Permit (58) CITY OF TIGARD MECHANICAL PERMIT
`' COMMUNITY DEVELOPMENT Permit#: MEC201600553
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/02/2016
Parcel: 2S111 DB12600
Jurisdiction: Tigard
Site address: 9430 SW LAKESIDE DR
Project: Blanchard Subdivision: SUMMERFIELD NO.12 Lot: 677
Project Description: Replace gas logs with gas insert.
Contractor: SHAMBURG HEATING LLC Owner: BLANCHARD TRUST
PO BOX 829 BY BLANCHARD, LAIRD M&JUDITH M TR
TUALATIN, OR 97062 18707 TUALATA AVE
LAKE OSWEGO, OR 97035
PHONE: 503-692-5563 PHONE:
FAX: 503-691-6855
FEES
Specifics: Description Date Amount
Gas Fireplace 08/02/2016 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 08/02/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/02/2016 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notif enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir questions to •,NC by lin. 503.232.1987 or 1.800.332.2344.
I-sued By: � , . Permittee Signature: e
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE U SL ONLv
City of Tigard C E'V E D Received Permit No.:{�/ . /'
Date/By: ilfairtmi
I (L , dlll�-pV:)53
13125 SW Hall Blvd.,Tigard,OR IFIEPlan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
AUG 2 2016
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIIGARD
TYPE�� G DIVISION COMMERCIAL FEE*SCHEDULE - USE CHECKLIST
' Mechanical permit fees*are based on the value of the work
❑New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
'
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: Cr6/..g.�6 S c,.2
1.-A-tet S 41)6, .(.)r. . Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 'i crA,a ) (.9d c7772,1 Furnace 100,000+BTU(ducts/vents) 54.91
�C Heat pump 61.06
Suite/bldg./apt.no.: Project name: / ,�614c, �/2.q 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
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
} ' ' - ;` Gas fireplace/insert if 33.39
DESCRI�*3'ION�OF W()ItK " ep
,%jam �� Flue vent for water heater or gas
/ (Z-6 jC- fireplace 23.32
Log lighter(gas) 23.32
L"-A7114 6;i)s C/N./c L.,-P---7-
Wood/pellet
., Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
d PROP) 1< Wr Eat ,TENANT 4' ,
Name: 4 Environmental exhaust and ventilation:
6-d �'� 6 L,4--A1(L j Range hood/other kitchen
equipment 33.39
Address: C-"i j1C) Vic-.- Lf-V e-s tpc. 3 6,7, Clothes dryer exhaust 33.39
City/State/ZIP: --7 4. eL,1� c), c Cr 2.p . Single-duct exhaust(bathrooms,
l toilet compartments,utility rooms) 23.32
Phone:( J3) f 3;Z cy ' Fajr:-(-- -)'- Attic/crawlspace fans 23.32
Cl APPLICANT µ U CONTACTY'PERS01 Other: 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 dryer(gas)
Business name: Other:
51/'4" c4.'0..Y/f(, /I�rig77-'7 LS
MECHANICAL PERMIT FEES*
Address: i3 Subtotal
` G 90
CYO
City/State/ZIP: '--�cJA, Z'jtt o�t �06‘e---- Minimum permit fee($90.00)
Plan review(25%of permit fee) '-
Phone:(4' ) . s'-'5-'0 t'EM/ ) State surcharge(12%of permit fee) /Q.8V
CCB lic.: t)-‘-' q5'/ TOTAL PERMIT FEE /Gt:2, F"O
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized Signature: /" - �� �P * Fee methodology set by Tri-County Building Industry Service Board
.-j<-
Print name: G --4 i .rC° ry-fK _. 17`-).---/6
Date:
I:\Building\Permits\MEC_PennitApp 040113.doc 440-4617T(11/02/COM/WEB)
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.
I:\Building\Permits\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
9430 SW LAKESIDE DR, TIGARD, OR, 97224
Residential - Mechanical
615 Mechanical rough-in
PASS
MEC2016-00553
Jeff Grove
Installed per manufacturers instruction
Violation Summary:
Inspector Contractor