Permit p CITY OF TIGARD MECHANICAL PERMIT
11111 8 COMMUNITY DEVELOPMENT Permit#: MEC2015-00224
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/21/2015
Parcel: 2S103CB02000
Jurisdiction: Tigard
Site address: 12220 SW JAMES ST
Project: IVERSON Subdivision: WILLAMETTE NO.2 Lot: 44
Project Description: Gas piping for new gas stove.
Contractor: J &M CONTRACTOR SERVICES INC Owner: IVERSON, LARRY T&SANDRA L
15604 NE RUID RD 12220 SW JAMES ST
AMBOY,WA 98601 TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 04/21/2015 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 04/21/2015 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 04/21/2015 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requi :_ •.0 • •Ilow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through O•' 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Si!nature: /'ii _._..6 ...e... 10‘.... • ,w
Call 503.639.4175 by 7:00 a.m.for the next availab - ••-••ctio •ate.
This permit card shall be kept in a conspicuous place on the job site until c• pletion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application i��I FOR OFFICE USE ONLY
((�� 1r Received
City of Tigard
1� DateBy: �1 . 1 /5 �� i ��<<����1�„
MI il
13125 SW Hall Blvd.,Tigard,OR 97223 �"�'
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
DateBy:
T I G A R D Inspection Line: 503.639.4175 p p R 2 1 2015 Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: LIU Supplemental Information
T OF WOR `
`1 o�kr tV1SI0N COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Ii �imf D Mechanical permit fees*are based on the value of the work
❑New construction Ad dition/alteratiO ep acement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
-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:
220 S Air conditioning 46.75
Job site address:
�R/h�,S %r Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: R g_461 #2_ 97zz.7 Furnace 100,000+BTU(ducts/vents) 54.91
i Heat pump 61.06
Suite/bldg./apt.no.: Project name:ivees-ey3 t Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32 _
/ 7---- -- Residential boiler(radiator or
`p�! J; 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
./ 000 L!/Uc v /.S77AJ 7 /4/„Qtg fireplace 23.32
Zj Lio5 - /C N d'� / j��-�� , / Log lighter(gas) 23.32
/r"7> f / T(J j�/ Wood/pellet stove 33.39
•
CO/!r ��,0 I- Wood fireplace/insert , 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: L�.� �c�e�D Range hood/other kitchen
Address: /2...2.:2.e) kciCJ �6� �� Clothes dryer 33.39•
r Clothes dryer exhaust 33.39
City/State/ZIP: �62/42� t 0� Q'7Z Single duct exhaust(bathrooms,
'/ toilet compartments,utility rooms) 23.32
Phone:(S,3 ����Z7�L Fax:( ) Attic/crawlspace fans 23.32
At APPLICANT CONTACT PERSON Other: 23.32
Fuel piping:
Business name: Gr A) e� $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
Range l
E-mail: Barbecue _
CONTRACTOR Clothes dryer(gas) _
S %o Other:
Business name: MECHANICAL PERMIT FEES*
Address: 1 40 te ive Ir1ie Subtotal
City/State/ZIP: gn/J rot/ j 9(C,D/ Minimum permit fee($90.00)
Phone:302)2417 ■ SCe o d _ Fax:
Plan surcharge(25%of permit fee)
( ) State surcharge(12/o of permit fee)
CCB lic.: / ,� 5< TOTAL PERMIT FEE /d1. r_o-
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorize.signatu -: ' * Fee methodology set by Tri-County Building Industry Service Board
Print n. ��j� J _ . E • Date: i.c.
1.\BuildingtPenoits\MEC ' rmitApp_040113.doc 44.-461 ,(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.
I:\Building\Permits\MEC_PermitApp_040 1 i 3.doc 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
12220 SW JAMES ST, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2015-00224
George Heimos
NOTE: New FS piping from meter location to stove. 10psi/15/min, pass
Violation Summary:
Inspector Contractor