Permit (19) CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit#: MEC2019-00041
TfGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/22/2019
Parcel: 2S110BD02600
Jurisdiction: Tigard
Site address: 14921 SW 116TH PL
Project: WEBER Subdivision: HELM HEIGHTS Lot: 3
Project Description: Gas piping for gas cooktop.
Contractor: HOLMES INSTALLATION SERVICE Owner: WEBER, DANIEL E
33535 NW VADIS RD 14921 SW 116TH PL
CORNELIUS, OR 97113 PORTLAND, OR 97224
PHONE: 503-647-9320 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 01/22/2019 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 01/22/2019 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 01/22/2019 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1*: : :61.332.2344.
Issued By: �- / Permittee Signature:
ppd_____ 47)4,44mi
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
_ Received
City of Tigard Date/By:
Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 y' �� �i117 �/ �� 'i�t)°j
! Phone: 503.718.2439 Fax: 503.598.196 Plan Review Other Permit:
Date/By:
TI C ARD Inspection Line: 503.639.4175 �yy ) {(� Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.govI� !�lam+ Notified/Method: IMSupplemental Information
u ITY OF nGAHir: -mac
TYPE OF COMMERCIi L IEE S II DULE Ia IST5 ry.
Mechanical permit fees*are based on the value of the work
0 New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition Other: mechanical materials,equipment,labor,overhead,and profit.
Ku; Value:$
CATEGORYOF ON RII t ION
`' RESH)tNTiAL 1t'nQUIPMEN�'/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
'. t. W Heating/cooling:
r 7 OB SITE INFQ�t1VIATION. .kAA ' OC .AION ;
/ Air conditioning 46.75
Job site address: /t/ 9�/ t IAD'i.L /ICC'Q. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: _�
1 [ ex 1,., V 1,e...- Furnace 100,000+BTU(ducts/vents) 54.91
tyStato/ZIP: �
Heat pump 61.06
Suite/bldg./apt.no.: Project name: 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
_ 'to-'10 " .a F YORK •p Gas fireplace/insert 33.39
_ A. Flue vent for water heater or gas
-S.-K t=uu Day A 4.6 S fireplace 23.32
�0/`f��" Log lighter(gas) 23.32
� 6) Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
R I' t PITY'Q�R <. A 0. ' V- '. t": r- Environmental exhaust and ventilation:
Name: 'M N W Q VJt Range hood/other kitchenequipment 33.39
Address: 14 9 ?...I S' ,J II D I t,tC ` Clothes dryer exhaust 33.39
City/State/ZIP: * r �� Q�/� Single-duct exhaust(bathrooms,
_ Fax: toilet compartments,utility rooms) 23.32
Phone:
(q7y.�.- L(� 7!— 7 fj g ( ) Attic/crawlspace fans 23.32
' ':,----44,', ACT PERSON � :; Other: 23.32
:'
Business name: Fuel piping:
$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
CONTRACTOR :, Clothes dryer(gas)
Busin s LSC e� Other C% / r
C S l S �J` t MECHANICAL PEP a;: r
Address: ,5 ` Subtotal /t1,1.�
3S3S V 5
City/State/Z AA e O 'r-t q,� i r Minimum permit fee($90.00) la.r;,
3
r o
7...... .--->v` � Plan review(25%of permit fee)
Phone: ) ,� Fax:( ) State surcharge(12%of permit fee) id Gh
CCB lit.: 7 0d_ 7 TOTAL PERMIT FEE f�; ,
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized si natur ' •.--_�___J * Fee methodology set by Tri-County Building Industry Service Board
Print name: ?A.
� Q, Date: f/2,214,1.01 i
ci
I:\Building\Perits\MEC_PAPP_040113.doc17T�1COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
total Valuation: Permit Fee:':'f..,.
$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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14921 SW 116TH PL, TIGARD, OR, 97224 January 23, 2019 at
9:58:32 AM
Record Type: Record ID:
Residential - Mechanical MEC2019-00041
Inspection Type: Inspector:
699 Mechanical final Jeremy Burrows
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor