Permit (33) CITY OF TIGARD MECHANICAL PERMIT
.1111
a.' COMMUNITY DEVELOPMENT Permit#: MEC2016-00404
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/06/2016
T[e, R,O 9 Parcel: 2S 103ACO2700
Jurisdiction: Tigard
Site address: 11105 SW ERROL ST
Project: Holter Subdivision: ECHO HEIGHTS Lot: 7
Project Description: Install gas line and fireplace insert.
Contractor: T&K MECHANICAL Owner: HOLTER, SCOTT A&
PO BOX 116 HOLTER, LYNN M
FOREST GROVE, OR 97116 11105 SW ERROL ST
TIGARD, OR 97223
PHONE: 503-844-9173 PHONE:
FAX: 503-846-0195
FEES
Specifics: Description Date Amount
Wood Fireplace/Insert 06/06/2016 $23.32
Type of Use: SF Fuel Piping 06/06/2016 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 06/06/2016 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 06/06/2016 $52.53
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
(//11//7 "
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applicati4ECEIVED FOR OFFICE USE ONLY
City of Tigard EEie /
_ rO7 Permit N D O11111
13125 SW Hall Blvd.,Tigard,OR 97223 �UN 6 2016 Pw
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Date/By:
I I , 1 I:I) Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: ' Juris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method. Supplemental Information
MIMTYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLI1111
Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
13/. I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
■ Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total
v r 'x Heating/cooling:
JOB SITE INFORMATION AND LOCATIONr .
_ t „,',1,,,,,, -,*,' Air conditioning 46.75
Job site address: 1 t I C4`J j(°*t L i v' i. I 4 Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: �i E i, C CI,� Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: 1 Project name: �” 0 I-+ Y 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
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert j 33.39 31.35
" Flue vent for water heater or gas
•
i.\(�C--. 1 t e ,t- . I Y 4" L7 lo.CO-- fireplace 23.32
J f Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent ) 23.32 .3 3;.x
0 PROPERTY OWNER ElTENANT Other: 23.32
Environmental exhaust and ventilation:
Name: 11 e.Y Range hood other kitchen
equipment 33.39
Address: 1 t 1 0 tj t,t_.) 1=r- V 0 1
Si-1T Clothes dryer exhaust 33.39
City/State/ZIP: '1 U` Single-duct exhaust(bathrooms,
t toilet compartments,utility rooms) 23.32
Phone:(ej(r) ) (v3(1 1 i.,iy SS-1 Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name: -' , k... iyuciA r., I
(c.1 $14.15 for first four;$4.03 for each additional
Contact name: (C` s,>,,) Furnace,etc.
11 Gas heat pump
Address: L �3�'x ! I Wall/suspended/unit heater
City/State/ZIP: fcv-e 4 G\Cc/t- p C)j / 1 T1,, 1 110 Water heater
Phone:(c 1 )) Lig _ (1 (1 3 Fax::(5(,) t{LV- 0 (ci 5 R peace ) y. l 5
E-mail: —I V\Q C \5 1 G tMl,Vl i4L\0,IVOt CC.11°V Barbecue
J CONTRACTOR Clothes dryer(gas)
Business name: IL Other:
" '�«1(Nah 1 Cc`1 MECHANI
Address: -P 6 C k 1,U)
Subtotal
City/State/ZIP: (J%( e c ("V e � (ill(Lc Minimum permit fee($90.00) (1(�.i
Phone:(665)CO44 -C i ", Fax:( G ) ( Plan review(25%of permit fee)
3 5 ', 4SU(9 ff State surcharge(12%of permit fee) i C-j(.'
CCB lic.: 1r.\\1 Lot—) TOTAL PERMIT FEE t o Q•ci-O
This permit application expires if a permit is not obtained within 180
i _ days after it has been accepted as complete.
Authorized signature: (\,\.'�,1/ * Fee methodology set by Tri-County Building Industry Service Board
Print name: .J\k , v\u l _ W I no e Date: • to . I La
1:Building'Permits,MEC_PermitApp_040113.doc 440-4617T(I 1 02COM,WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Feer;';
$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_PennitApp_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
11105 SW ERROL ST, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2016-00404
Jeff Grove
Violation Summary:
Inspector Contractor