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Permit Support Document „I CITY OF TIGARD MECHANICAL PERMIT X.�' COMMUNITY DEVELOPMENT ' ''° • Fr& Permit#: MEC2017-00933 T 1 f(3,A 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 © / Date Issued: 11/27/2017 n Parcel: 2S 110DD06000 Site address: 10655 SW HIGHLAND DR Jurisdiction: Tigard Project: Andrilenas Subdivision: SUMMERFIELD NO.4 Lot: 160 Project Description: Gas Piping. 1/4/18:REPRINTED to add range hood. Contractor: GASPRO INC Owner: BULLOCK, JOSEPH FRANKLIN 7603 SE LOUNSBERRY LN BULLOCK, INGRID ELIZABETH PORTLAND, OR 97206 10655 SW HIGHLAND DR TIGARD, OR 97224 PHONE: 503-775-7020 PHONE: FAX: 503-775-7019 FEES Specifics: Description Date Amount Range Hood/Other Kitchen 11/27/2017 $33.39 Type of Use: SF Fuel Piping 11/27/2017 $14.15 Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 11/27/2017 $42.46 Occupancy Grp: 12%State Surcharge-Mechanical 11/27/2017 $10.80 Stories: Fuel Fuel Types: Natural Gas Gas Pressure: Total $100.80 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: at / u75o17 Call 503.639.4175 by 7:00 a.m.for the next available inspection p n date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Meeh RFCEE Mechanical Permit Application City of Tigard R2U 13eceived 11 u 13125 SW Hall Blvd.,Tigard,OR 97223 I}ate/By: >' �� Permit No Of Q tt Phone: 503.718.2439 Fax: 503.5981%p Plan Review T I C:n it D Inspection Line: 503.639.4175 .`,4 yi;, * r t,r i pale/By: Other Permit: Internet: www,tigard-or.gov , �r Date Ready/By: lens-}pk., J" t o ti.:•',t l /f l Notified/Method: S See Page 2 for r J,± � , Supplemental Information YPE OF WORK COMMERCIAL FEE* SCHEDULE USE CHECKLIST Mechanical permit fees*are based on the value of the work ❑New construction Addition/alteration/replacement ❑Demolition performed.Indicate the value(rounded to the nearest dollar)of all ❑Other: mechanical materials,equipment,labor,overhead,and profit. �/ CATEGORY OF CONSTRUCTION Value:$ Ler! 2-family dwelling 0 Commercial/industrial Accessory industrial - RESIDENTIAL EQUIPMENT/SYSTEMS FEES* building For special information use checkllsL ❑Multi-family 0 Master builder 0 Other. Description I Qty. I Ca. I Total JOB SITE INFORMATION AND LOCATION AHieractoinngonliinng g: it Job site address: I 51/0 ( vi vO- & (requires site plan showing placement) 46.75City/State/ZIP: Ti ljf \ 912` Furnace 100,00013TU(ducts/vents) Furnace 100,000+13TU(ducts/vents) 46.75 54.91Suite/bldg./apt.no.: I Project name: 4-Vid,0 teals Heat pump Cross street/directions to job site: (requires site plan showing placement) 6l•06 Duct work 23.32 tlydronic hot water system 23.32 Residential boiler(radiator or hydropic) 23.32 (fuel-type,not electric), in-wallUnitheaters,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: I Lot no.: Tax map/parcel no.: Other: 23.32 Other fuel appliances: DESCRIPTION OF WORk Water heater �C 1 „ 23.32 �d4�� (� ,.Q(,�}�,1-,� Gas fireplace 33.39 p o �- �,( n ✓1`3 l Flue vent for water heater or gas -P � J_1 -0 (7-0015 fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 0 TENANT Chimney/liner/flue/vent 23.32 0 PROPERTY OWNER I Name: Other: 23.32 Environmental exhaust and ventilation: Address: Range hood/other kitchen City/State/ZIP: equipment j 33.39 Clothes dryer exhaust 33.39 Phone:( ) I Fax:( ) Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 "APPL1CANTVn 0 CONTACT PERSON _Attic/crawlspace fans G.ry k ?1 U �-r 23.32 Business name: eia,) JJ�/ ci Other: 23.32 Contact name: (/) i (J �S Fuel piping: �6 I n 5 Vt�I t/�. SI4.15 for first four;54.03 for each additional Address: L- H,�� ,/I -y Furnace,etc. City/State/ZIP: H.i. � Q v vOK 972 2( 7 Gas heat pump V Wall/suspended/unit heater Phone:(0175—702-0 I Fax::( ) Water heater E-mail: 15ar)(7(/n 10(,@ 90/Y1 0/ 1 WI I (•�,„i Fireplace C' V `��CONTVRAr iCTOR • W'/vr Range r'^ Barbecue Business name: 0 C�5'pm r,i l e) Clothes dryer(gas) Address: 5 it 2_ 5E Hes/)Vi k / Other: City/State/ZIP: 'I,.` / Q i) i Il .. I( V.. VV'� cy74�� MECHANICAL PERMIT FEES* �t^^� wt� "( Subtotal Phone:( ) VS-- 0 I Fax:( ) Minimum permit fee($90.00) CCB lie.: I(674. f Plan review(25%ofpermit fee) �j State surcharge(12%of permit fee) OXUAC� hAll4P TOTAL PERMIT FEE ' p Authorized signature: This permit application expires if a permit is not obtained within 180 Print nemC: AI r days after it has been accepted as complete. ` ��il.(�(,L�s Date: �� !I S I • Fee methodology set by Tri-County Building Industry Service Board t:\OwtdinglPermnsl►IEC-Permi,App"doe 09/09/10 (ll 440-16177(1 iro2/COWWEs)