Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2018-00136
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/26/2018
Parcel: 2S 104AA08500
Jurisdiction: Tigard
Site address: 12650 SW KATHERINE ST
Project: DODSON Subdivision: BELLWOOD NO.2 Lot: 100
Project Description: Gas piping for range.
Contractor: CENTRAL OREGON PLUMBING SERVICE LLC Owner: DODSON, ERIC J& KATIE L
PO BOX 696 12650 SW KATHERINE ST
NEWBERG, OR 97132 TIGARD, OR 97223
PHONE: 541-390-4797 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 02/26/2018 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 02/26/2018 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 02/26/2018 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.19: �.. .2344. r
Issued By:
� �� Permittee Signature: /
Call 503.639.4175 by 7:00 a.m.for the next available isn }Section date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application vvil FOR OFFICE USE Ont.)
AV CAI v Las Received , ,
: City of Tigard . A e Date/By: ,... • /$ Alirjr
w 13125 SW Hall Blvd.,Tigard,OR 972 -
II Phone: 503.718.2439 Fax: 503.598.1960
III Permit No.: At:.: ..,, 1 i• .
7 11?i, Date/By:PIanReiew a
Other Permit: - i .. _iip
Inspection Line: 503.639.4175
1.7:--B 2 6 -- ' Date Ready/By: 0 See Page 2 for
TIGARD
Internet: www.tigard-or.gov
Notified/Method: Supplemental Information
OVIIG Pat
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TVPEOF
WO 1G DIVISI(Pti ' COMMERCIAL FEE* SCHEDULE 1:.'USE CHECKLIST
A. Mechanical permit fees*are based on the value of the work
0 New construction KAddition/altelo replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION ,. ' ' - - ' RESIDENTIAL E(IJIPMENT I SYSTEMS FEES*
Q 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
'-
Air conditioning 46.75
Job site address: I 24 5'..) / i44,-,--wcya,,../e_ 7---.
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 7/C --1/7/7 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:
ANZiani 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
iiESCROIT101+4 tw4.0mc, '..t, '7 ' '1-:N9,`7, " Gas fireplace/insert 33.39
Flue vent for water heater or gas
/10 ,• •• 6---4-5 g*,---6.-L--7 fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other:
1:3,-)FIPP-Elqir-OWNER 0 TENANT 23.32 7 c' Environmental exhaust and ventilation:
Name: 6-7z i
DL7/.)f.:C:'•"\ Range hood/other kitchen
equipment 33.39
Address: /is 6 5,,, 5,,..., / ?1eZ .,,...-7 e: 97
Clothes dryer exhaust 33.39
City/State/ZIP: 'TrC.„/-t/Z.,c e-,e, Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT ,.. --'. ' ' ;' ' to CONTACT PERSON ,.. i''‘. Other: 23.32
Fuel piping:
Business name: C 0 f 5 ,,,i,y 3.3 3-" t ec:- 2_1_C ,
$14.15 for first four;$4.03 for each additional
Contact name: J 1-5,1,--\ Furnace,etc.
Gas heat pump
Address: e, ge„,_ -6
Wall/suspended/unit heater
City/State/ZIP: /4/14_„1,ei-26. C-1.7/7.Z. Water heater
Phone:($'( ) 3 _ /...7.--7,2 7 Fax::( ) Fireplace
Range /
E-mail:
Barbecue
CONTRACTORn '''.: 1, . :„.1 - ---''' 4",' re ':::s ' Clothes dryer(gas)
_
Other: .,.
Business name: 6,_ c)/,/-1..4i.-,c.. Se./2,,,c ,-. Lic:-
7' '''' MECHANICAL PERMIT FEES*
Address: ;2„ g. c 6,
Subtotal
Minimum permit fee($90.00)
City/State/ZIP: „...t.,/, /S'v.„2 6 e ....2" ',--;713 z
fr
Plan review(25%of permit fee)
Phone:(5-i-(( ) 3 fie -/-(79--7 Fax:( )
State surcharge(12%of permit fee) /0,
CCB lie.: ?t 4-7:2 5-9
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: 7* --------- .,----) ' .6-----
* Fee methodology set by Tri-County Building Industry Service Board
Print name: ,4-5,,,--. 72(--Ar--/-7(.1- Date: 2.72
VBuildingTermits\MEC_PermitApp_040113 doc 440-46171(1 I/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
Total Valuation:° Permit Foe:
$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:
12650 SW KATHERINE ST, TIGARD, OR, 97223 March 23, 2018 at 9:49:29 AM
Record Type: Record ID:
Residential - Mechanical MEC2018-00136
Inspection Type: Inspector:
610 Gas line David Young
Result:
FA I L
Comments:
Provide approved gas line pressure test.
No test on new branch line. G2417.1 .3
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12650 SW KATHERINE ST, TIGARD, OR, 97223 April 16, 2018 at 11 :45:30 AM
Record Type: Record ID:
Residential - Mechanical MEC2018-00136
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor