Permit Support Document CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2020-00028
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 •
Date Issued: 01/14l2020
T I t;:1 R.C) 9 �r Parcel: 2S114BB04100
Jurisdiction: Tigard
Site address: 16535 SW GREENLAND DR
Project: Kim Kelleher Subdivision: PICKS LANDING NO.1 Lot: 55
Project Description: Free standing Woodstove and piping. 3/9/20: REPRINT to change from gas wood stove to gas stove add gas line.
Contractor: CHIMCARE HOME SERVICES Owner: KELLEHER, JAMES P&KIMBERLY C
27929 SW 95TH AVE#1001 16535 SW GREENLAND DR
WILSONVILLE, OR 97070 TIGARD, OR 97224
PHONE: 503-55-2446 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 01/14/2020 $33.39
Type of Use: SF Fuel Piping 01/14/2020 $14.15
Class of Work: ALT Type of Const: Chimney/Liner/FlueNent 01/14/2020 $23.32
Occupancy Grp: Minimum Fee Adjustment-Mechanical 01/14/2020 $19.14
Stories: 12%State Surcharge-Mechanical 01/14/2020 $10.80
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by callin 503. 2.1987 or 1. 0.332.2344.
Issued By: Permittee C-C Signature: 2+ �/
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application , i : 17_<�)R of l lcl: USl ()No'
.
Received 5' 7'/ � i 2-0--( ✓J
ill ' City of Tigard �t�r• � -` /
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other Permit:
11111 Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
.k Inspection Line: 503.639.4175 Date Ready/By: Mrix la See Page 2 for
T I G A R D
Internet: www.tigard-or.gov Notified/Method: Supplemental information
COMMERCIAL FEE• SCHEDULE - USE CHECKLIST
TYPE OF WORK Mechanical permit fees"are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of ail
mechanical materials,equipment,labor,overhead,and profit.
❑Demolition 0 Other: Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES°
'® l-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For spade!information use checklist
Master builder 0 Other. Description Qty. Ea. Total
❑Multi-family 0 Heating/cooling:
JOB SITE INFORMATION AND LOCATION Air conditioning 46.75
Job site address: 1 (pt 3rj Svc (lvt'P.rid mind \r Furnace 100,000 BTU(duets/vents) 46.75
City/State/ZIP: D p 9-)7 7 Furnace 100,000+BTU(ducts/vents) 54.91
1 f?l1 (C `, `Y Heat pump 61.06
Suite/bldg./apt no.: �5 Project name: ysi M Kt ll't.b P tr Duct work 2332
Cross street/directions to job site: Hydronic hot water system 2332
Residential boiler(radiator or
hydronic) 23.32
Unit beaters(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 23•32
DESCRIPTION OF WORK Gas fireplace/insert , 33.39 33,35
Flue vent for water heater or gas
MC G 2 07 n- X C>z g U\_13?6 S kZ- ICIL fireplace 2332
23 32
Log lighter(gas)
0_V1(1V O,.Q_ Q v owl v JfYle. cam( k 3as Wood/pellet stove 33.39
`l.)Nre ( Arl 6 rLui (Q,p ( Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other 23.32
[, 'PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:
Name: 11,r.lif V-��r t ,c,yylyD -- -V Ktvytkc,t"-Ire° lly equipment
heed/ether kitchen
33.39
Address: \(n e>F1 C 1 S)(\j Cl ye r.r( `fa In t6 TM Clothes dryer exhaust , 3339
City/State/ZIP: Cl'17,Z('[ Single-duct exhaust(bathrooms,
1 �Ct r C� toilet compartments,utility rooms) _ 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name: �;tl•YI C ('A_v C_ S14.15 for first four;$4,03 for each additional
Contact name: Furnace,eta
Yl1R 12 p,( 1(l V (>l�C
Gas
Address: 2lg2C1 �w c)F3-tin PJC �'l'P \( � Wall/suspended/unit
\ heat pump
heater
City/State/ZIP: \(,0 i 15b.,n V v\\F (3 IZ can(1 b Water heater
Phone:(%rJ) IpSS 2L{440 Fax::( ) Fireplace t W,lrjRange
E-mail: ,t,v"..•n\L 6) CV' 'try,C.Cti.K. C-CD vvi Barbecue -
CONTRACTOR Clothes dryer(gas)
Business name: Other.
(s�1 t-'rYLC 0._rt. MECHANICAL PERMIT FEES*
Address: 2;7 q 2.9 SW °t S}I" Pi-v)L 5s1rC l(-h\ Subtotal
Minimum permit fee(S90.00)
City/StaW23P: w i\SCY>\TI l V2 � CI 1 0-10 Plan review(25%ofpemiit fee)
Phone:(5l� >,f� - 7 l i(�d Fax:( ) State surcharge(12%of permit fee)
CCB lie.: )4 S t�1 e> TOTAL PERMIT FEE
This permit application expires If a permit Is not obtained within 180
days after It bill been accepted as complete.
Authorized si • Fee methodology set by Tri-County Building Industry Service Board
Print name Date: 31912DZ-V
t:tBuildinglPermw PermaA 0113.d°e 440-4617r(11ro2/COM/NEB)