Permit (39) CITY OF TIGARD MECHANICAL PERMIT
`E 711 COMMUNITY DEVELOPMENT Permit#: MEC2016-00569
T[GAD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/09/2016
Parcel: 1 S134DA01400
Jurisdiction: Tigard
Site address: 11095 SW 106TH AVE
Project: Burrell Subdivision: NORTHERN PINE Lot: 5
Project Description: Gas piping for fireplace,range,and barbecue.
Contractor: NORTHWEST HOME RENOVATION LLC Owner: BURRELL,AMANDA
11125 SW 106TH AVE 11095 SW 106TH AVE
TIGARD, OR 97223 PORTLAND, OR 97223
PHONE: 503-267-5552 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 08/09/2016 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 08/09/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/09/2016 $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 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.
C
Issued By: /)/ 1"111b Permittee Signature: ` C
/♦
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 USE oNt,v
Received
City of Tigard -� Permit No.: ,.
13125 SW Hall Blvd.,Tigard,OR 9 + 3 it73' Date/By: �1� C. 1 �-
Phone: 503.718.2439 Fax: 50359: ,.`''.g .., ,4 :�.i ' D Reviewan Other Permit:.pc, bi -,, 5,-.
T 1 G A R D Inspection Line: 503.639.4175 Date Ready/By: •13 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: MI Supplemental Information
TYPE OFreff OF ` COMMERCIAL FEE* SCHEDULE -- USE CHECKLIST
� �>t Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/ G f yier h`x ,• performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: if P 2 is mechanical materials,equipment,labor,overhead,and profit.
Value:$$1,200.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
0 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORAM TI ND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:11095 SW 106th Ave Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:Burrell 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
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
additional gas lines installed from existing system fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
0 PROPERTY OWNER 0 TENANT
Environmental exhaust and ventilation:
Name:Amanda Burrell Range hood/other kitchen
equipment 33.39
Address:11095 SW 106th Ave Clothes dryer exhaust , 33.39
City/State/ZIP:Tigard,OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(971)645-9914 Fax:( ) Attic/crawlspace fans 23.32
ra APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:Northwest Home Renovation Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Steve Purves Furnace,etc.
Address:11125 SW 106th Ave Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Tigard,OR 97223 Water heater
Phone:(503)380-0008 Fax::( ) Fireplace 1 14.15 14.15
Range 1 14.15 14.15
E-mail:steve@nwhomerenovation.com Barbecue 1 14.15 14.15
CONTRACTOR Clothes dryer(gas)
Business name:Northwest Home Renovation Other:
MECHANICAL PERMIT FEES*
Address:11125 SW 106th Ave Subtotal 42.45
City/State/ZIP:Tigard,OR 97223 Minimum permit fee($90.00) 7s). ea)
Plan review(25%of permit fee) --
Phone:(503)380-0008 Fax:( ) State surcharge(12%of permit fee) jI 32
TOTAL PERMIT FEE Ji,;?_x]j
CCB lie.:201587
This permit application expires if a permit is not obtained withinY 80
days after it has been accepted as complete.
Authorized signature: _ * Fee methodology set by Tri-County Building Industry Service Board
Print name:Steve Purves Date:7/25/2016 18'i h,h,
I:\BuildingiPermits\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
11095 SW 106TH AVE, TIGARD, OR, 97223
Residential - Mechanical
610 Gas line
PASS
MEC2016-00569
Jeff Grove
Standard pressure verified 10 psi 15 min
Violation Summary:
Inspector Contractor