Permit (210) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2018-00573
T f GATd D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/25/2018
Parcel: 1S133DD05600
Jurisdiction: Tigard
Site address: 12753 SW WINTERLAKE DR
Project: ISAACS Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 95
Project Description: Gas piping to range.
Contractor: OWNER Owner: ISAACS, MICHAEL A AND CHERYL A
MICHAEL ISAACS 12753 SW WINTERLAKE DRIVE
12753 SW WINTER LAKE DR TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-524-0874 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 07/25/2018 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 07/25/2018 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 07/25/2018 $75.85
Occupancy Grp:
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 .
Issued By: - - - • ure: C
jar
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 OI FR sr ONl.v
City of Tigard Received
7 Permit No.: , t 7
"' 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598 1940 I� D Reviewy
Other Permit:
Inspection Line: 503.639.4175 r /
T[G A R Dr n F t, $t Date Ready/By: MI Hi See Page 2 for
Supplemental www.tigard-or.gov Notified/Method: Supplemental Information
JUL 2 2018
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
New construction / Addition/a r► rt 7.$ performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$$250.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 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
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:12753 SW Winter Lake Dr Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:97223 Furnace 100,000+BTU(ducts/vents) 54.91
' Heat pump 61.06
Suite/bldg./apt.no.: Project name: 3-r i G c_.5 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
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
Gas line to Kitchen fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:Michael Isaacs Range hood/other kitchen
equipment 33.39
Address:12753 SW Winter Lake DR Clothes dryer exhaust 33.39
City/State/ZIP:Tigard OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)524-0874 Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT ® CONTACT PERSON Other: 23.32
Fuel piping:
Business name: $14.15 for first four;$4.03 for each additional
Contact name:Michael Isaacs Furnace,etc.
Address:12753 SW Winter Lake Dr Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Tigard OR 97223 Water heater
Phone:(503)524-0875 Fax::( ) Fireplace
Range 1 14.15 14.15
E-mail:mc.isaacs@frontier.com Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: C � MECHANICAL PERMIT FEES*
Address: / Subtotal /II-t5
City/State/ZIP: Minimum permit fee($90.00) cid.✓)
Phone:( ) Fax:( ) Plan review(25%of permit fee) .---
State surcharge(12%of permit fee) la-e)
CCB lit.: TOTAL PERMIT FEE
This permit application expires if a permit is not obt ned wi hin 180
days after it has been accepted as complete.
Authorized signature: /141, * Fee methodology set by Tri-County Building Industry Service Board
Print name:Michael Isaacs Date:7/25/2018
I:\Building\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:
12753 SW WINTERLAKE DR, TIGARD, October 11 , 2018 at
OR, 97223 11 :08:58 AM
Record Type: Record ID:
Residential - Mechanical MEC2018-00573
Inspection Type: Inspector:
699 Mechanical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Gas line approved with test at 15 psi for 15 minutes.
Violation Summary:
Inspector Contractor