Permit RECEIVE eb
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard FEB 3 2022 DatReceeBy (,9 22 .> PermitNo.:MEC2o22.-Citoo
/• 13125 SW Hall Blvd.,Tigard,OR 97223 ived
Plan Review �� Other Permit:
' Phone: 503.718.2439 Fax: 503.598.1960 t.JITY OF CIGARLi Date/By: < _ J
u;,^,Iii1 Internet:n : 503.639.4175 3UILDING DIVISI DateReadyethod � rum„ 611 pie Supplemental
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Internet: www.tigard-or.gov [[(>/ , 1. Su lemental Information
TYPE OF WORK OMMERCIAL FEE* SCHEDULE—USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction I Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$5,750.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling I]Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:10565 SW Nimbus Ave. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard/Oregon/97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suiteroldg./apt.no.:110 Project name:SBC-Big Leaf Networks 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
Other: 23.32
Subdivision: I Lot no.:
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
Install (1) Ductless Wall Mounted Split System fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
MI PROPERTY OWNER ❑ TENANT Environmental exhaast and ventilation:
Name:KG Investment Range hood/other kitchen
equipment 33.39
Address:10300 SW Nimbus Avenue Clothes dryer exhaust 33.39
City/State/ZIP:Portland/Oregon/97223 Single-duct exhaust(bathrooms,
9 toilet compartments,utility rooms) 23.32
Phone:(503)598-9980 Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:Oregon-Alre Inc. $14.15 for first four;$4.03 for each additional
Contact name:Ian McDonald Furnace,etc.
Gasheatpump
Address:7715 NE 33rd Drive I Suite A
Wall/suspended/unit heater
City/State/ZIP:Portland I Oregon/97211 Water heater
Phone:(503)335-2222 Fax::( ) n/a Fireplace
Range
E-mail:permits@oregon-aire.com Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name:Oregon-Aire Inc. MECHANICAL PERMIT FEES*
Address:7715 NE 33rd Drive I Suite A subtotal
City/State/ZIP:Portland/Oregon/97211 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(503)335-2222 Fax:( ) n/a State surcharge(12%of permit fee)
CCB lic.:64235 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: c 1ai //Kph id * Fee methodology set by Tri-County Building Industry Service Board
Print name:Ian McDonald Date:2/2/22
I1Building\Permits1MEC_PerrnitApp_040I 13.doc 440-4617r(1 I/OLCOMRVEB)