Permit IL CITY OF TIGARD MECHANICAL PERMIT
Permit#: MEC2018-00931
COMMUNITY DEVELOPMENT Date Issued: 12/03/2018
T[(3 ARO 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103DA04702
Jurisdiction: Tigard
Site address: 10500 SW PARK ST
Project: ELLSWORTH Subdivision: 1998-084 PARTITION PLAT Lot: 2
Project Description: (1)furnace with gas piping for replacement.
Contractor: OWNER Owner: ELLSWORTH, JONATHAN R&KATHERIN
JONATHAN R&KATHERIN ELLSWORTH 10500 SW PARK ST
10500 SW PARK ST TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 541-292-2350 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 12/03/2018 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 12/03/2018 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 12/03/2018 $43.25
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 or 1.800.332.2344.
Issued By: ' •• Si.nature:
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 ,
f ; FOR OFFICE USE ONLY
City of Tigard ' Date/Bya , �. Permit No.: -. y i'
11,,, v 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
S Phone: 503.718.2439 Fax: 503.598.1960g 1 h Date/By. Other Permit:
T IGA RD Inspection Ltne: 503.639.4175 ,_l i`.l 3 ' Date Ready/By: INI
H See Page 2 for
Internet: www.tigard-or.gov Ngtified/Method: Supplemental Information
. _ - t ,,. <..'
' `� ' ^''''-''-'4"� w.',.� Mechanical permit fees*are based on the value of the work
❑New construction [Addition/alteration/replacement performed. Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
t Value $
m, -c^ sem, th, - :t' '�}'" 6 +a
`�. °� :. ) �u K� , t* � 4", �, . ,{;3 ,r.',.,`'REQ(pF1?LIU hwc�[f�F�IEN'I'/SYS`t'EMSFIJES*
gl-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
�.. _ 4 q i. r e Heating/cooling:
Air conditioning 46.75
Job site address: 105 OG ' 9a_r. S+, Furnace 100,000 BTU(ducts/vents) % 46.75 6(,(:,.-Z5'
City/State/ZIP: -1-;- J / 0 ii` / 61'7 2,2 3 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:
N pt f��,!.✓c1� Duct work 23.32
Cross street/directions to job site: C o rner ok- �a.-rid- G Hydronic hot water system 23.32
Residential boiler(radiator or
Nigel ViP nS hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46,75
Ni
Flue/vent for any of above 23.32
Subdivision: NI.1 1 Lot no.:N i Other: 23.32
f Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
t a F/ t Gas fire lace/insert 33.39
4''''''''''''''''''''''''' 'w° -'v '' ' Q '''''''''''''''''''44 Flue vent for water heater or gas
e PA a cI ri. etc c�1 y�C e fireplace 23.32
�j Log lighter(gas) 23.32
X51 QC� Wood/pellet stove . 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
r .2400,111111; � 7 Other: 23.32
' ; i' gipF R ''° T -1 '--- Environmental exhaust and ventilation:
Name: k 0, r'n \9 (N 0 Y- Range hood/other kitchen
• `v equipment 33.39
Address: 1 OS OD .,1 c'1) X S-k-, Clothes dryer exhaust 33.39
City/State/ZIP: Q�� / pc— / 61,12:2- 3 Single-duct exhaust(bathrooms,
Jtoilet compartments,utility rooms) 23.32
Phone:(591 ) 2J(Z -2 3 5 (N Fax:( ) Attic/crawlspace fans 23.32
4I2r1-140001,11V `z-,, a ❑ cO TA TM .'��PERsor Other: 23.32
Fuel piping:
Business name: 5W _
Q) et C' $14.15 for first four;$4.03 for each dditional
Contact name: Furnace,etc. - / 114:15 ty.I5J
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
it e -< $ "'O1 'RAQI,-O, Rb Clothes dryer(gas)
eit
Other:
Business name:
Address: (�rJ 005� Vox. � � EC��C`AL;FEI?MIT FEES*' ,
SA-, Subtotal 1113-r35-6/.1?
City/State/ZIP: Minimum permit fee($90.00)x l0.ct
Plan review(25%of permit fee) -
Phone:( ) Fax:( ) State surcharge(12%of permit fee) - �>�/.d-V
CCB lie.: TOTAL PERMIT FEE��� lt%d.2,
v.:
This permit application expires if a permit is not obtained within 18
days after it has been accepted as complete.
Authorized si nnrature:V.,64),A, W * Fee methodology set by Tri-County Building Industry Service Board
Print name: ( IiirkikkyLa I y\ V I Date: 12-6 2f(
I:\BuildingU'ermits\MEC_PermitApp_040113.doe 440-4617T(I 1/02/COM/WEB)