Permit Support Document Mechanical Permit Application ® � FOR OF FICE USE ON] 1
City of Tigard ECC Y E D Dale/By: UJ` J'z 4_O Permit NP'(eC Zo20"00-71 d'
II 13125 SW Hall Blvd.,Tigard,OR 972B G+ Plan Review
i Phone: 503.718.2439 Fax: 503.598.1 Date/By Other Permit:
Inspection Line: 503.639.4175 8 20�
T i C;:,R n Q�T Dale ReadyBy: hais_ ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method.i i,`j/Zd .Cl1 v
r,r- Alp Supplemental Information
„� 0t St �' pyfi7c— PPT- -f'-/AI
TYPE OF WORK _ '�1r, COMMERCIAL FEE* SCHEDULE- USE CHECKLIST
New construction - Mechanical pemrit fees*are based on the value of the work
❑ :.❑Addition/alteration/replacement performed Indicate the value(rounded to the nearest dollar)of all
❑Demolition D Other: mechanical materials,equipment,labor,overhead,and profit
Value:$
r CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FELTS*
:❑.1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. I Total
HealinJOB SITE INFORMATION AND LOCATION cooling:
Air conditioning 46.75
lob site address:/.L' 6 2 o S Zed /35 .4/J e. Furnace 100,000 BTU(ducts/vents) 46.75
F54.91
City/State/ZIP: T Q Q/.,ct - ? 7_/...23 H ace 100,00Pt BTU(ducts/vents) 61.06 J `t pump"
Suite/bldg apt.no.: 1 Project name: Duct work 23.32
Cross street/directions to job site: EXPIRED Hydronic hot w system 23.32
y ] Residential er(radiatoror
�/1l�[ C r�uf ,s' _ O/� ],r�/ / by 23.32
. � t heaters(fuel-type,not electric),
y-„r��- in-wall,in-duct,suspended,etc. 46.75
------- "�JK^ r 4,L Flue/vent for any of above 23.32
Other:
Subdivisiona.�.ty .4''P- I Lottno.: I Otter feel appliances: 23.32
Tax map/pareel no.: ,Z_ Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
ems%-'',cL -5 f<°z G !.A/rt.C J zert,'h u J4',. �67 , fireplace 23.32
t2 Tit lighter(gas) 23.32
�'o -�, s�e �¢-s [/T s'tczLl e' 9 6 Cst s r/Ze_ec Wood/pellet stove ! 33.39
e,,2 s/Jc e i'�,,,. ., e� 3j e.",m, Le:. Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
aa-PCIOPERTY OWNER l El TENANT Other: 23.32
Environmental exhaust and ventilation:
Range hood/other kitchen
Name:
, l %�Ec:-/Z_kct,aL
equipment 33.39
Address: / -2.. G. C� emu'' / 3 6 �h �ie'. Clothes dryer exhaust 33.39
'�� Single-duct exhaust(bathrooms,
City/State/ZIP:
-f 5 eZ"'� el'Z? ' '2.L.l 3 toilet compartments,utility rooms) 23.32
Phone:(5-e 3 )s i.t.--I1- '7 3 c ,. Fax:( ) Attic/crawlspace fans 23.32
/t._ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel
$14.15 for tint four;$4.03 for each additional
Contact name: .J Gc ir2 C cz s cz_6 D,a .e_ Pomace,etc.
Address: •, .r Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:156 3 ), .....*/-- `3 3 cP 4 I Fax:( ) Fireplace
Range
E-mail: 3 ct,^Y e' 1 Ci / c_/ --c•L'. ..:---"..,.--,--7 Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: Other:
%r y .J e, ,,15 rrs/I-d T''/1��1 /3�-�: tcz/Y) MECHANICAL PERMIT FEES*
Address: /d -/ 5 JG2n .4' ,rl el,`�I"L Lt/ccc( /J Try" `[ 1Qe,J Subtotal
City/State/ZIP: /7 e t clN,.....7:,-,,,., C-/,,:e J 7 o O 7 Minimum permit tee ) q�
Plan review(25%of permit mit f feeee)
Phone:(5-0 3 ),,/ -. 7 d a S Fax:( ) State surcharge(12%of permit fee) Ary
CCB lie.: TOTAL PERMIT FEE /, , 1---,O
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-Comity Building Industry Service Board
Print name:)y.4cr.'! :I n c rk1I._u.>, Date: /D -Z4.- .Lo
Bm P,utdieg\ ermits vdEC_PermitAppJ 04o113.doc 4 0-461 IT(nro7 COM1WE6)
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.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
Dianna Ornelas
From: #Building Permit Technicians
Sent: Thursday, November 5, 2020 7:17 PM
To: garveb@icloud.com
Subject: MEC2020-00718 - Beckham - 12620 SW 135th Ave.
Attachments: MEC2020-00718.pdf
Hello Marilyn,
This permit is ready to issue and the balance due is$100.80 (see attached invoice).
The fees can be paid online at https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record
number MEC2020-00718 under the 'Building'tab.
• On the permit screen, click on the 'Payment' tab and then click on 'Fees'.
• At the bottom of the page, click on 'Pay Fees' link to see a list of fees.
• Click on 'Continue' at the bottom of the page to be redirected to the Paygov payment screen.
• To the right of the 'Payment' field, click on the dropdown arrow to select'card' payment (3%service fee) or
select 'check'option (no service fee).
Please email the permit technicians at TigardBuildingPermits(a@tigard-or.gov once the fees are paid so that we can
issue the permit and email a copy to you.
Thank you and please let me know if you need assistance with the online payment.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct 1503-718-2439 Permits
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