Permit Support Document Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: v 6l , •-r- Permit No.: is I l _ tx .1
ill Phone: 503.718.2439 Fax: 503.598.1960 RECEIVE other Permit:
Inspection Line: 503.639.4175 I�r t
TIGARD P Date Ready/By: 65 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
FEB 4 2019lini
r TYPE OF W(f0koriY F 0A440 , MMia 04-FEE• **---L ***-1ECIfT
0 New construction ®Addition/alteratio NVIVISION Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
`CATEGORY O •CONSTRUCTJON SValue:$
'�' ��� z REIDENTIA7,EQUIPNIENT/SYSTEMS FEES*•, '`_'"
® I-and 2-family dwelling 0 Commercial/industrial = n .. '.In
='Cl g For special information use checklist.
❑Multi-family 0 Master builder Other: L ) 4 Description
., P Qty. Ea. Total
'JOB'SITE INFORMATION AND)<.,OCA N„, :::,,i,' Heating/cooling:
Job site address:11455 SW LOMITA AVE Air conditioning ] 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:TIGARD,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name:BERGER Heat pump 61.06
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
DESCRIPTIONS OF'WORK Gas fireplace/insert 33.39
INSTALLING&REPLACING EXISTING AC. Flue vent for water heater or gas
fireplace 23.32
NOTE:PLEASE ADD"AC”TO EXISTING PERMIT#MEC2019-00040 Log lighter(gas) 23.32
Wood/pellet stove 33,39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other:
®,PROPERTY OWNER 23.32
., _, � TEi�ANT
Environmental exhaust and ventilation:
Name:CLIFF BERGER Range hood/other kitchen
Address:11455 SW LOMITA AVE equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP:TIGARD,OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)914-8398 Fax:( ) Attic/crawlspace fans 23.32
" APP,L;<:6-*4 CONTACT: 'ERSQN ,? Other: 23.32
Business name:A-TEMP HEATING&COOLING Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:GARY TRAN Furnace,etc.
Address:16000 SE EVELYN ST Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:CLACKAMAS,OR 97015 Water heater
Phone:(503)650-5014 Fax::( ) Fireplace
E-mail:GARY@ATEMPHEATING.COM Range
Barbecue
ue
, CONTRACTOR Clothes dryer(gas)
Business name:A-TEMP HEATING&COOLING Other:
:'MECIIAIVICAJ'Ekiii FEES*
Address:16000 SE EVELYN ST
Subtotal
City/State/ZIP:CLACKAMAS,OR 97015 Minimum permit fee($90.00)
Phone:(503)650-5014 Fax: Plan review(25%of permit fee)
( ) State surcharge(12%of permit fee)
CCB lic.:71878 rte_ TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name:GARY TRAN Date:02/04/19
1nBuilding\Permits\MEC PermitApp_040113.doc 440-4617T(I 1/02/COM,WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11455 SW LOMITAAVE, TIGARD, OR, 97223 February 26, 2019 at
10:00:03 AM
Record Type: Record ID:
Residential - Mechanical MEC2019-00040
Inspection Type: Inspector:
699 Mechanical final Jeremy Burrows
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor