Permit CITY OF TIGARD MECHANICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: MEC2014-00296
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/12/2014
Parcel: 2S 112CA04300
Jurisdiction: Tigard
Site address: 15215 SW 79TH AVE
Project: Arvidson Subdivision: DURHAM ACRES Lot: 29
Project Description: Gas leak repair for furnace and water heater
Contractor: J&M CONTRACTOR SERVICES INC Owner: ARVIDSON, OVE S&DENISE L
15604 NE RUID RD 15215 SW 79TH
AMBOY,WA 98601 TIGARD, OR 97224
PHONE: 503-680-0195 PHONE: 503-639-6541
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 06/12/2014 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 06/12/2014 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 06/12/2014 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No• -• enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0 You may obtain a copy of the rules
or dir-P questions to •. NC • ..Alin• 503.232.1987 or 1.800.332.2344. itiqr(-‘wiC\Is ed By: ' Permittee Signature: c p
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard l� Received ,[�,,
Cr
• 13125rSW Hall Blvd.,Tigard,OR 9722 ` DateBy: Q ,Li � l Permit No.: lit /�j,/r/a'. 9
Phone: 503.718.2439 Fax: 503.598.19 Plan Review
Date/By: Other Permit:
Inspection Line: 503.639.4175
T I G A R D r b V,, Date Ready/By: furls.
® See Page 2 for
Internet: www.tigard-or.gov UN 1
Notified/Method: Supplemental Information
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TYPE OF WORD roitgt�p COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
r Mechanical permit fees*are based on the value of the work
El New construction ❑Addition/alteratio nt performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: ( S c)...l 5 S 7 9 K 11-ttZ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: , G_t/P` 0 0 d 9 7 1-, CI-4- 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: Hydronic hot water system 23.32
Residential boiler(radiator or
R
1 J O N t 'T ( 00 ,f N 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
Flue vent for water heater or gas
VA ivo C.,A-s Lc-___,- t< i 6 `� a T2 .C-f �� fireplace 23.32
�,�` p „ ! j Log lighter(gas) 23.32
�,1",S f l YS I l_''1 ✓�iJ/' L f C �I 0 Wood/pellet stove 33.39
VL-121, l>{ Imot--r s 4-CY`-Qsz . -r✓-t°rc-mod! Wood fireplace/insert 23.32
C t- -y I I c- J11-„ ^ O Chimney/liner/flue/vent 23.32
1-4-PROPERTY OWNER I ❑ TENAN�T"� Other: 23.32
Environmental exhaust and ventilation:
Name: D r� 1St. [1 0`j 1 of �w Range hood/other kitchen
VT equipment 33.39
Address: ( s 1 ( S cv 7 q (--k'
Clothes dryer exhaust 33.39
City/State/ZIP: --r . Oa_ `4 -7 .. 2.t..L C a�–C Single-duct exhaust(bathrooms,
p� 41-Q� toilet compartments,utility rooms) 23.32
Phone:(5'63) 6 '?)9 _ 6 5 ,1- ( (9 2) q a -1 l Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: rn¢ /1 p Fuel piping:
S D 0 U --e $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc. ( _
Gas heat pump
Address: -
Wall/suspended/unit heater
City/State/ZIP: Water heater I ,
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: Other:
��T�/ T W� �v S MECHANICAL PERMIT FEES*
Address: I c6o4 Aft Re I4 PA. Subtotal /y. iq--
City/State/ZIP: 4 rn bo Y C (1
/w - U i Minimum permit fee($90.00) 'Q cf)
.
I Plan review(25%of permit fee)
Phone:(5t3) /p q O- 0 t 9 c Fax:( ) State surcharge(12%of permit fee)
CCB lic.: ( T. D' s 9 S TOTAL PERMIT FEE /W. dU –
This permit application expires if a permit is not obtained within 180
_ _ V/ ' c days after it has been accepted as complete.
Authorized signature: (._. IN–) ((^S[- v ( i 6 6- ' Fee methodology set by Tri-County Building Industry Service Board
Print name:` ' �l I cit 7 s, Date: J Z _ (_
I:\BuildingWermi c_PmnitApp_o40113.doc!- 440-4617T(I
*
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\Perm its\MEC_PermitApp_040113.doc 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15215 SW 79TH AVE, TIGARD, OR, 97224
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2014-00296
George Heimos
Violation Summary:
Inspector Contractor