Permit (55) CITY OF TIGARD MECHANICAL PERMIT
IIICOMMUNITY DEVELOPMENT Permit#: MEC2019 00461
-TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/03/2019
Parcel: 2S 1038801100
Jurisdiction: Tigard
Site address: 12465 SW 124TH AVE
Project: Goodrich Subdivision: BROOKWAY Lot: 11
Project Description: Adding NC unit. Placement of A/C unit must comply with manufacturers requirements.
Contractor: K S HEATING&AIR CONDITIONING INC Owner: GOODRICH, DAVID R&COLLEEN C
14925 BAKER CREEK RD 12465 SW 124TH AVE
MCMINNVILLE, OR 97128 TIGARD, OR 97223
PHONE: 503-602-8283 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 07/03/2019 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 07/03/2019 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 07/03/2019 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-e r 40. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / �,
4 „ ,
Issued By: Permittee Signature: I f
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application, f s f_."'y 1(;i< (ii ; N' i_ _ 6/
City of Tigard 1 r' . .. ' Received t'3 �T
1413125 SW Hall Blvd.,Tigard,OR 97223L Date/By: iii` �i�`i��, i�
Phone: 503.718.2439 Fax: 503.598.1960 J l� Plan Review
f` Date/By: Other Permit:
i Inspection Line: 503.639.4175 :- , i Date Ready/By: Juris: ® See Page 2 for
u; it3 i
Internet: www.tigard-or.gov r ➢i` : lU.�.a.9 Notified/Method: Supplemental Information
.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE- USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction C Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
141_1-and 2-family dwelling 0 Commercial/industrial 0 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:
6,5 to Air conditioning 46.75
Job site address: l Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:—rt t v l 4-6 of" 9-7„9-23 Furnace 100,000+BTU(ducts/vents) . 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:
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 IPT OF Wim{ Gas fireplace/insert _ , 33.39
Flue vent for water heater or gas
fireplace 23.32
lqe--- l e 0 Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent . 23.32
0
PROPERTY OWNEROther: 23.32
0 TENANT
Environmental exhaust and ventilation:
Name: )kf V ' G-O o c RI c 'ti Range hood/other kitchen
equipment 33.39
Address: 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 _
0 APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name: $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Gas heat pump
Address:
Wall/suspended/unit heater
CttyfStatdZlP: — Watesbeater __ i
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
/r Other:
Business name: MECHANICAL PERMIT FEES*
Address: ) `3 - �i"
Subtotal
City/State/ZIP: ¶\f CA v t I t ®( CI 7/ Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone: ) ca:), Eic Fax:( ) State surcharge(12%of permit fee)
CCB lic.: 1 6 1 TOTAL PERMIT FEE
I,' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized si afore: 4, el\ * Fee methodology set by Tri-County Building Industry Service Board
Print name: +k . , ,i Date: 7-3 -/F
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
12465 SW 124TH AVE, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Mechanical MEC2019-00461
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS - NoCofO
Comments:
Minor label ELS 710514
Violation Summary:
Inspector Contractor