.32
Fuel piping:
Business name:Excel HVAC,Inc
$14.15 for first four;$4.03 for each additional
Contact name:Jennifer Fulsher Furnace,etc.
Gas
Address:PO Box 1188 heat pump
Wall/suspended/unit heater
City/State/ZIP:Canby,OR 97013 Water heater
Phone:(503)504-3627 Fax::( ) Fireplace
Range
E-mail:Jennifer@excelhvac.net
Barbecue
CONTRACIOR Clothes dryer(gas)
Business name:Excel HVAC,Inc Other:
MECKAN1641.MOOT FEES*
Address:PO Box 1188
Subtotal
City/State/ZIP:Canby,OR 97013 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)504-3627 Fax:( ) State surcharge(12%of permit fee)
CCB lie.:214345 TOTAL PERMIT FEE I57 70
This permit application expires if a permit is not obtained within 180
s...4z..............._
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:Jennifer Fulsher Date:10-2-2017
I\Budding\Permits\MEC PermitApp_040113 doc 440-4617T(11/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16650 SW 72ND AVE B12, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Mechanical MEC2017-00750
Inspection Type: Inspector:
699 Mechanical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor