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Permit
CITY OF TIGARD MECHANICAL PERMIT IIII 'F Permit#: MEC2018-00767 � COMMUNITY DEVELOPMENT 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/24/2018 T I c.;4 I C7 g Parcel: 2S103BC03700 Jurisdiction: Tigard Site address: 12420 SW ALBERTA ST Project: WILHELM Subdivision: None Lot: None Project Description: Replace forced air furnace with forced air natural gas furnace. Contractor: OWNER Owner: WILHELM, MICHAEL W MICHAEL WILHAM 13085 SW 124TH AVE 13085 SW 124TH AVENUE TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-590-4495 PHONE: 503-595-4495 FAX: FEES Specifics: Description Date Amount Furnaces<100K BTU 09/24/2018 $46.75 Type of Use: SF Fuel Piping 09/24/2018 $14.15 Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 09/24/2018 $10.80 Occupancy Grp: Minimum Fee Adjustment-Mechanical 09/24/2018 $29.10 Stories: Fuel Fuel Types: Natural Gas Gas Pressure: Total $100.80 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 32.1987 or 1.800.332.2344. U/, s Issued By: e.et L _.. Permittee Signature: --7 �2 10 �,.c, ---, C Y Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard SEP 2 2018 Date/By:Received i� Pe , .+bs , ' III 13125 SW Hall Blvd.,Tigard,OR 9722 t y r C Phone: 503.718.2439 Fax: 503.598. •.f°3�r r Date/By:eview Other Permit: Inspection 503.639.4175 '��� t��u vl.s"t4bJi T 1 G A R D p Date Ready/By: Jury ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information ,TYPE OF WORK COMMERCIAL FEE* SCHEDII „E'"- USE CHECKLIST Mechanical permit fees*are based on the value of the work ❑New construction J1 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all mechanical materials,equipment,labor,overhead,and profit. ❑Demolition ❑Other: Value:$ CATEGORY:DT CONSTRUCTION q , .., :w- RESIDENTIAL EQUIPMENT/sysytivi§FEES* Z 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total - JOB SITE INFt3R�.�4t.1bl4.AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: q pd Furnace 100,000 BTU(ducts/vents) / 46.75 City/State/ZIP:AR'¢,2 O 50 AL b e r feL ,..q,./ 110_1_41 or `1pl Furnace 100,000+BTU(ducts/vents) 54.91 `1 Heat pump 61.06 Suite/bldg./apt.no.: Project name: a/4 ly eG Duct work 23.32 Cross street/directions to job site: j j 51� Av �/''A.v-A0,1/'. Hydronic hot water system 23.32 1 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 ; NOF'WORKn =• Gas fireplace/insert 33.39 . EsCi tP l G ' x,', r. t Flue vent for water heater or gas H -e -caped-GQ , 0r{ Y1l \ fireplace 23.32 O( y 2f _ n Log lighter(gas) 23.32 VQ a - t ! G✓kr� d1, ,_ Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 „T;:,_. "• Other: 23.32 }aPRSIPEYii ' OWNER i © TEI .:: _. ., �, .A.. .. 4 :� ., � *4-s, Environmental exhaust and ventilation: Name: W jC h C_& 4 / W` uf,,Z 4 4 Z M Range hood/other kitchen �/ equipment 33.39 Address: / 3a 8.5 5. W. 1 a4 ,77 ..4V�' Clothes dryer exhaust 33.39 City/State/ZIP: yd.- < r 1 74a 3 Single-duct exhaust(bathrooms, / toilet compartments,utility rooms) 23.32 Phone:(503) 5/D 4-4 o 5 Fax:( ) "✓- Attic/crawlspace fans 23.32 / Other: 23.32 47"-4'51436'4'' ® APPLICANT" ., ❑ CONTA C• : - -44 Business name: Fuel Fuel piping: �- ''--' $14.15 for first four;$4.03 for each additional Contact name: Furnace,etc. i Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace Range • E-mail: fYI S N i C kx4.FA t' TZ Ca»2<-64 {'e/V e.`f' Barbecue CONTRACTOR ,;,„ , Clothes dryer(gas) Business name: S 0-01,e_ at days_ Other: r a 9 r'yERl4 "I'FEES* 7,t' 5;;; Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lic.: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 14 l C '0 e I., ti,/. 4 4 G 2r lvt, days after it has been accepted as complete. Authorized signature: f g * Fee methodology set by Tri-County Building Industry Service Board Print name:• ?�P6K / Id- ��iL1/1'2 Date: ?/t+/s7 O/r 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: Total Valuation: 'Permit Fee: $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: 12420 SW ALBERTA ST, TIGARD, OR, 97223 Record Type: Record ID: Residential - Mechanical MEC2018-00767 Inspection Type: Inspector: 699 Mechanical final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor