Permit CITY OF TIGARD MECHANICAL PERMIT
111111 " COMMUNITY DEVELOPMENT Permit#: MEC2015-00613
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/14/2015
Parcel: 2S102AD01400
Jurisdiction: TIGARD
Site address: 9075 SW BURNHAM ST
Project: Tigard Alignment Subdivision: TIGARD HIGHWAY TRACTS Lot: 21
Project Description: Gas piping for a new gas meter.
Contractor: NATURAL GAS CUSTOM PIPING INC Owner: HENDERSON, JACK R&MARY S
1014 NE 177TH AVE 9075 SW BURNHAM ST
PORTLAND, OR 97230 TIGARD, OR 97223
PHONE: 503-319-6557 PHONE:
FAX: 503-335-9950
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 09/14/2015 $69.06
Class of Work: ALT Type of Const: VB Plan Review 09/14/2015 $17.27
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 09/14/2015 $8.29
Info Process/Archiving-Sm$0.50(up to 09/14/2015 $0.50
Stories: 11x17)
Project Valuation: $500.00
Fuel Air Handlers
Fuel Types: Natural Gas Units< 10000 cfm:
Gas Pressure: Units> 10000 cfm:
Furnaces Boilers&Compressors
Furnaces< 100K BTU: 0-3 HP:
Furnaces>=100K BTU: 3-15 HP:
Floor Furnaces: 15-30 HP:
Unit Heaters: 30-50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $95.12
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir questions is •U •y calling 503.232.1987 or 1.800.332.2344.
Is ued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available ins.- on date.
This permit card shall be kept in a conspicuous place on the job site completion of the project.
Approved plans are required on the job site at the time o•each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received c ('
( j Date/By: l I
Permit No
/ l o2W`�006;
N •
03 SW Hall Blvd.,Tigard,OR 9
Phone: 503.718.2439 Fax: 50 9837.223 c ED Plan Review
Date/By: 10(( -a• er Permit:
Inspection Line: 503.639.4175 -
i I G A R l) Date Ready/By: I : ® See Page 2 for
Internet: www.tigard-or.gov SEP 8 2. 5 Notified/Method: /j0 �5 Ia.. "Jj Supplemental Information
SEP 8 ^ [ Y+r�� ��Cf�
t
Mechanical permit fees'are based on the value of the work
❑New construction Ni Addition/altirliknM S cement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
❑ 1-and 2-family dwelling A Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total
Heating/cooling:
Air conditioning 46.75
Job site address: q Q 7 Sty/ 824 i-N a m S Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: / !4f •r q-7.V.3 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: 0 Project name: -l �( T�1 ,fr Heat pump 61.06
I Duct work 23.32
Cross street/directions to job site: 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: I Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK 111.11 Gas fireplace/insert 33.39
_` ' Flue vent for water heater or gas
(AC` Me VI oas r/i� --e4" fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
IIIIIP Other: 23.32
PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:5 Name: j a c k �,.i± `^'q,--t-
Clothes I Range hood/other kitchen
�" equipment 33.39
Address: ] t ! dryer exhaust 33.39
City/State/ZIP: I r a✓,��VA""" �r- `7 3 Single-dud exhaust(bathrooms,
��r-;� �� toilet compartments,utility rooms) 23.32
Phone:(( 3) t,z y 1-19 Fax:( ) Attic/crawlspace fans 23.32
CO „P N Other: 23.32
Fuel piping:
Business name:
�.--- $14.15 for first four;$4.03 for each additional
Contact name: 0.,, k p 1,4 /_01"...girt,' Furnace,etc.
Address: t ( /( q U S kJ L n�Q C-t' Gas heat pump
-[ q Wall/suspended/unit heater
City/State/ZIP: T I t- i 79„. 2.3 Water heater
Phone:($' ,1 .7 ( -L qC.i GJ I Fax::( ) Fireplace
Range
E-mail: . at O 4` e$ . v k / Barbecue
Clothes dryer(gas)
4/ Other:
Business name: JP A R - 4._ �� ..�
Address: /0 I / / -f' „t
v� Subtotal
City/State/ZIP: �,r Y .,3 c) Minimum permit fee($90.00)
Phone:( ) t :( ) Plan review(25%of permit fee)
I State surcharge(12%of permit fee)
CCB lic.: 1 c 31 TOTAL PERMIT FEE
�/ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized si=a re: , • Fee methodology set by Tri-County Building Industry Service Board
Print name: ,MULIMP Date: ���
I:U3uilding\P kai _PermitApp_04o113.doc 'i .1 (11/02/COM/wEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Famil Fee Schedule:
$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_Per nitApp_040I 13.doc 2
DBA: Polaris of Portland
IIORTFI WEST
44 Oki 101
SEA-D00 • CAN-AM • SKI-D00 • SEGWAY
(503) 238-2510
250 S.E. Division Place • Portland,OR 97202 • (503)238-2510 Phone • (503)238-2193 Fax•www.SKNorthwest.corn
f
/
/
September 4, 2015
•
Jack Henderson
9075 S.W. Burnham Street
Tigard, OR 97223
Dear Jack,
After five months of owning your'15 RZR, you are probably aware of most of its capabilities in
performance and handling. Our parts and accessories department at SK continues to be
supplied with featured items that will add to those capabilities.
The time has never been better to equip your Polaris with our brand nab products. We have
helmets, clothing, performance parts and accessories by Polaris as well as many other
manufacturers. Our staff is expertly trained in application and installa ' n for your personal
riding style. •a �s
t
We appreciate you and your business and look forward to talking with yotfi°again sport , . .
Until then! w , ;
' , ,`
l
(4,Y ri 4
Monica :rYb-as, Office Manager `� 3 ,,
SK Northwest
la
1
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
9075 SW BURNHAM ST, TIGARD, OR, 97223
Commercial - Mechanical
699 Mechanical final
PASS - No C of O
MEC2015-00613
Chip Barnett
Violation Summary:
Inspector Contractor