Permit (2) CITY OF TIGARD 2�,
17 ° MECHANICAL PERMIT
R COMMUNITY DEVELOPMENT �f f '� Permit#: MEC2020-00021
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1/13/2020
TIGARDParcel: 2S109AA00700
Jurisdiction: Tigard
Site address: 14255 SW 125TH AVE
Project: BLACK SHEEP CONSTRUCTION LLC Subdivision: None Lot: None
Project Description: Replacing(1)exhaust fan and adding(2)new exhaust fans in bathroom and kitchen. Installing(1)new range hood
and(1)tankless water heater. 8/7/2020: Add gas fireplace insert to permit and inspection already performed.
Contractor: BLACK SHEEP CONSTRUCTON Owner: BLACK SHEEP CONSTRUCTION LLC
16340 NE YAMHILL RD 16340 NE YAMHILL RD
YAMHILL, OR 97148 YAMHILL, OR 97148
PHONE: 503-437-3998 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Water Heater 01/13/2020 $23.32
Type of Use: SF Range Hood/Other Kitchen 01/13/2020 $33.39
Class of Work: ALT Type of Const: Single Duct Exhaust(Bathrooms,Toilet, 01/13/2020 $69.96
Occupancy Grp: Utility Rooms)
Stories: Fuel Piping 01/13/2020 $14.15
12%State Surcharge-Mechanical 01/13/2020 $16.90
Gas Fireplace 08/13/2020 $33.39
12%State Surcharge-Mechanical 08/13/2020 $4.01
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $195.12
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: ®iv, !¢./j/_C 7
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. �TJ
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVE Ir eceived y4/ Permit N
y g ISateBy: O/ "/� -Q GC.9. (/ei0�/
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
® Phone: 503.718.2439 Fax: 503.598.1960 J U L 2 2 2020 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By. inns: fa See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: P'/'/ 49 v Supplemental Information
"TYPE OF WORK
n ' VIRILE USE CHECKLIST
' Mechanical permit fees*are based on the value of the work
0 New construction ❑x Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
O Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION"'
RESIDENTIAL EQITIPMEAtT--� + d�en
❑x 1-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITEINFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 14255 SW 125th Ave Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Tigard,OR 97224 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: Bull Mountain&125th Ave 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 1 33.39
---- " ' Flue vent for water heater or gas
Adding gas fireplace insert to existing permit:MEC2020-00021. fireplace 23.32
Rough-in already inspected but need to pay for additional permit Log lighter(gas) 23.32
fee Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
lI PROPERTY OWNER D TENANT Other: 23.32
----- Environmental exhaust and ventilation:
Name: Black Sheep Construction,LLC Range hood/other kitchen
16340 NE Yamhill Rd equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Yamhill,OR 97148 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( 503 ) 437-3998 Fax: ( ) Attic/crawlspace fans 23.32
® APPLICANT ❑ CONTACT PERSON Other: 2332
Business name: Black Sheep Construction,LLC Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Jack F.Shepherd HI Furnace,etc.
Address: 16340 NE Yamhill Rd Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Yamhill,OR 97148 Water heater
Phone:( 503 ) 437-3998 Fax::( )
Fireplace
- Range
E-mail: jfsOblack.shecpmgmt.com
_ Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: Black Sheep Construction,LLC MECHANICAL PERMIT FEES*
Address: 16340 NE Yamhill Rd Subtotal
City/State/ZIP: Yamhill,OR 97148 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( 503 ) 437-3998 Fax:( )
State surcharge(12%of permit fee)
CCB lie.: 217112 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
9,A �(f days after it has been accepted as complete.
Authorized signature: 1. * Fee methodology set by Tri-County Building Industry Service Board
Print name: Jack F.Shepherd II Date: July 21,2020
133uilding\Permits\MEC PermitApp_040113 doc 440-4617T(I1/02/COM/WEB)
CITY OF TIGARD FEE AND PAYMENT HISTORY
illh, 2 -U
. 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
MEC2020-00021 - 14255 SW 125TH AVE, TIGARD, OR 97224
BLACK SHEEP CONSTRUCTION LLC
Fee Description Revenue Fee Amount Invoiced Paid Date Paid Payment Receipt# Due
Account Number Method
12%State Surcharge-Mechanical 100-0000-24001 $16.90 $16.90 $16.90 1/13/2020 Check 427714 $0.00
12%State Surcharge-Mechanical 100-0000-24001 $4.01 $4.01 $0.00 $4.01
Fuel Piping 230-0000-43102 $14.15 $14.15 $14.15 1/13/2020 Check 427714 $0.00
Gas Fireplace 230-0000-43102 $33.39 $33.39 $0.00 $33.39
Range Hood/Other Kitchen 230-0000-43102 $33.39 $33.39 $33.39 1/13/2020 Check 427714 $0.00
Single Duct Exhaust(Bathrooms,Toilet, 230-0000-43102 $69.96 $69.96 $69.96 1/13/2020 Check 427714 $0.00
Utility Rooms)
Water Heater 230-0000-43102 $23.32 $23.32 $23.32 1/13/2020 Check 427714 $0.00
Totals for Fees $195.12 $195.12 $157.72 $37.40
Receipt# Payment Method Check# Pavor: Receipt Date Receipt Amount
427714 Check 1066 Black Sheep 01/13/2020 $157.72
Construction, LLC
Total Payments: $157.72
Balance Due: $37.40
s C 4-j
Dianna Ornelas
From: David Young
Sent: Thursday,July 30, 2020 7:51 PM
To: Dianna Ornelas
Subject: Re: MEC2020-00021 - 14255 SW 125th Ave.
Dianna,
Yes, that would work good or it could be issued on a separate mechanical permit as noted in the inspection also as I
closed both mechanical permits as well as the final at the contractors request. Whichever is easier for you.
Thanks,
David
Get Outlook for iOS
From: Dianna Ornelas<Dianna@tigard-or.gov>
Sent:Thursday,July 30, 2020 6:03:22 PM
To: David Young<DavidY@tigard-or.gov>
Subject: MEC2020-00021 - 14255 SW 125th Ave.
Hi David,
I see from the inspection notes on 6/16/2020 that you requested the applicant to add gas fireplace prior to final
inspection. On 7/22/2020 the applicant submitted the application, and we are just now processing it, however the final
inspection was scheduled and passed on 7/23/2020 and now the permit is closed.
I propose that we add the gas fireplace to this permit and collect the fees, but leave it in closed status if you are ok with
that.
Thank you.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule."
1
CITY OF TIGARD MECHANICAL PERMIT
•
COMMUNITY DEVELOPMENT
Permit#: MEC2020-00021
Date Issued: 01/13/2020
"CIGAR>D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S109AA00700
Jurisdiction: Tigard
Site address: 14255 SW 125TH AVE
Project: BLACK SHEEP CONSTRUCTION LLC Subdivision: None Lot: None
Project Description: Replacing(1)exhaust fan and adding(2)new exhaust fans in bathroom and kitchen. Installing(1)new range hood
and(1)tankless water heater.
Contractor: BLACK SHEEP CONSTRUCTON Owner: BLACK SHEEP CONSTRUCTION LLC
16340 NE YAMHILL RD 16340 NE YAMHILL RD
YAMHILL, OR 97148 YAMHILL, OR 97148
PHONE: 503-437-3998 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Water Heater 01/13/2020 $23.32
Type of Use: SF Range Hood/Other Kitchen 01/13/2020 $33.39
Class of Work: ALT Type of Const: Single Duct Exhaust(Bathrooms,Toilet, 01/13/2020 $69.96
Occupancy Grp: Utility Rooms)
Fuel Piping 01/13/2020 $14.15
Stories:
12%State Surcharge-Mechanical 01/13/2020 $16.90
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $157.72
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: L`% `". Permittee Signature: Ei /L' .Z
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
Cityof Tigard Received
g n ����� Date/Be )3 /.rrr._ Permit No ��.#)e-tip
• 13125 SW Hall Blvd.,Tigard,OI4Cj Plan Review/ // (,�� Wool
1 a Phone: 503.718.2439 Fax: 503.598.1960 q Date/By: Other Permit:/ 7 ` l N` ), I „
T I GAR D Inspection Line: 503.639.4175 j AN 1 3 2020 Date Ready/By: Jana'. /® See Page for �
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
.;IVY OF TIGARD
TYPE aiiiriiiiiG DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
0 New construction m Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
f I-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:
Air conditioning 46.75
Job site address: 14255 SW 125th Ave Furnace 100,000 BTU(ducts/vents) 46.75
City/State/Z1P: Tigard, OR 97224 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: 125 &Bull Mountain 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
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 1 23.32 23.32.
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
New Bath and Kitchen fans for remodel fireplace 23.32
�,( (. Log lighter(gas) 23.32
kk W vm // Wood/pellet stove 33.39
(C4'i 1T�sVt.- 17A, L !z c-S (�� f/4 r'4 t Wood fireplacc/insert 23.32
K rr ` r,l ki st `- /At� (n) l �S Chimney/liner/flue/vent 23.32
Y` GA PP(RGOPE TY OWNER
ud( 0 TENANT
Other: 23.32
Environmental exhaust and ventilation:
Name: Black Sheep Construction, LLC Range hood/other kitchen I
equipment 33.39 33.39
Address: 16340 NE Yamhill Rd. Clothes dryer exhaust 33.39
City/State/ZIP: Yamhill, OR 97148 Single-duct exhaust(bathrooms, 3 69.96
toilet compartments,utility rooms) 23.32
Phone:( 503)437-3998 Fax:( ) Attic/crawlspace fans 23.32
® APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name: Black Sheep Construction, LLC S14.15 for first four;S4.03 for each additional
Contact name: Jack F. Shepherd III Furnace,etc.
Address: 16340 NE Yamhill Rd. Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Yamhill, OR 97148 Water heater I /14• l]—
Fireplace
Phone,:( 503)437-3998 Fax: :( ) Range
E-mail: jfs@blacksheepmgmt.com Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: Blank Sheep Construction, LLC MECHANICAL PERMIT FEES*
Address: 16340 NE Yamhill Rd. Subtotal 44Q,03_
City/State/ZIP: Yamhill, OR 97148 Minimum permit fee($90.00)
Plan review(25%of permit fee)Phone:( 503)437-3998 I Fax:( ) State surcharge(12%of permit fee) J(.,,-i,`
CCB Tic.: 217112 17 - TOTAL PERMIT FEE (5-7, 7
t✓w This permit application expires if a permit is not obtained within 180
/ �. ,4,//-_ days after it has been accepted as complete.
Authorized signature: /� G ll * Fee methodology set by Tri-County Building Industry Service Board
Print name: Jack F. Shep erd III Date: Jan. 7,2020
MBuilding\Permits\MEC_PermitApp 0401 I3.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\MCC_PermitApp_040113.doc 2