Permit CITY OF TIGARD MECHANICAL PERMIT
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�: Permit#: MEC2015-00744
„! _ COMMUNITY DEVELOPMENT
Date Issued. 11/02/2015
I1 Gi4RD 13125 SW Hall Blvd ,Tigard OR 97223 503 718 2439
Parcel: 2S103B606800
f ;1.
Jurisdiction: Tigard
Site address: 12442 SW 122ND AVE
Project: Tapia Garcia Subdivision: BROOKWAY Lot: C
Project Description: Relocating range hood
Contractor: OWNER Owner. TAPIA, SERGIO
SERGIO TAPIA GARCIA 12442 SW 122ND AVE
12442 SW 122ND AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE 503-481-3408 PHONE
FAX
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 11/02/2015 $33 39
Type of Use: SF 12%State Surcharge-Mechanical 11/02/2015 $10 80
Class of Work ALT Type of Const: Minimum Fee Adjustment-Mechanical 11/02/2015 $56 61
Occupancy Grp:
Stories:
Fuel
Fuel Types
Gas Pressure
Total $100 80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obtain a copy of the rules
or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By. '• mittee Signature:
.I ,
Call 503.639.4175 by 7:00 a m.for the next available inspection date
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application _N FOR OFFICE USE ONLY,
i C
City of Tigard Received
�\`, Date/By• .? LT Zi4. Permit No AiarFL_ ! _
° 13125 SW Hall Blvd,Tigard,OR 972$
C Phone 503.718 2439 Fax• 503.598 1960
p �Inspection Line: 503 639 4175 \C\I
y y ® See Page t for
Date Read /l3 Jurts
Internet: www.tigard-or.gov p p (t(! Notified/Method Supplemental Information
TYP OF WOE (��� 1"�� fi COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
�L Mechanical permit fees*are based on the value of the work
❑ New construction ddition/alter ion/replacement performed. Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
Value-S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYS EMS 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:
J Z Air conditioning 46.75
Job site address: /
r ���7 � I � � �� Furnace 100.000 BTU(ducts/vents) 46 75
City/State/ZIP: ., ylta� d r- 97L . 3 Furnace 100.000+BTU(ducts/rents) 54 91
Suite/bldg./apt. no.: Project name• / Heat pump 61 06
TO/0/G /2-e)'4O c'P-/ Ductwork 23.32
Cross street/directions to job site: / Hydronic hot watei 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 f'oi 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 watei heater or gas
}�
J -e !p muff /4.„4 e (12ctAA h c fireplace 23 32
J Log lightei(gas) 23.32
Wood/pellet stove 33 39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23 32
❑ PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: S�rS To A rCI 4 Range hood/other kitchen
C equipment / 33 39
Address: /
l L etc/ L S 4} 7Z7/1d 4 U e Clothes diyer exhaust 33 39
City/State/ZIP: 17-3611- 0 r • 7/ J 77- T Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23 32
Phone:( 5'0?) �! 3 (7,1 Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Othei. 23.32
Fuel piping:
Business name:
$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
E-mail: Barbecue
CONTRACTOR Clothes diyer(gas)
0C' , ^r. \ G n Other:
Business name: .v V C ,L MECHANICAL PERMIT FEES*
Address:
Subtotal
City/State/ZIP: Minimum permit fee($90.00) Q .•Cl°
Plan review(25%of permit fee) -----
Phone:( ) Fax:( ) State surcharge(12%of permit fee) /v. $'Q
CCB lie.: TOTAL PERMIT FEE /60 • ge)
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signatur * Fee methodology set by Tri-County Budding Industry Service Board
Print name: Sc�T,,
e /a,f Cl Date: ///Q L //5
1AmuddingAi'ei mils\MECPo n _040113 doc 440-466171(ii(02/COM/WEii)
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\Pcrnuts\M EC_PcrmitApp_040113 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
12442 SW 122ND AVE, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2015-00744
Chip Barnett
Violation Summary:
Inspector Contractor