Permit N CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2021-00886
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/9/2021
Parcel: 2S 104BA07200
Jurisdiction: Tigard
Site address: 14030 SW LIDEN DR
Project: EVANS Subdivision: CASTLE HILL NO.2
Lot: 107
Project Description: Furnace replacement and A/C installation. Placement of A/C unit must comply with manufacturer's installation
requirements.
Contractor: OWNER Owner: EVANS, DAVID J&ALLE M
14030 SW LIDEN DR
TIGARD, OR 97223
PHONE PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 11/03/2021 $46.75
Type of Use: SF Furnaces<100K BTU 11/03/2021 $46.75
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 11/03/2021 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: Ho{_, Va.w De-VJege, Permittee Signature: 0IA'A
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application rOlz Orel( F. l s1. 0yl.1
Received
City of Tigard Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 E C E I V E DateBy: 11�3// — ,/'1.�j1(�?Da-I.a) rQs
fi Phone: 503.718.2439 Fax: 503.598.1960 ' Plan Review Other Permit. W u+�-
DateBy:
1 I G 1 R D Inspection Line: 503.639.4175 2 8 2UZ1 Date Ready/By: Juris: Fa See Page 2 for
Internet: www.tigard-or.gov OCTl� L{ILI Notified/Method: -all
Supplemental Information
„i IY OF TIGARD
��'�i�
TYPE OF WORK,
JILDING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning I 46.75 4140.V.
f
Job site address:
14030 SW Liden Dr Furnace 100,000 BTU(ducts/vents) f 46.75 Plar75d
City/State/ZIP: Tigard, OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Evans 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
Subdivision: Castle Hill Lot no.: 107 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
Furnace Replacement - No permit was pulled by the previous owner fireplace 23.32
when it was installed in 2017 Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
_ . Other: 23.32
11 PROPERTY OWNER ® TENANT Environmental exhaust and ventilation:
Name: David Evans Range hood/other kitchen
equipment 33.39
Address: 14030 SW Liden Dr
Clothes dryer exhaust 33.39
City/State/ZIP: Tigard, OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503 )488-9209 Fax:( ) Attic/crawlspace fans 23.32
IX) APPLICANT ® CONTACT PERSON Other: 23.32
Business name: Fuel piping:
S14.15 for first four;$4.03 for each additional
Contact name: David Evans Furnace,etc.
Address: 14030 SW Liden Dr Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Tigard, OR 97223 Water heater
Phone:(503 )488-9209 Fax::( ) Fireplace
Range
E-mail: davidjevans4@gmail.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: frliikitown own Other:
MECHANICAL PERMIT FEES*
Address:
Subtotal oj 3,5-1)
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) j. //,"A
CCB lie.: TOTAL PERMIT FEE g`ptt 70?
This permit application expires if a permit is not obtained within 180
.a.,, days after it has been accepted as complete.
Authorized signature: David Evans=.�.aM...., - * Fee methodology set by Tri-County Building Industry Service Board
Print name: David Evans Date: 10/28/21
1:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(1I/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.
I:\Building\Permits\MEC_PennitApp_040113.doc 2
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building,electrical, mechanical,and plumbing permits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
X I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
David Evans
Print Name of Permit Applicant
ON SMdbyDdEven
?pulVYru@nre�r.
David Eva .a��u��j, .a.a 11/08/21
{s3'"9Y.V. 0811. mono.
Signature of Permit Applicant Date
Permit#: MEC2021-40886- 1
14030 SW Liden Dr ��° �
Address: • ;
•
Tigard, OR 97223
Issued by: Date: X'j'
This Copy for Permit Offices