Permit (12) IN CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2019-00748
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/24/2019
Parcel: 1S134CD00400
Jurisdiction: Tigard
Site address: 11945 SW KATHERINE ST
Project: 19-240R Subdivision: LERON HEIGHTS NO.3 Lot: 74
Project Description: Gas piping installation for furnace.
Contractor: OWNER Owner: LHOTKA, GLEN M
GLEN LHOTKA 11945 SW KATHERINE ST
11945 SW KATHERINE ST TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-330-9723 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 10/24/2019 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 10/24/2019 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 10/24/2019 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 95 :t1-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
l
Issued By: Permittee Signature: >l 4/4 AL
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
Cl Tigard i l and \\ Received
limm•
11 L C El VE D Date/By: fes. I>� Permit No.: )�
13125 SW Hall Blvd.,Tigard,OR 97 2 Plan Review
11 Phone: 503.718.2439 Fax: 503.598.1960
Date/By: /t .��r.IA
T i c,A I.ra Inspection Line: 503.639.4175 OCT 2 4 2019 Date Ready/By: ® See Pae 2 for
Internet: www.tigard-or.gov Notitied/Method: Supplemental Information
CITY OF TIGARD Alt
i F`ca ,,ciAL FEE* i
Mechanical permit fees*are based on the value of the work
El New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
EI Demolition El Other:
Value:$
"ATEGORY<OF CONSTRUCTION =.,Rta<i " i3s cZi,f t Y
g.
1-and 2-familyt«-chin � 1� � " � l� i
ig ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB 511E INFOR ,'s l ION 1ND LOC.1 TION Heating/cooling:
\I
�`\� _ 1_ 21 _` _ Air conditioning _ 46.75 J�
Job site address: Tj�{�(j,N Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: "j'1 tk1 O Z_-7..-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
Residential boiler(radiator or
�
5 ' `2\51- 14,-A"?-tEg_t)3E Sec o4..J() N^boc(k-) hydronic) 23.32
i �.- Unit heaters(fuel-type,not electric),
�-�T- in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: i I 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
s, ill' J .R$FIO1 )'Wt31 s^`, fireplace/insert 33.39
.._. Gas e/
n'y� Flue vent for water heater or gas
1'� �i--\-C O\L. �. fctSA \ f w E\r.1 NJ gm LIA ..� fireplace 23.32
5' 111)(1-1`/iA Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
I Other: 23.32
o r 1NRO. . . OW4ER I ❑ TC1 ANT
' Environmental exhaust and ventilation:
Name: &Le JJ 1....\w4 u T(�_A, Range hood/other kitchen
Address: l\ \l1; S� \`pc t'1,-��� 5equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: 7-1Cwiie.g126 ces. 007:2,S Single-duct exhaust(bathrooms,
---- - toilet compartments,utility rooms) 23.32
Phone:(SS) --3"-- b P`\-1-L Fax:( ) Attic/crawlspace fans 23.32
APPLIf. ;l� OI�I'I' tCT PERSON
Other: 23.32
Business name: Al Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: i� �r %�%�� I� Furnace,etc.
Address:///9
/ �� �.4ff Z n /� Gas heat pump /
/
1 G t[ Wall/suspended/unit heater
City/State/ZIP: >,M, �/ 4 �,, Q Water heater
Phone: f "lig! /� Fax::( ) Fireplace
E-mail:
/ Range
Barbecue
TC) r ftClothes dryer(gas)
Business name: � (/GU Other,� .F
Address: ii. ;6:: Malt>" 4
SubtotalD'L, t!'5 '
City/State/ZIP: Minimum permit fee($90.0° '0.
Plan review(25%of permit fee) '-
Phone:( ) Fax:( ) State surcharge(12%of permit fee) 10,
CCB lic.: TOTAL PERMIT FEE va"),,
This permit application expires if a permit is not obtainea within 180
days after it has been accepted as complete.
Authorizes Sl: tuie' �� _ /1 J. ��/J �/ * Fee methodology set by Tri-County Building Industry Service Board
Print nam,, / i ,ii 0`t) Ait � Date: it,pa-ici
I:\Building\Permits\MEC_PermitApp_04 113.doc 440-4617T(11/02/COM/WEB)