Permit CITY OF TIGARD MECHANICAL PERMIT
Ili s COMMUNITY DEVELOPMENT Permit#: MEC2014-00185
Ti c R R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/24/2014
Parcel: 2S 102AB00910
Jurisdiction: Tigard
Site address: 12145 SW 92ND AVE
Project: LARSON Subdivision: KIMBERLY ADDITION Lot: 10
Project Description: Replacing existing natural gas line to furnace,water heater,and clothes dryer.
Contractor: OWNER Owner: LARSON,ALEC E
ALEC LARSON 12145 SW 92ND AVE
12145 SW 92ND AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-706-8902 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 04/24/2014 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 04/24/2014 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 04/24/2014 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applicatio RECEIVED FOR OFFICE USE ONLY
Received J
. City of Tigard Date/By: ,)Jj -- Permit •No.: M � 1 K 0)i 15,.5,
• 13125 SW Hall Blvd.,Tigard,OR 97223 APR 2 4 2014
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: 6zz gx.),( lx i to
Inspection Line: 503.639.4175
T I G A R D Date Ready/By: 1uris• 0 See Page 2 for
Internet: www.tigard-or.gov CITY O TIGARD
Notified/Method: 7`j"j Supplemental Information
BUILDING DIVjSI' �'`P
..WORK TYPE WORK COMMERCIAL FEE* SCHEDULE-- USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY 1tY Q1F CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family ❑ Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 12145 SW 92ND AVE Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:TIGARD,OR 97223 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:CENTER 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:KIMBERLY ADDITION Lot no.: 10
Other: 23.32
Other fuel appliances:
Tax map/parcel no.:2S102AB00910 Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert , 33.39
Flue vent for water heater or gas
REPLACE EXISTING NATURAL GAS LINE,ADD DROP FOR DRYER fireplace 23.32 _
Log lighter(gas) 23.32
Wood/pellet stove _ 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER
Other: 23.32
®
❑ TENANT Environmental exhaust and ventilation:
Name:ALEC E LRSON Range hood/other kitchen
equipment 33.39
Address: 12145 SW 92ND AVE Clothes dryer exhaust 33.39
City/State/ZIP:TIGARD,OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)706-8902 Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc. I
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater i "414 1
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue !
CONTRACTOR Clothes dryer(gas) A .
Business name:
Other:
�
AJ Air-4,— MECHANICAL PERMIT FEES*
Address: Subtotal ;y.IT
City/State/ZIP: Minimum permit fee($90.00) 4 c.10, 2..�
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) 10 Ft
CCB lie.: TOTAL PERMIT FEE ,l/40,Crt)
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board
Print name: a 1 e L Lar So n Date: ti/?.... e/
I\BuildingPermits\MEC_PermitApp_040113.do 440-4617T(1 OM/W
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