Permit CITY OF TIGARD MECHANICAL PERMIT
ieCOMMUNITY DEVELOPMENT Permit#: MEC2017-00831
T[ a�1 D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/24/2017
Parcel: 2S103DA02000
Jurisdiction: Tigard
Site address: 10865 SW DERRY DELL CT
Project: HOWE Subdivision: DERRY-DELL NO.2 Lot: 21
Project Description: Gas furnace installation with gas piping for furnace.
Contractor: OWNER Owner: JORDAN &RACHAEL HOWE
JORDAN &RACHAEL HOWE 10865 SW DERRY DELL CT
10865 SW DERRY DELL CT TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 971-228-9512 PHONE: 971-228-9512
FAX:
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 10/24/2017 $46.75
Type of Use: SF Fuel Piping 10/24/2017 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 10/24/2017 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 10/24/2017 $29.10
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: _ Perms'ee Signature:
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.
4
i r
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tl and Received
C�
_ g Date/By: 6 (7
' Permit No.: L .,v�s/?
� 13125 SW Hall Blvd.,Tigard,OR 9722 Y J Plan Review i — -�
Phone: 503.718.2439 Fax: 503.598.19EL0111 Date/BY: Other Permit: ,s
Ins
Inspection Line: 503.639.4175TIGARD ED
Date Ready/ed/Met Supplemental
y: See age 2 for
Internet: www.tigard-or.gov Notified/Method: PMSInformation
0 C T 24 2017 *07.44-41$000011t.4'.- ���` :'(} �ei I ii iiiii . CO.N MER ) S DU1 U5' ��CHEC IST''
'IIxJ �-�� —:'1''''
ill ''''''''''I''
,il -' -=.- �iE�}F� Imo+ �r � 6 �' � "'i�f� -�`_
�� A IG,� Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/altpe�rga�tioy re ayc�ementt performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: BUILDING DIVISION mechanical materials,equipment,labor,overhead,and profit.
;_ ��! ', i' ,CAT OR OiF 9 NSTR CTION ii Value:$
Fi� � � � itESXIQI13P**14YS :14k4„,,14
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
1 JB SITE FO i4TI3 AN OCOp6 ,. " Heating/cooling:
„ '°''''
,
Air conditioning 46.75
Job site address:10865 SW DERRY DELL CT Furnace 100,000 BTU(ducts/vents) / 46.75 44,1 S---
City/State/ZIP:
City/State/ZIP:TIGARD/OREGON/97223 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.:NA Project name:NA
Heat pump 61.06
Duct work 23.32
Cross street/directions to job site:99W,Non PARK ST,Ron DERRY DELL CT 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: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
��� �� " �'� �� " k' % Gas fireplace/insert
'._ t. inn, (:, SC IP 4";1l 4'OR4�__:2 " �i33.39
Flue vent for water heater or gas
INSTALL NEW 2 STAGE GAS FURNACE fireplace 23.32
RUN—40-45'1.25"GAS LINE FROM NEW METER TO FURANCE(-20'EXTERIOR Log lighter(gas) 23.32
Wood/pellet stove 33.39
OF HOUSE,REMAINING INTERIOR Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
(1 }4 ����� �� Other:
ROPE Y"ikWNl 2 �„ -Y lI ❑ TENANT ' �� .. 23.32
- .k Environmental exhaust and ventilation:
Name:JORDAN HOWE Range hood/other kitchen
equipment 33.39
Address:10865 SW DERRY DELL CT
Clothes dryer exhaust 33.39
City/State/ZIP:TIGARD/OREGON/97223 Single-duct exhaust(bathrooms,
Phone:( )971-228-9512 toilet compartments,utility rooms) 23.32
Fax ( ) Attic/crawlspace fans 23.32
_ //♦ thLIA X61 ��_'_t�.
� 'F� _„ ) �„ �I�! �"COAC'I'il�1P'ERS'ON , i Other: 23.32
Business name:NA Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:JORDAN HOWE Furnace,etc. M.I.S
Address:10865 SW DERRY DELL CT Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:TIGARD/OREGON/97223 Water heater
Phone:( )971-228-9512 Fax::( ) Fireplace
Range
E-mail:JORDAN LOWERY HOWE@GMAIL COM Barbecue
111-,:' lir- '' IC,„ tI( ,�O'tJN Olt, 4� J .�a�,.IIS I �I ilii Clothes dryer(gas)
Business name:NA Other:
" ,^yin i L7* FS* 'm.
Address:NA
Subtotal
City/State/ZIP:NA Minimum permit fee($90.00) Cl 0..,=:.'"-`-d
Plan review(25%of permit fee)
Phone:(NA) Fax:(NA)
State surcharge(12%of permit fee) iL,.V
CCB lic.:NA TOTAL PERMIT FEE i„,t.) at
j ` This permit application expires if a permit is not obtained within 180
i y, days after it has been accepted as complete.
Authorized signature: Gr” i f /4/Ni./7 * Fee methodology set by Tri-County Building Industry Service Board
Print name: /1 41 c, Date: t 42,4/0"--
I:\Building Termits)MEC_PermitApp_040113 doc
4/0}--I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
u,4 ,111,
Valuation; Permit"dee k' _r
$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:1Building\Permits\MEC_PennitApp_040113.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10865 SW DERRY DELL CT, TIGARD,
OR, 97223
Record Type: Record ID:
Residential - Mechanical MEC2017-00831
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor