Permit CITY OF TIGARD MECHANICAL PERMIT
: ' COMMUNITY DEVELOPMENT Permit#: MEC2020-00177
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/02/2020
T f C.;A R 09 Parcel: 25103AD03200
Jurisdiction: Tigard
Site address: 12905 SW 107TH CT
Project: PETERSON Subdivision: PATHFINDER Lot: 22
Project Description: Installing a new gas range to replace electric range.
Contractor: OWNER Owner: PETERSON, DAVID EARL/MARILYN K
DAVE PETERSEN 12905 SW 107TH CT
12905 SW 107TH CT TIGARD, OR 97223
TIGARD, OR 97223
PHONE:
PHONE: 503-516-5148
FAX:
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 04/01/2020 $33.39
Type of Use: SF Fuel Piping 04/01/2020 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 04/01/2020 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 04/01/2020 $42.46
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.00
•
Issued By: _ /l am �,�j''' PermitteeSignature: ` / // ea 71-1
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
• 13125 SW Hall Blvd.,Tigard,OR 9722 ] \/C® Date�ny. ���,' _��
_ 9� `/ G Ptao Review
Phone: 503.718.2439 Fax: 503.598.1 pate By: Other Permit:
11 inspection Line: 503.639.4175 Date x /& furs: 0 See Page 2 for
Internet: www.tigard-or.gov MAR 3 0 2020 Notified/Method: Supplemental Information
'TY OF TIGARD
TYPE OF W + COMMERCIAL FEET SCHEDULE— USE CHECKLIST
.'�'LDING DIV ION Mechanical permit fees'are based on the value of the work
❑New construction Er Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES'
fiil 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description I Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION IIeaoOOt
Air conditioning 46.75
Job site address: 1 Z.at 0 L S 1.., I O 1 k t. Ci— Furnace 100,000 BTU(ducts/vents) 46.75
Ci /State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91
ty l oGd- tD � � TZZ3
Suite/bldgJapt.no.: 1 Project name: (a S\ C1/4 t°IA C e Heat pump 61.06
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 OF WORK Gas fireplace/insert 33.39
it Flue vent for water heater or gas
4;l r~I\ A e.vJ G a 4, „r-cos-,& G f_� `GCG fireplace 23.32
-e if\ S h v'\G E �irv'`i L' Y 6...4c
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
li PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
Name:
GcUG -c>c-A"' C1rSP.--s. Range hood/other kitchen
ydequipment I33.39
12_q 0
Address: s 1�� � C ) Clothes dryer exhaust 33.39 ,
City/State/ZIP: ( ` ! �� d Q ek 1 ZZ'� Single duct exhaust(bathrooms,
toilet comparnnents,utility rooms) 23.32
Phone:610- I L 5 14 46 Fax:( ) Attic/crawispace fans 23.32
A APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$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
E-mail: /pp Range 1
L' , �G f C r�SQN �C=0/4/ !�c f �zT Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: ()'u. 'v.w. Other:
MECHANICAL PERMIT FEES'
Address:
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lic.: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
- 'nJ days after it has been accepted as complete.
Authorized signature: P.(�'X 9.:-... ' Fee methodology set by Tri-County Building Industry Service Board
Print name: lax 2_ `p §jjC r Date: ^
I:1Building\Permits4MEC PelmitApp 040113.doc 4404617T(11/02/COM/WEB)