Permit CITY OF TIGARD MECHANICAL PERMIT
111
I ' COMMUNITY DEVELOPMENT Permit#: MEC2019-00596
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/12/2019
T-1( A R ng Parcel: 2S103CD09000
Jurisdiction: Tigard
Site address: 13571 SW PIPER TER
Project: Crook Subdivision: 2008-074 PARTITION PLAT Lot: 3
Project Description: Gas piping for in ground swimming pool.
Contractor: RUSS AARON SLOTHOWER Owner: CROOK, NATHANIEL
14543 SE WEST PARK CT CROOK, CHRISTY
DAMASCUS, OR 97089 13571 SW PIPER TER
TIGARD, OR 97223
PHONE: 503-927-8732 PHONE: 503-481-5937
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 08/12/2019 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 08/12/2019 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment-Mechanical 08/12/2019 $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 •re set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OU, by calling 503. 3 .1987 or 1 :00.332.2 44.
Issued By: 71 /, Permittee Signature: ,i tom(
/ Call 503.639.4175 by 7:00 a.m.for the next available inspec• .n date. ��
Thispermit card shall be kept in a conspicuousplace on the site until cm letion of the project.
p P jobP
Approved plans are required on the Job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE LSE ONLY
Of Received / ���
`J g Date/By: 4. / G �//T /
11114
r
City
SW HallTl Blvd.and
, ,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1 F Date By: MINN/3571/1M•
I I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: fa See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
- ' ` 1''' ' ".,_. "'u» '''A "` `t '° -`�' '" . Mechanical permit fees*are based on the value of the work
❑New construction ii41.Addition/alteration/replacement perfonned.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:
TY, OF '..,,Is I ON r} -t I/ t ':''F I S*
0 1-and 2-family dwelling ❑ Commercial/industrial jaAccessory building For special information use checklist.
❑ Multi-family ❑ Master builder ❑Other: Description I Qty. I Ea. I Total
'` ais' nA Ars =r
Heating/cooling:
.1,, , , � �� , �- , � .�
Air conditioning 46.75
Job site address: Fj t I,e f T-,C,rc- Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: --V t c d.e?,
't C V__ CIJ 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
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
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
5-t 1''_/. / t , Gas33.39
. ; t 1 NOF `�o ' ; fireplace/insert
. �, =z .. 1' z Flue ventfor water heater or gas
( c&� Cc..-_,c- yC.JC)CXR 10A-to ''''` fireplace 23.32
Log lighter(gas) 23.32
I--k _.-. -k-e' Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent` 23.32
., Other: 1-3 ,.t.'‘ k'ee k r 23.32
• - (n, ,,,, Environmental exhaust and veptilation:
Name: /\)GAC .k Oa C't 5*1 C c.r 5 Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
Othet: 23.32
Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional
Contact name: 105 S VO c-cice Furnace,etc.
Address: Gas heat pump I
Wall/suspended/unit heater
City/State/ZIP: Water heater
Fireplace
Phone:(C5674 �a'�-��3�. Fax: :( )
Range
E-mail: CSS.,krJ-th ei,c 1 CCM Barbecue
, ° ,,. ja ,eV... '. Clothes dryer(gas)
Other:
Business name: q'Ji� C�`. �Y1� t �-1 . ;�,", ,.,. 2-1`€ *i a -- .-
Address: ( J 'I l Li&Lk S ,3 U:3 pc\r, Q}^ Subtotal
City/State/ZIP: � . cc,5Q,;h (S(7-- 4-/cj ;--1 Minimum permit fee($90.00)
Plan review(25%of pennit fee)
Phone:(gC)S) 9`,--/ - Cd'-/`s�, Fax:( ) State surcharge(12%of permit fee)
CCB lie.: 18(c;a,.A TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
p days after it has been accepted as complete.
Authorized signature: r'�- * Fee methodology set by Tri-County Building Industry Service Board
Print name: i5."-:-) SVIC s�`C Date: _la- (CI
I:ABuilding APermits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
,-*°4‘;" �� .
$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.
1:\Building\Pennits\MEC_PennitApp_040113.doc 2