Permit Support Document CITY OF TIGARD MECHANICAL PERMIT
1111
COMMUNITY DEVELOPMENT ^>v Permit#: MEC2020-00006
Date Issued: 01(03/2020
T I G All C7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 �0
///'✓✓✓' Parcel: 2S114AB01000
141 L Jurisdiction: Tigard
Site address: 16095 SW 92ND AVE
u
Project: Summit Reconstruction&Restoration Subdivision: None Lot: None
Project Description: Gas lines to water heater,furnace,fireplace and range.Venting range hood. 1/16/20:REPRINT to add(4)exhaust
fans and(1)clothes dryer exhaust.
Contractor: J&M CONTRACTOR SERVICES INC Owner: CRONE, MICHAEL D& DEBORAH M
15604 NE RUID RD 16095 SW 92ND AVE
AMBOY,WA 98601 TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Clothes Dryer Exhaust 01/16/2020 $33.39
Type of Use: SFA Single Duct Exhaust(Bathrooms,Toilet, 01/16/2020 $93.28
Class of Work: ALT Type of Const: Utility Rooms)
Occupancy Grp: Range Hood/Other Kitchen 01/03/2020 $33.39
Stories: Fuel Piping 01/03/2020 $14.15
12%State Surcharge-Mechanical 01/16/2020 $20.91
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $195.12
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by caalli/ng'50033.232.19 or 1.800.332.2344.
Issued By: Permittee Signature: Sce L. // !L
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application [OR OI l I( I t '.( (1\1.1
City of Tigard Received
pate.By Permit Vn.
• 13123 SW'Hall Blvd.,Tigard,OR 97223 / rG �J MECaZQ`Qf��1"�(li
►� Plan Review
tr ' 7 g' Phone: 503.7182439 Fax' 503.598.1960 I ` 1 Doter By. Other Permit
i i�• \I.I o Inspection Line. 503 639 4175 part Read ,By. vn
Internet. WAIT tigard-or.gov Nmilied:x ethexl See 2 for
Supplemental
ml Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE-USE CHECKLIST
Mechanical permit tees*arc haled on the Value of the work
0 New construction [p Addition/alteration/replacement performed.. Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials.equipment.labor.overhead,and profit
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special lnjnnrmrinn use chetkftsr.
Multi-family 0 Master builder ❑Other. Description Qly. 1 Ca. _ Total
JOB SITE INFORMATION AND LOCATION limiting/cooling:
r� 1 �\ Air conditioning 46.75
Job site address: I�o3gI] SW C 1 d Ave, Furnace 100.01)0Itt flu tam is'vents) 46.75
City/State/ZIP: f ct4- ( (11 r.i L Furnace 100,000+B IU(duos/tents) 54.91
JC'� Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: Hydronte 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/sent for any of above 23.32
Subdivision: Lot no,: tither: 23.32
Other fuel appliances: _
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplacc/insert 33.39
/p y� 1 L r'��. �j I_ G � Flue vent for water heater or gas
Vim. i;4a Gi�o F-C 7l C ' )ba'�t"I r l.' S j: (0/Auve ry fireplace _23.32
r / Log lighter(gas) 23.32
Far) a cirri- Ven t. Ar Inl i✓Iq �)PS e_ Wood/pellet stove 33.39
F�Ct irlq 10.1-10 Wood fireplace/insert 23,32 ,
J Chimney/Iiner/fue/vent 23.32
0 PROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothesdrverexhaust ) 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) -4 23.32
Phone:I ) Fax:( ) Attie crawlspace fans 23.32 _
0 APPLICANT ❑ CONTACT PERSON Other 23.32 _
Fuel piping:
Business name:.7-et•M Seit11V i C_P
514.I iS for first four;S4.03 for each additional
Contact name: ZIi4 e.f..uit'PS Furnace.etc.
Address: 35co I E g5I Ave Gas heat pump
N 1 wail/suspended/unit heater
City/State/ZIP: rla 4-J LAIA Qf 675 Water heater
Phone:( (,,,C)14.3-5000 Fax::( ) fireplace
[ Range
E-mail: Td,('anta 55 i -€, i ( error:f( . corn Barbecue
CONTRACT Clothes dryer(gas)
Business name: i Other
�a/"1 S P�C / i C P "j MECHANICAL PERMIT FEES*
Address: e saille, Subtotal
City/State/ZIP: c..,am6 Minimum permit tee($90.00)
Plan review(25%of permit fee)
Phone:( ) 5atMe Fax:( ) State surcharge(12%of permit fee)
CCB lie,: 1 6Q 5Gj 5 TOTAL PERMIT FEE
�7 this permit application expires ifa permit is not obtained within ISO
days after It has been accepted as complete.
Authorized signature: ti tzet_ ./� Fee methodology set by Tr-Ceun y Building Industry Se ice Board
Print name:' ebtei Lt e'.c� - e Date: T,CJ i oS!l O90
I,auddinelPere 5MEC_PemetApp oral l I deo 440-617T(I I.W/COMAVEB)