Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2013 -00108
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/20/2013
Parcel: 2S 111 CC 14500
Jurisdiction: Tigard
Site address: 10165 SW HIGHLAND DR
Project: Pepper Subdivision: SUMMERFIELD NO.4 Lot: 196
Project Description: Install gas insert with venting and gas line.
Contractor: EVERGREEN GAS INC. Owner: PEPPER FAMILY TRUST, THE
PO BOX 388 BY HARRY & TERESA PEPPER TRS
WEST LINN, OR 97068 10165 SW HIGHLAND DR
TIGARD, OR 97224
PHONE: 503 - 407 -9542 PHONE: 503 - 598 -8638
FAX: 503 - 344 -6345
•
FEES
Specifics: Description Date Amount •
Gas Fireplace 02/20/2013 $33.39
Type of Use: SF Flue Vent for Water_Heater or Gas 02/20/2013 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel Piping 02/20/2013 $14.15
Stories: 12% State Surcharge - Mechanical 02/20/2013 $10.80
Minimum Fee Adjustment - Mechanical 02/20/2013 $19.14
Fuel
Fuel Types: Natural Gas
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
Utili otification =.ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules
or .irect questions to OU • --b -Ilin 3.232.1987 or 1.800.332.2344. -
Is ed By: a Permittee Signature:
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 Appli - ti ` V FOR OFFICE USE ONLY
City of Tigard FEB 2 0 2013 Date/By: IA 90 /* , j'Ig6,413- . 0o/DS'
Permit No.:
: a 13125 SW Hall Blvd., Tigard, OR 9
, oF DIGAI�® Plan Review
' Other Permit:
Phone: 503.718.2439 Fax: 503.59 Date/By:
Line: 503 B UILD G Q I � ISI Juris: ® See Pa e 2 for
T I G A R D /� t Date Ready/By: g
Internet: www.tigard or.gov VI! 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 TO r ition/alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition • Other: mechanical materials, equipment, labor, overhead, and profit
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
2a and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special Information use checklist.
Multi family 0 Master builder 0 Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND L 6 CATION Heating/cooling:
A ir conditioning
. �, (requires site plan showing placement) 46.75
Job site address: 411 _ i pie_ Furnace 100,000 BTU (ducts/vents) 46.75 Aar
City /State /ZIP: .4 j.. , . Furnace 100,000+ BTU (ducts/vents) 54.91
■
Suite/bldg. /apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
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
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK ' Water heater 23.32
' /A Gas fireplace/insert f! 33.39
`'�
�t "//15 / 4 ��� m /r
( Flue vent for water heater or gas
� � �� Pf fi replace /1 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney/liner /flue /vent 23.32
p�ROPERTY OWNER 0
Other: 23.32
Name: ,v I /.r npe. re_ // ` Environmental exhaust and ventilation:
Address: /,ry / 6 5 rSi,.) , i h L y� Range hood/other kitchen
C ! equipment ment 33.39
City/State /ZIP: 4t-ea, 1 Clothes dryer exhaust 33.39
..--- G., . Single -duct exhaust (bathrooms,
Phone:8 p Z / , 46, 38 Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: Other: 23.32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional_
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace `_ p
E -mail:
Range
CONTRACTOR Barbecue
—� Clothes dryer (gas)
Business name: . c1.(o. Tr_4 S C--
Other:
Address: p, g_„, r 3 1 F) MECHANICAL PERMIT FEES*
City/State /ZIP: J 5` Li .z l �n/ s` 97j, S Subtotal
C /� Fax: ( ) Minimum permit fee ($90.00)
Phone: (5-4)3) �� �- �s < Plan review (25% of permit fee)
CCB lic.: / Op .5 r State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: 44 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: P Date: jet • • Fee methodology set by Tri -County Building Industry Service Board
I:\Building\Permits\MEC- PermitApp.doc 03/07/12 : •0 -4617' 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.
1:\ Building \Permits\MEC- PermitApp.doc 03/07/12 2
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10165 SW HIGHLAND DR, TIGARD, OR, 97224
Residential - Mechanical
699 Mechanical final
02/21/2013 00:00
MEC2013-00108
PASS - No C of O
Violation Summary:
Inspector Contractor