Permit (160) CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: MEC2019-00257
T I(;A I<(-) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/24/2019
" ' Parcel: 2S104AD04000
Jurisdiction: Tigard
Site address: 12570 SW WALNUT ST � l
Project: Jones Su'division: None Lot: None
Project Description: Converting to gas water heater and gas furnace and replacing A/C. Placement of A/C unit must comply with
manufacturer requirements. 5/28/19: REPRINT to add(2)bath exhaust fan,and(4)fuel pipes for fireplace,range,
and(2)exterior branches.
Contractor: OWNER Owner: JONES, DAVID R&AMY L
DAVID JONES 12570 SW WALNUT ST
13016 SW BROADMOOR PLACE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-260-0021 PHONE: 503-260-0021
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 04/24/2019 $46.75
Type of Use: SF Furnaces<100K BTU 04/24/2019 $46.75
Class of Work: ALT Type of Const: Water Heater 04/24/2019 $23.32
Occupancy Grp: Fuel Piping 05/28/2019 $22.21
Stories: 12%State Surcharge-Mechanical 05/28/2019 $16.68
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $155.71
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 952-0' '!'' 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: Ar
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 11
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 Applicatio p, r Z17 r FOR OFF1(E [SE()NEN
City of Tigard ;'gip `" Received T�
Date/By: /41 Jana! t /
13125 SW Hall Blvd.,Tigard,OR 97223 s/ Plan Review
III I Phone: 503.718.2439 Fax: 503.598.1960 '''-'1 - $ "�'''g Date/By: Other Permit:
T I G A R I) Inspection Line: 503.639.4175 f -.. } Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov 4 I r,a Notified/Method: Supplemental Information
... .. .-,x
TYEE;OF WOliiii COMMERCIAL'FEE*(SCHEDULE P.W.CHECKLIST
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 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
„CATEGORY OF CONS-IRUCTION n•
' RESIDENTIAL EQUIPMENT!SYSTEMS FEES*
[tj 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 INFbRMATION *°LOCATION f Heating/cooling:
Air conditioning 46.75
Job site address: I?�s-7 b g . /� 1 �ike c-...6,-..4„.„1---- Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: `7/646,,-y, _(!t/ ' ^2-25Furnace 100,000+BTU(ducts/vents) 54.91
/ 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: Other: 23.32
Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32k QV,;, Gas fireplace/insert • 33.39
<' � "".� 1' MON � I'401� k�.� � '
/� CZ
� /� � Flue vent for water heater or gas
( tr 04---- .CZ) �� at77r'.— Yf�'►+--1' fireplace _ 23.32
1 e)744/ ik.- ✓pd ! i Q7„-" 5 Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
.` ;' ,..O Other: 23.32
❑ TENANT
' Environmental exhaust and ventilation:
Name: f l Ab
by��� Range hood/other kitchen
equipment 33.39
Address: (�() (3 (a lik,t,VP%-4-Ij✓ `/(�.
Q Clothes dryer exhaust 33.39
City/State/ZIP: -'�'1 6.01,,..14l 7 '2/5 Single-duct exhaust(bathrooms, /n �/
Phone: ru J= toilet compartments,utility rooms) ��. 23.32 46,..,`L
(Sa5 ) = hl Fax:( ) Attic/crawlspace fans 23.32
4 CONTACT RSON' - Other: 23.32
Business name:
Fuel pip'
14.15 for first four;$4.03 for each additional
Contact name: 4.£& 1A-t/c-- Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range ' f
E-mail:
Barbecue
Y C- /�-O�NTRACTOR Clothes dryer(gas)
Business name: 6 GO VQ-.. Other:
2
MECHANICAL PERMITTEES*,
Address:
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized si ature: * Fee methodology set by Tri-County Buidilig Industry Service Board_ ___
Print name: Date: G(z..% 1 I
I:\Building\Permits\ _ermitApp_040t13.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
TOO Valuation; Permit Fed;
$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 MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2019-00257
T I ;;A R ID13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/24/2019
Parcel: 2S104AD04000
Jurisdiction: Tigard
Site address: 12570 SW WALNUT ST
Project: Jones Subdivision: None Lot: None
Project Description: Converting to gas water heater and gas furnace and replacing NC. Placement of NC unit must comply with
manufacturer requirements.
Contractor: OWNER Owner: JONES, DAVID R&AMY L
DAVID JONES 12570 SW WALNUT ST
13016 SW BROADMOOR PLACE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-260-0021 PHONE: 503-260-0021
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 04/24/2019 $46.75
Type of Use: SF Furnaces<100K BTU 04/24/2019 $46.75
Class of Work: ALT Type of Const: Water Heater 04/24/2019 $23.32
Occupancy Grp: Fuel Piping 04/24/2019 $14.15
Stories: 12%State Surcharge-Mechanical 04/24/2019 $15.72
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $146.69
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you • • • •- rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-01 -0090. You ma obtain a cop of the rules
or direct questions to OU by calling 503.2 .1987 or 1.80 .332.2344.
Issued By: AseApP'ermittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR()III(l_ I SF.()N1.1
City of Tigard " ReceivedtByy: ��j� F�,
Date !�
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' II g Phone: 503.718.2439 Fax: 503.598.1960 A p, 2 >' 2:`,..i7,i 9 Date/By: Other Permit:
l'1 G n R D Inspection Line: 503.639.4175 Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
.
TYPE':OF WORK COIHMERC AL FEE* SCHEDULE -USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction dition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY DF CONSTRUCTION
.. s ' RESIDENTIALEQU ..I r4T/SYSTEMS!�EES*
(trp-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: (7 )U 'i,� j 1 ''L 13 k S-cC 42,-r Furnace 100,000 BTU(ducts/vents) ( 46.75
City/State/ZIP: ( (C61:1-e„.0 "l.?12_3 Furnace 100,000+BTU(ducts/vents) 54.91
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
9 GJ t \ L)A 1 N Residential boiler(radiator or
tU l.3 `L-S"---- •f v hydronic) 23.32
CZ-S-'--. (r7 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 t 23.32
$ Gas fireplace/insert 33.39
DESC�toN Or WORK" eP
Cry / ' Flue vent for water heater or gas
1/'(1 6)r 6 0 p` I c Y.f're,t e%t-v...Q�c...4". fireplace 23.32
�i A' J / 1 n ( t� i `K� �� Log lighter(gas) 23.32
Yw i \ Wood/pellet stove 33.39
(.51C4 i t17 a",C S Wood fireplace/insert 23.32
t/ Chimney/liner/flue/vent 23.32
w ¥.. ., Other: 23.32
PROPERTY[f , . -�' -' D TENANT d 1
" Environmental exhaust an venti ation:
Name: 7/;\-v t,(1 l'.� Range hood other kitchen
Address: �j equipment 33.39
�CC � Igo(tP '°" (� 1' --�_ Clothes dryer exhaust 33.39
City/State/ZIP: -T c L,py^0 5'?V2',
- Single-duct exhaust(bathrooms,
l toilet compartments,utility rooms) 23.32
Phone:((� ) 2 DCC?Z\ Fax:( ) Attic/crawlspace fans 23.32
I1 T "- coN"i" ' t.:Ls Other: 23.32 ---
Business na ( Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc. j
Gas heat pump
Address:
Wall/suspended/unit heater
City/State/ZIP: Water heater i
Phone:( ) Fax::( ) Fireplace
Range
E-mail:
Barbecue
CONTRACTOR _ `. Clothes dryer(gas)
Oth
Business name: 7')/1f1i"7 ,-,...-- �'
MECHANICAL PERMITTEES*
Address:
_ Subtotal
City/State/ZIP: _" Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signatur
* Fee methodology set by Tri-County Building Industry Service Board
Print name: Date: q(,,1.,{ /C( 1
1:\Building\Permits\ _PermitApp 040113.doc 440-4 17T(11/0 OM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
Total.Valuation: PermitFee
$0.00 to$500.00 I 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