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Permit Support Document (4) Mechanical Permit Application AN FOR OFFICE USE ONLY City of Tigard �, Received �/ 3 J`� 1� Plan Rev �- / r Permit No.: e gr_`l_f/y� ill 13125 SW Hall Blvd.,Tigard,OR Plan Review , I L� (jJ�Ie s Phone: 503.718.2439 Fax: 503.59 .1960 �p1`o OtherPermit DateiBy: P `\ ` �3 lMt�0f6—rY�31s' Inspection Line: 503.639.4175 w Ready/By: El See Page 2 for TIGARD U`� Date Read i8 tans Internet. wWw.tlgazd-or.gov `t ,�4�A0,7f tom, - Notified/Method: j Supplemental Information TYPE OF W(� tys-n °:`t 1 ' :COMMERCIAL FEE* SCHEDULE - LSE CHECKLIST ��� Mechanical permit fees*arc based on the value of the work ❑ New construction [Addition/alterat replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑ Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* MI-and 2-family dwelling ❑ Commercial/industrial Accessory building For special inJorma:ion use check/is!. ❑ Multi-family ❑ Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: C Air conditioning 46.75 Job site address: Il�31 dw 'i 1Li* 97ti�t Furnace 100,000 BTU(ducts/veins) 46.75 City/State/ZIP: 7 41 oil_ � 2'z,3 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: U I Project name: \JA, {( e.) Heat pump 61.06 Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or -1-S t1-A $ J-- ,�-- sW oti Pk.“- 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 DESCRIPTION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas i /4 )o`10 c o� �� •�a� fireplace 23.32 \/I'(� ®�� ,- Log lighter(gas) 23.32 �f {7 _O�Pc M t�h��� Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation: Name: S f(- Vh.,'\ Range hood/other kitchen Address: \g y-1 c ki l o(Ntf boo C-p_cr,i (t_ . 1S eqClothes nt dryer ' 33.39 - e� (i Clothes dryer exhaust 33.39 City/State/ZIP: ' , ©� -'L Single duct exhaust(bathrooms, I Phone:(So> 7�? 7 Fax: toilet compartments,utility rooms) 23.32 2-3 t31 ),��,,l/Sz-3,T72Z-L. ( ) Attic/crawlspace fans 23.32 1 APPLICANT ❑ CONTACT PERSON Other: 23.32 Fuel piping: Business name: $14.15 for first four;$4.03 for each additional Contact name: (Sdti(A-t a f A�, Furnace,etc. Address: tl" f Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax: :( ) Fireplace Range E-mail: Barbecue CONTRACTOR Clothes dryer(gas) Business name: rn fv4— Other: Vs't/ MECHANICAL PERMIT FEES* Address: Subtotal 56, 7/ City/State/ZIP: Minimum permit fee($90.00) g)..0c) Phone:( ) Fax:( ) Plan review(25%of permit fee) State surcharge(12%of permit fee) (0,„ CCB lie.: TOTAL PERMIT FEE K V This permit application expires If a permit is not obtained within _---- ? days after it has been accepted as complete. Authorized signature: �— f • Fee methodology set by Tri-County Building Industry Service Board �J� Print name: ' � WO\ Date: 623 (,V I:1Building'Permis\MEC_PermitApp_0401 13.doc 440-617T(I I/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-Family Fee Schedule: Total Valuation: Permit Fee: $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\Permits\MEC_PermitApp_040I I 3.doc 2 Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 11631 SW 114TH PL, TIGARD, OR, 97223 Residential - Mechanical 699 Mechanical final PASS - No C of O MEC2016-00465 Chip Barnett Violation Summary: Inspector Contractor