Permit � n
`` CITY OF TIGARD MECHANICAL PERMIT
1 ' COMMUNITY DEVELOPMENT Permit#: MEC2015-00785
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/18/2015
Parcel: 1S133AD15800
Jurisdiction: Tigard
Site address: 11241 SW SUMMER LAKE DR
Project: Vhay Subdivision: SUMMER LAKE Lot: 39
Project Description: Installation of gas insert and gas line.
Contractor: T& K MECHANICAL Owner: VHAY, JOHN S&ANN E
PO BOX 116 11241 SW SUMMER LAKE DR
FOREST GROVE, OR 97116 TIGARD,OR 97223
PHONE: 503-844-9173 PHONE: 503-643-3201
FAX: 503-846-0195
FEES
Specifics: Description Date Amount
Gas Fireplace 11/18/2015 $33.39
Type of Use: SF Fuel Piping 11/18/2015 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 11/18/2015 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 11/18/2015 $42.46
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili . • ._• er. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
• direct questions to OU"- by calli.< 13.232.1987 or 1.800.332.2344.
Issued By: �
AL. O Permittee Signature: L �
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application �j' FOR OFFICE I SE ONLY
City of Tigard
13125 " '� � Permit No.: �-'�ewe,5-� S
. 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.59$.,I 1 Duey Other Permit:
Inspection Line: 503.639.4175 N J�J 1 g �' Date Ready/By: Fit See Page 2 for
TIG� RDA y/By: rum:
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY a ' 'i'R AKlr
TYPIir °'i, -,. 1 y COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction (j51,\Addition/alterat ion/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
"�-and 2-family dwelling ❑Commercial/industrial ❑Accessory building
For special information use checklist.
❑Multi-family ❑Master builder ❑Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling _
Job site address: l I a N 1 5 L3 5 v,n Air conditioning
0 YY�QA./ �(�� �Y (requires site plan showing placement) 46.75
City/State/ZIP: —1 I r G,�d 0 v,e. CO a a 3 Furnace 100,000 BTU(ducts/vents) 46.75
Furnace 100,000+BTU(duets/vents) 54.91
Suite/bldg./apt.no.: Project name: V i`I f Heat pump 61.06
Cross street/directions to job site: Duct work . 23.32
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: Lot no.: Other: 23.32
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
1 Gas fireplace 33.39 3 3,3`)
C1GS V t VIAL_. 5 \ )'l`asl\-T Flue vent for water heater or gas
J fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent } 23.32 ') 3
Jo PROPERTY OWNER ❑ TENANT Other: 23.32
Name: To I;' 1.\ V 6 ,ate, Environmental exhaust and ventilation
JJ Range hood/other kitchen
Address: ` l a,`-I I „j l,J tJ rrl mQ.✓c R LQ 04- equipment 33.39
City/State/ZIP: ` GyIM(cl �v c a 3 Clothes dryer exhaust 33.39
J _ Single-duct exhaust(bathrooms,
Phone:( S(f, ) ?ce( .. 3 act I ( 5c ) [-3 c)q - 3U-7 I toilet compartments,utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawispace fans 23.32
Other: 23.32
Business name: -C}. 1'`n� \0.n_1 (L Fuel piping
Contact name: ,C; y..,, $14.15 for first four;$4.03 for each additional
S etc.
Address: Q 0 X -i ( R - Gas heat p um p
City/State/ZIP: � a -1 t.
�r v V� a� ��� j � Wall/suspended/unit heater
Phone:(SCr)- ) c�4 q —01 t l -' I Fax::( ) '(_,t(D- 0 I C, Water heater
Fireplace 1 1 11 , I j
E-mail: QC.J GS t....)0 V\CON y CN a, , C 1 Range
CONTRACTOR Barbecue
(gas)name: 4_ /� inc r 1,.\ a Xl I C c,I Other
Address: r 0 3 C x I l U) MECHANICAL PERMIT FEES*
City/State/ZIP: 5 C!Y e_z., 9( e O� (Ilia" Subtotal 7(,_7T)
; 5 J Minimum permit fee($90.00)
Phone:( ) �y vl - q 1 3 Fax:(5(J3) T(!(. -0)9 5 Plan review(25%of permit fee)
CCB lie.: i a '� ` I ,.., State surcharge(12%of permit fee) 1 )�d
lJ� J TOTAL PERMIT FEE !0Cl)D d
Authorized signature: l!TL� \\ This permit application expires if a permit is not obtained within IRO
1 days after it has been accepted as cnmplct:_
•Print name: Y�1 t CJ r\\" C 1 Date: 17 'c
III Fee methodology-set by Tr Cou ry Building industry S n cc Board
,
r+ nil di, +a.noitr� r_n..neApp.doe tnmtaw een.eSrlT(!tpn.COMAYES)
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
11241 SW SUMMER LAKE DR, TIGARD, OR,
97223
Residential - Mechanical
610 Gas line
PASS
MEC2015-00785
Jeff Grove
Standard pressure verified 10 psi 15 min
Violation Summary:
Inspector Contractor