Permit CITY OF TIGARD MECHANICAL PERMIT
°"'! 2 . COMMUNITY DEVELOPMENT Permit#: MEC2020-00828
TIGARD13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/18/2020
Parcel: 2S112BA03800
Jurisdiction: Tigard
Site address: 14115 SW 80TH CT
Project: 20R297 Subdivision: WAVERLY MEADOWS Lot: 17
Project Description: Install range hood for kitchen remodel.
Contractor: FIFTH ELEMENT CARPENTRY LLC Owner: FASTENOW,AARON M
PO BOX 2217 14115 SW 80TH CT
LAKE OSWEGO, OR 97035 TIGARD, OR 97224
PHONE: 541-520-9263 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 12/17/2020 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 12/17/2020 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 12/17/2020 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: `` U�,.y�e �� Permittee Signature: 6,4/ FI4-7 ei---770
Av Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
6- 12/1/1 a
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVED ReceivedDate/ J, pennitN ZJ
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Re Re: r Z f('/ !yQ EC'1(j Z(7 'QD
Plan
Phone: 503.718.2439 DEC 1 12020 Date/By: Other Permit:
Inspection Line: 503.639.4175
TIGARD Date Ready/By: IN
® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: (2/(7/ 7
4 0 11� Supplemental Information
TYPE OF t DING DIVISION Al I-4-4-1-f�..�COMMERCIAL FEE*SCHEMYULE-USE CHECKLIST
E New construction ® Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
E Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
dwellingRESIDENTIAL EQUIPMENT/SYSTEMSFEES*
® 1-and2-family ❑ Commercial/industrial ❑ Accessory building
0 Multi-familyFor special information use checklist.
❑ Master builder 0 Other:
Description Qty. Ea. Total
mgJOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address:14115 SW 80th Court Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard, OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Heat pump 61.06
Duct work 23.32
Cross street/directions to job site: SW Fanno Creek Dr is closest cross street 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
Tax map/parcel no.: O[her fuel appliances:
Water heater __ 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Kitchen remodel - adding a range hood, exhausted through roof. Fluefor water heater nrgas
fireplace
23.32
Roof vent to be cut in by Interstate Roofing. (503-684-5611) Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
® PROPERTY OWNER 0 TENANT Other: 23.32
Name:Aaron Fastenow Environmental exhaust and ventilation:
Range hood/other kitchen
Address:same as job site above equipment 1 33.39 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
Phone:(503)881-1775 Fax:( ) toilet compartments,utility rooms) 23.32
Attic/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON . Other: 23.32
Business name: Fuel piping: _
Contact name: S14.15 for first four;S4.03 for each additional
Furnace,etc.
Address: Gas heat pump __
City/State/ZIP: Wall/suspended/unit heater
Water heater
Phone:( ) Fax: :( ) Fireplace
E-mail: GfclSt-el'loL 1R5(f) COM Range
Barbecue
CONTRACTOR
Clothes dryer(gas)
Business name:Fifth Element Carpentry Other:
Address;PO Box 2271 MECHANICAL PERMIT FEES*
Subtotal 33.39
City/State/ZIP:Lake Oswego, OR 97035 Minimum permit fee($90.00) 90.00
Phone:(541) 520-9263 Fax:( ) Plan review(25%of permit fee) 0.00
State surcharge(12%of permit fee) 10.80
ccB lie.:232840 TOTAL PERMIT FEE 100.80
/J This permit application expires if a permit is not obtained within 180
Authorized signature: iry Q/2•B,ifif (if}' days after it has been accepted as complete.
._.._ * Fee methodology set by Tri-County Building Industry Service Board
Print name:Aaron Fastenow Date:12/11/2020
I\Building\Permits\IEC_PeimilApp_082520-doc 440-4617T(11/02/COMIWEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Submittal Requirements:
• (2) sets of plans,drawn to scale.
• (2) sets of equipment cut sheets.
• (2) copies of site plan for ground and roof top equipment
location and screening per Tigard development code.
Commercial & Multi-Family Fee Schedule:
otal1aluation: 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.
I:\BuildinglPermits\MEC_PermitApp_082520.doc 2