Permit Support Document CITY OF TIGARD MECHANICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit#: MEC2018-00957
•
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 l Date Issued: 12/11/2018
Parcel: 1S134CB02100
3 17 14 4-7 Jurisdiction: Tigard
Site address: 12175 SW SUMMER CREST DR
Project: Randall Subdivision: SUMMER HILLS PARK Lot: 18
Project Description: New Gas Piping. 3/27/19: REPRINTED permit to include(1)gas fireplace,(1) range hood,and fuel piping for
fireplace.
Contractor: GASPRO INC Owner: RANDALL, SEAN A& LENORA R M
7603 SE LOUNSBERRY LN 12175 SW SUMMER CREST DR
PORTLAND, OR 97206 TIGARD, OR 97223
PHONE: 503-775-7020 PHONE:
FAX: 503-775-7019
FEES
Specifics: Description Date Amount
Gas Fireplace 12/11/2018 $33.39
Type of Use: SF Range Hood/Other Kitchen 12/11/2018 $33.39
Class of Work: ADD Type of Const: Fuel Piping 12/11/2018 $14.15
Occupancy Grp: Minimum Fee Adjustment-Mechanical 12/11/2018 $9.07
Stories: 12%State Surcharge-Mechanical 12/11/2018 $10.80
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:
Par +ittee Signature:
_
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit App 'cation �1
City of Tigardroll OFFICL FO
SE NI.I
(� 1)5
ReceivedDateBy: Permit No.:m Ec _ s—
ill
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960Date/By: Other Permit:
T i G A R D Inspection Line: 503.639.4175 l Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov RECE184.1
I fied/Method: Supplemental Information
TYPE OF"WORK hi Y�(�R %ni Z 19 ' ` COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction 0 Addition/alteration/replacement. f(3A performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: y� C NI,`,° i mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CON TION
" RESH)ENTIAL
��' EQI(Il'MENT/SYSTEMS FEES*
0 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0Other r '
Description Qty. Ea. Total
ri eating/cooling:
4 )<# SITE:IIVFO�ATIONAND:L{)CATI
Air conditioning 46.75
Job site address:
f lj I 1 7 4 ln) 1U w16+,k'r ( e„.161, p/ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: ',`t) ,.J 1 at Cl 1-1.--4:b Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: I Project name: v 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
" ) : DE ' MON O WO 4 " *, �? Gas fireplace/insert / 33.393).31
F Mme„;” `rt t` ' -v.41.4-,v, Flue vent for water heater or gas
G1tlZ- i, 6) .u- I �) /-4,, r .4.0, ,^..ori a ) .. fireplace 23.32
J 7j�,. ��,`` �/ / Log lighter(gas) 23.32
(S ii - 74,2,14-u /u ,.sit , -/ 1"'�/I Wood/pellet stove 33.39
� 'C c'u if —C1c)`t S—7 Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
'", ❑ )adrERTY OWNERS :.t 1 ,i Other: 23.32
mK . TENANT.',
"` Environmental exhaust and ventilation:
Name: Range hood/other kitchen L
Address: equipment 1 33.39 33.Y)
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
Ao AI*LICANT ',
"' "• r, .. Other: 23.32
❑,'..�oNTn �RsoN
Business name: Fuel piping:
'" i S $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace / _/
Range _
E-mail: Barbecue
CONTRACTOR - Clothes dryer(gas)
Business name: Other:
(h c‘.S rO .wL,
MECHANICAL PERMIT FEES*
Address: 4 I1D 4 E Z m-e.rt'lA+®hA( W.I. 4iii/J O6l Subtotal
City/State/ZIP: M i
.t aukc�e ��- Minimum permit fee($90.00)
26
111-c,1-07...6 Plan review(25%of permit fee)
Q
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: I (31-4 1 3 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Q days after it has been accepted as complete.
Authorized signatur • el i&f(S i I 11 1/17 * Fee methodology set by Tri-County Building Industry Service Board
Print name: l Date: 3/?4 frG1
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 Fees
$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
Tel: 503.718.2439
Location: Inspection Date:
12175 SW SUMMER CREST DR, TIGARD, June 18, 2019 at 12:28:30 PM
OR, 97223
Record Type: Record ID:
Residential - Mechanical MEC2018-00957
Inspection Type: Inspector:
699 Mechanical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor