Permit CITY OF TIGARD MECHANICAL PERMIT
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2.. COMMUNITY DEVELOPMENT Permit#: MEC2018-00468
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/20/2018
TIGARD Parcel: 2S103DB01400
Jurisdiction: Tigard
Site address: 13505 SW 110TH AVE
Project: BUYER Subdivision: MIRA PARK Lot: 10
Project Description: Radon mitigation system.
Contractor: XAVIER ENVIRONMENTAL INC Owner: BUYER, DANIELLE
11300 SW CAHALIN RD 13505 SW 110TH AVE
SHERWOOD, OR 97140 TIGARD, OR 97223
PHONE: 503-991-7250 PHONE:
FAX: 503-682-9506
FEES
Specifics: Description Date Amount
Other,ExhaustNentilation 06/20/2018 $23.32
Type of Use: SF 12%State Surcharge-Mechanical 06/20/2018 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 06/20/2018 $66.68
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 0875122944...,.
r >
Issued By: Permittee Signature:
, :‘ar:ir.s...... ._
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application , FOR (a l•I(.1•. I '4. (l\I 1
City of Tigard - , / „
p it No•
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13125 SW Hall Blvd Tigard,OR 97223
.'
' Phone: 503.718.2439 Fax: 503.598.1960
Date/By: Other Permit:
Inspection Line: 503.639.4175 JUN 2 0 2018 Date Ready/By: huis: El See Page 2 for .
Internet: www.tigard-or.gov
Notified/Method:
rr--6 Supplemental Information
CITY 0111:kc ARP„,„,,,,,.,,,,.,,,,„ -' _.''' ' :61iff':' ''''''s'"4';'' Mechanical petmit fees*are based on the value of the%Tar)
0 New construction I Addition/alteration/replacement performed.Indicate the value(rounded to the nearestaxidopml profit all
mechanical materials,equipment,labor,overhead,
0 Demolition 0 Other: , , ... ,n.AL;t1toulalue:$ toows Far ,
4 t:;*:::A::41 ."41.441•4115911N"'"""hffi'll'''' ; ion use checklist.
• 0 Accessory
rffi 1-and 2-family dwelling 0 Commermal/mdustnal building . FlIr&Pedal le Qty. Ea. Total
0 Multi-family 0 Master builder 0 Other: Description
• Heating/cooling:
, )I'i::'rr*! t ,I3 /etvi....,;.1:lDIEMr:ia,.'.5;ie,i,:Mliia FurnaceAi.r conditioningw000
46.75
Job siteaddress: - l 3--CO-- 561 //o46.75
City/State/ZIP: 1-;ere/t4 6,,,<- 97 z,i..,3BTU(ducts/vents)
Furnace 100,000+BM(ducts/vents) 54.91
Heatpump 61.06
Suite/bldg./apt.no.: Project name: „......,/Xf-Pfirt"84,rm Duct work 23.32
Cross street/directions to job site:
Hydronic hot water system 23.32
Residential boiler(radiator or
23.32
UhYndrit°hneiact)ers(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Other: 23.32
Lot no.:
Subdivision:
Other fuel appliances:
Tax map/parcel no.: Water heater 2332
33.39
, , .,,,„,,,,,,,,,,,A.L.4Kmrmirz flrePlaoolinsert
Ellailialliatta-IGasit'S:2!4'1,1'4,'3,0,.,c,t,',' 9NYK., , filiffifiamm,,,,,,,,,,I,,,,,,,,„„,„,,,,„,„:,,,,,,,,,,,,,,,,,„„,,,
Flue vent for water heater or gas
.
23.32
124,14_ irVae•Ye /1,0 -S-Ya'r4M- fireplace
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 2332
Other: 2332
Environmental exhaust and ventilation:
Name: /r.,k__
i""'1;147rv1)-4VITII•141gat"'4:A''''::""t'"E'9'N'w'''' Range 1d/hood/otherkitchen
illirlififirt .7.10'',",,,,'......-7;-, 1?,-.--E,,, ,,--,1-i.,'•' --- -*•- -
2,60., ate-yet----/
equipment
Address: ied d4 d1 414Ve' Clothes dryer exhaust : 3333..3399
Single-duct exhaust(bathrooms,
City/State/ZIP:
toilet compartments,utility rooms) 23.32
Phone:(60Z-) .; 7 --- (8' ,7 3 Fax
c:L,--.7.1itigsk tretet.,;:-:`::r.T.ZiyallIEROther:ri4orks"ce farl'Lit;4140' I 2323:33 22
,
Fuel piping:
cr+4-liiram,g, -.•,--,,.......„.„ ,, „ ,
Business name: XAA/le.t/-"t";v1.."71,:tris,..."././.__,Xce• 14.15 for first four;$IM for each additional
Furnace,etc.
Contact name: J-/ - /v4,4,7
,
Gas heat pump
Address: PO iso>6 // ??
Wall/suspended/unit heater
3.7
a
Water heater
Phone:
City/State/ZIP: /7,-,46,,,,444---
2_ f-z.z,‘: Fireplace
(563)— gitc-o''' 9Fax::.-Ci 676 7 Range
K
E-mail: >(Avie.e-&A V g e. ci- „,...1 -cenAA Barbecue
wit,,,,I,nroff.711211688finfgalrfe,It Clothes drYcr(8as)
Other
-- ...
Business name:
Address:
gi:rill;111,,,.1n;i5zOilik: ,:. „ !„„,„„,:„.„,r...,,,..:;1;total 21.32.
JX/141.4 zed eetsf7
Minimum permit fee($90.00)
City/State/ZIP:
Plan review(25%of permit fee)
Phone:( ) Fax:( )
State surcharge(12%of permit fee) k).
TOTAL PERMIT FEE itZ
CCB lic.: / 'OS/t
This permit adappllyscaornitexitesbeeilnaacceplisasnocotmobtaipieled within 150
* Fee methodology set by Ili-County Building Industry Service Board
Authorized sign // er .frzi)
Date: 4Atiky
Print name:
44046171'(11/1)21COM/WEB)
I: ' • IsWIEC_PermitApp_040113.dac
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13505 SW 110TH AVE, TIGARD, OR, 97223 May 20, 2019 at 10:11 :32 AM
Record Type: Record ID:
Residential - Mechanical MEC2018-00468
Inspection Type: Inspector:
699 Mechanical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor