Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2015-00845
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/22/2015
Parcel: 2S111 CA07700
Jurisdiction: Tigard
Site address: 15286 SW 100TH AVE
Project: Moller Subdivision:3TATES NO.2 A REPLAT OF"GULF SII Lot: 21
Project Description: Gas piping to new range
Contractor: BRUNER PLUMBING Owner: MOLLER, ROBERT S&PENNY L
PO BOX 23985 15286 SW 100TH AVE
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503-624-4880 PHONE:
FAX: 503-624-2173
FEES
Specifics: Description Date Amount
Fuel Piping 12/22/2015 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 12/22/2015 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 12/22/2015 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: �/1 Q 0 It on4, (}�
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. l� �..,` 4
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard g�� � )dee B I Z�2�1�CJ .� Permit No.: M.6CZ0j�
13125 SW Hall Blvd.,Tigard,OR 97223 {u9W�41e flan Review 1
Phone: 503.718.2439 Fax: 503.598.1960 P1
-Re Other Permit:
Inspection Line: 503.639.4175 DEC 2 2 NUaje Ready/By: Juris. ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: ->-j Supplemental Information
CITY QF Ti l I
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TYPE OF WORK f3UILDINIG UIVINUIN COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family ❑ Master builder ❑Other: Description Qty. Ea. I Total
JOB SITE INFORMATION.AND LOCATION
Heating/cooling:
},� Air conditioning46.75
Job site address: �2 �j SUV 0D Ave, Furnace 100,000 BTU ducts/vents) 46.75
City/State/ZIP: C} ��Z + Furnace 100,000+BTU ducts/vents 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: M011W
Duct work 23.32
Cross street/directions to job site: H dronic hot waters stem 23.32
���I Residential boiler(radiator or
j w Ql l(J`(� S ' h dronic) 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
t -�-,�l Flue vent for water heater or gas
I fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Fl PROPERTY'OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawls ace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$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 dryer(gas)
Other:
Business name: jru MECHANICAL PERMIT FEES*
Address: 3 Subtotal
City/State/ZIP: -I g Minimum permit fee($90.00)
_ Plan review(25%of permit fee)
Phone:(�3) _ g Z) Fax:(03) � ���- - � 7 3
State surcharge(12%of permit fee)
CCB lic.: ?J TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
/1 �� � � r� days after it has been accepted as complete.
Authorized Signature: v� vl ��/ * Fee methodology set by Tri-County Building Industry Service Board
Print name: K( pi(/ Date: 2 Z.Z
I\Building\Permits\MEC_PermitApp_040113 doc 440-4617T(11/02/COM/WEB)
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
15286 SW 100TH AVE, TIGARD, OR, 97224
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2015-00845
David Young
Violation Summary:
Inspector Contractor