Permit (28) CITY OF TIGARD
MECHANICAL PERMIT
2 ; COMMUNITY DEVELOPMENT 1111
Permit#: MEC2016 00099
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/11/2016
Parcel: 2S104AA02400
Jurisdiction: Tigard
Site address: 12265 SW 127TH AVE
Project: Wyffels Subdivision: BELLWOOD Lot: 73
Project Description: Install gas line from meter to new dual fuel range.
Contractor: J &M CONTRACTOR SERVICES INC Owner: WYFFELS, HENRY R
15604 NE RUID RD 12265 SW 127TH AVE
AMBOY,WA 98601 TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 02/11/2016 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 02/11/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 02/11/2016 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Noti Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct uestions to UNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: . 6-60er- A.A. 14 Permittee Signature: r
17,---
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR(nucu: t SI':()Ni.‘
City of Tigard �, CEIVED Date/By:Received �-��� Permit No.:H �/!�
:I . 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
I i c;A R n Inspection Line: 503.639.4175 FEB 1 1 2016 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
I OF TIGARD
� ! Yy' XY4 ✓a.:' w4x it W 'r% 9 5a•: -,,,,,,,,g0,.,,,,,,,,,,,,,,, # k', swin-4.5F-y?i r i �' sa .y�
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$ • Mechanical permit fees*are based on the value of the work
0 New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
0 Demolition ❑ Other:
l'-'4'.'-/...' Value:$
-7 %' ` ; r7iE '" i '� t'' nd a
� pI, ''' ' -tr § - . .. z ";s..'. . i ' w.-tA'.ra'r>.'r,. „r efr s w ti r ; E ; `, 6! 6,':z x ? e'
gl 1-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist.
0 Multi-family ❑ Master builder 0 Other: Description I Qty. I Ea. I Total
sr Heating/cooling:
Air conditioning 46.75
Job site address: I 7.2(c c .,J I z,7 TM I h,c Furnace 100,000 BTU(ducts'vents) 46.75
City/State/ZIP: "r'kke�U � 972z Z, Furnace 100,000+BTU(ducts/vents) 54.91
JHeat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: WAIyI..s,1— a.n 0/112$4'^ Nti Os, Hydronic hot water system 23.32
AJ
f ) Residential boiler(radiator or
c:r‘. I ?j71\ /Y4_ , 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
DESCRIP11ON ot,WORK Gas fireplace/insert 33.39
A Flue vent for water heater or gas
(KA I AlAAA-) c,(--S At poyt yyuQJ L'..
4-0 ( -) fireplace 23.32
Q‘,-cA `1 , Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
rPERTY; wi+I r fl ' r +r
Environmental exhaust and ventilation:
Name: /44"7 wv l V"cd S Range hood/other kitchen
p equipment 33.39
t4�J� `2,7 TM
Address: 'L�S Aum Clothes dryer exhaust 33.39
City/State/ZIP: 't t 5,...rt Up_ -11tZ.' Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(50 3) 68-O -677(o Fax:( ) Attic/crawlspace fans 23.32
V Other: 23.32
Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Gas heat pump
Address:
Wall/suspended/unit heater
City/State/ZIP: Water heater _
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
1 ;,`'.5sk � �fa,t r yar . _ Clothes dryer(gas)
Business name: -3 it M Sf—rkA .X Other t
t M `i m , .14t4",,,!L '� i
Tr:1,
Address: 15(00 AJ e Rho— Subtotal eC
City/State/ZIP: AityAcoyOA O 0 601 Minimum permit fee($90.00)
Phone:(5)) (p�O r O[01 Fax:( ) Plan revw(25%1 %of permit fee)
State surcharge(12/o of permit fee) /0--8°
CCB lir.: / Tg5?I TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
/ days after it has been accepted as complete.
Authorized signature) * Fee methodology set by Tri-County Building Industry Service Board
Print name: il LAMtA.1"tv - Date: Z11(/rto.
t Building Permits MEC Permit pp_040!t .dor 440-4617T(1I?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\Pennits\MEC PermitApp_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
12265 SW 127TH AVE, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2016-00099
David Young
Violation Summary:
Inspector Contractor