Permit CITY OF TIGARD MECHANICAL PERMIT
1111
COMMUNITY DEVELOPMENT Permit#: MEC2022 00351
Date Issued: 5/4/2022
TfGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S106AC04600
Jurisdiction: Tigard
Site address: 12973 SW MEADBROOK LN
Project: MOSHTAGHIN Subdivision: RIVER TERRACE EAST 3 Lot: 18
Project Description: Air conditioner installation. Placement of unit must comply with manufacturer's installation requirements.
Contractor: ANTON HEATING Owner: MOSHTAGHIN, FARDAD AHMADI
7816 SE 68TH AVE 12973 SW MEADBROOK LN
PORTLAND, OR 97206 BEAVERTON, OR 97007
PHONE: 503-380-1311 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 05/04/2022 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 05/04/2022 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment-Mechanical 05/04/2022 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: /�`. , Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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Mechanical Permit Application FOR OFFICE USE ONLY
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Cl of Tigard RECEIVED Received
Date/By: r / -r Permit No.: /M//c ti, ��00151
111 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ' f
= Phone: 503.718.2439 MAY 4 2022 Date/By: Other Permit:,, .., c ,i1
-1 l G A R l� Inspection Line: 503.639.4175 Date Ready/By: luris: ® §ee aY ge Z for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
91 1!!_nIAIG DIVIq!ON
TYPE OF WORK COMMERCIAL FEE*SCHEDULE—USE CHECKLIST
&New construction ❑ Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building
For special information use checklist.
0 Multi-family 0 Master builder ['Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: \I`-t,-7--s S ',(-(Neo,,pi b (00 kLN Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: _ t� 8,ji 4, Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: 7a:' Heat pump 61.06
Duct work 23.32
Cross street/directions to job site:
Hydronic hot water system 23.32
c7 C✓ O‘1.S l-CfC C*.. a 6 a} 1 p 1,/S Residential boiler(radiator or
(\) / Ci1J U,1�0 ' 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
4doL5fireplace 23.32
Log lighter(gas) 23.32
A/C Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY OWNER 0 TENANT Other: 23.32
Name: y �CXs%� Environmental exhaust and ventilation:
c yievQ..t Range hood/other kitchen
Address: Wil Sj 12 ot 3 st.-cJ -a uipment 33.39
,y Clothes dryer exhaust 33.39
City/State/ZIP: kdAcx e-ci 0 ClkT 22_41 Single-duct exhaust(bathrooms,
Phone:(55 0) fir r) 4 �j ( Fax:( ) toilet compartments,utility rooms) 23.32
7 3 \ Attic/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:
Furnace,etc.
Address: Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
Phone:( ) Fax::( ) Fireplace
f / ® Range
E-mail: 1-`GLK' ?/l _ A r_Y.„,,,, i ( c,` Oc. Barbecue
CONTRACTOR �.J
Clothes dryer(gas)
Business name: n Nto,ct+lyL� 8 A/c LLL Other:
Address: 6, 5 0 G S g \ 2_ y\t( Awl✓ MECHANICAL PERMIT FEES*
�y Subtotal
City/State/ZIP: p0 I AA OL K 7,` 6 Minimum permit fee($90.00)
Phone:(1)(� Q 1 'S\\ Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB Iic.: \ 6 6 3(3 1/7/ TOTAL PERMIT FEE / ,
This permit application expires if a permit is not obtaincrd within 180
days after it has been accepted as complete.
Authorized signature:
'"� Fee methodology set by Tri-County Building Industry Service Board
Print name: Date: 0�,2
l:\Building\Permits\MEC_PernitApp_082520.doc 440-4617 1/02/COM/WEB)
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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:
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.
1:\Building\Pennits\MEC_PermitApp_082520.doc 2