Permit CITY OF TIGARD MECHANICAL PERMIT
`' �� COMMUNITY DEVELOPMENT Permit#: MEC2014-00506
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/17/2014
Parcel: 1 S135DB02800
Jurisdiction: Tigard
Site address: 11475 SW 91ST AVE
Project: Sandbo Subdivision: CHARBEN Lot: 13,DOG
Project Description: Gas pipe to range and water heater. Vent water heater and add ductless heat pump.
Contractor: WILLAMETTE HEATING&AIR CONDITIONING INC Owner: SANDBO REVOCABLE TRUST
4370 NE HUBER 11475 SW 91ST AVE
PORTLAND, OR 97221 TIGARD, OR 97223
PHONE: 503-284-3740 PHONE:
FAX: 503-284-2821
FEES
Specifics: Description Date Amount
Heat Pump 09/17/2014 $61.06
Type of Use: SF Flue Vent for Water Heater or Gas 09/17/2014 $23.32
Class of Work: OTR Type of Const: Fireplace
Occupancy Grp: Fuel Piping 09/17/2014 $14.15
Stories: 12%State Surcharge-Mechanical 09/17/2014 $11.82
Fuel
Fuel Types:
Gas Pressure:
Total $110.35
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct• - - - .OUNC by calling 503.232.1987 or 1.800.332.2344.
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11111111111111140
Issu•• By: i /i Permittee Signature: /
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received ? ,t,�G
g ( FIUFII
Date/By: / /7 �� Permit No.://Gy �0���
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III 13125 SW Hall Blvd.,Tigard,OR c
i Phone: 503.639.4171 Fax: 503.5' , Plan Review Other Permit:
Inspection Line: 503.639.4175
Date/By:
T 1 t.A lt it 1 Date Ready/By: Juns 0 �Page 2 for
Internet: www.tigard-or.gov SEP 1 7 i L. - Notified/Method:
Supplemental Information
TYPE OF `QUO' N A&
COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
no KO Mechanical permit fees*are based on the value of the work
❑New construction Addition/a�I5lacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
and 2-family dwelling ❑Commercial/industrial ❑Accessory building RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
Multi-family 0 builder ❑Other: For special information use checklist.
Description 1 Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: !� Air conditioning or heat pump / �/�
// 75-5A/ �/ / (requires site plan showing placement) / .l.4 O 6,/,m T'
City/State/ZIP: Furnace 100,000 BTU(ducts/vents) 14.00
'r11 ' Furnace 100,000+BTU(ducts/vents) 17.90
t�
Suite/bldg./apt.no.: Project name: IVJ 2 Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
�( ) Pel Re identi hot werer system 14.00
t/V Residential boiler(radiator or
hydronic) 14.00
i Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 10.00
Subdivision: Lot no.:
Flue/vent for any of above 10.00
Other: _ 10.00
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
,/ // PA �� IP_ _/ �'�. _ - L'✓• / Flue vent for water heater or gas
Nei'
Iw- A/ . / i fireplace i loo/ ;3.5;�-
�' ' • `. Log lighter(gas) 10.00
AM= i_ t� -' AL 4,� �� ar _ ,j
� / Wood/pellet stove 10.00
Wood fireplace/insert 10.00
PROPS OWNER 1 ❑ TENANT Chimney/liner/flue/vent 10.00
Other: 10.00 _
Name: Environmental exhaust and ventilation _
Address: Range hood/other kitchen
equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single-duct exhaust(bathrooms,
Phone:( ) Fax:( ) toilet compartments.utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping _
Contact name: S or first four;$1.00 for each additional / / , ,
Address: Furnace,etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone:( ) I Fax: :( )
Water heater F
Fireplace
E-mail:
Range
CONTRACTOR Barbecue
Business name tic` d
Clothes dryer(gas)
�a/L` ■
J Other:
Address: 3 20 /— /` ,1 MECHANICAL PERMIT FEES* t�
City/State/ZIP: / Olt.I7� f� l Subtotal 9d •5.
y `J ems" Minimum permit fec-
Phone:( jj/ 7 . Fax:( ) Plan review(25%of permit fee)
CCB lic.: / �/ / State surcharge(8%of permit fee) 11.y9.--_,
TOTAL PERMIT FEE /l7,35'_
Authorized signature: / / , This permit application expires it a permit is not obtainrt within 180
i' days after it has been accepted as complete.
Print name: ALW.P rw - J Date: �ikRvka • Fee methodology set by Tri-County Building Industry Service Board
t-\Building\PermitsVMEC-PermitApp.doe 04/06/06 440-46171(11/02/COM/WEB)
' Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee$72.50
$2,001.00 to$5,000.00 $72.50 for the first$2,000.00 and$2.30
for each additional$100.00 or fraction
thereof,to and including$5,000.00.
$5,001.00 to$10,000.00 $141.50 for the first$5,000.00 and
$1.80 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,001.00 to$50,000.00 $231.50 for the first$10,000.00 and
$1.35 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,001.00 to$100,000.00 $771.50 for the first$50,000.00 and
$1.25 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first$100,000.00 and
$1.10 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
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1:kBuilding\Permits\MEC-PermitApp.doc 12/30/05 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11475 SW 91ST AVE, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2014-00506
George Heimos
Violation Summary:
Inspector Contractor