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CITY OF TIGARD MECHANICAL PERMIT
s: COMMUNITY DEVELOPMENT Permit#: MEC2022-00553
Date Issued: 6/29/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111BA13600
Jurisdiction: Tigard
Site address: 9744 SW VIEW TER
Project: MITCHELL Subdivision: ADAMAMY TERRACE Lot: 6
Project Description: (2)new bathroom exhaust fans for addition previously located at 14405 SW 97th Avenue.
Contractor: OWNER Owner: MITCHELL, PATRICIA&MICHAEL
9744 SW VIEW TER
TIGARD, OR 97224
PHONE PHONE:
FAX:
FEES
Specifics: Description Date Amount
Single Duct Exhaust(Bathrooms,Toilet, 06/29/2022 $46.64
Type of Use: SF Utility Rooms)
Class of Work: ADD Type of Const: 12%State Surcharge-Mechanical 06/29/2022 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 06/29/2022 $43.36
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 adapted 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 oft rule
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.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Receivedermit No.: `�o���`1114 Ill 13125 SW Hall Blvd.,Tigard,OR 97223RECEIVE
�f froV � �
#Date/By: � P
Plan Review
Phone: 503.718.2439 Date/By: Other Permit:
T I GA 1:U Inspection Line: 503.639.4175 Date Ready/By: kris: 0 See Page 2 for
Internet: www.tigard-or.gov JUN 2 9 2022 Notified/Method: ZVI Supplemental Information
;ITY OF T(GARD
TYPE OF WC/RA j
,:� : ,' ; t 7C''1 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:S
El1-and 2-family dwellingRESIDENTIAL EQUIPMENT/SYSTEMS FEES*
El Commercial/industrial ❑Accessory building
For special information use checklist.
❑Multi-family 0 Master builder 0 Other:
Description Qty. Ea. Total
JOB SITE INFORMATION ND LOCATION Heating/cooling:
f w` Air conditioning46.75
Job site address: g y S(,.c1 (1 ( e.U/ e�
/ ` Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: / ( 6 0 j� 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: M
/ 'r 0-11 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
Other fuel appliances:
Tax map/parcel no.:
Water heater
DESCRIPTION OF WORK Gas fireplace/insert 33.39
./V r -84 t C�` / - '•T Flue vent for water heater or gas
7 li ? C�r1`!?(j / fireplace 23.32
/4�� Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent _ 23.32
OPERTY OWNER 0 TENANT Other: 23.32
,/ Environmental exhaust and ventilation:
Name: /� 06 6 14 - i a(G Range hood/other kitchen
Address: ! �� Ve('el S-ei -zedequipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
//6 � t(9 t�- Single-duct exhaust(bathrooms,
Phone:(7 ) o el3 Fax:( ) toilet compartments,utility rooms) 09....... 63.3) 144,.(rT
Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: I/,._.‘5` a - Fuel piping:
Contact name: $14.15 for first four;$4.03 for each additional
Furnace,etc.
Address: Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
Phone:( ) Fax::( ) Fireplace
E-mail:
Range
CONTRACTOR Barbecue ,
Clothes dryer(gas)
Business name: Other:
Address: MECHANICAL PERMIT FEES*
Subtotal '1.(-, L i'
City/State/ZIP:
Minimum permit fee($90.00) /d,..44.)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
(' State surcharge(12%of permit fee) Ia
sv
CCB lic.: TOTAL PERMIT FEE
ram..14
This permit application expires if a permit is not obta' ed within 180
Authorized signature: days after it has been accepted as complete.
/ * Fee methodology set by Tri-County Building Industry Service Board
Print name,Lf �wz,.- /c/j C e orj ._ Date: p 47 Z2'
BuildingP 1:\ \ ermitssM(((EC_PermitApp_082520.doc 440 617T( /02/COM/WEB)
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.
I:\Building\Permits\MEC_PennitApp_082520.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:
We-(4rt._ (-
Name CCB# Expiration Date
I
J I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
fiLail or
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.
41/
cff E rcitf .---
P t Name of Permit Applicant
ZK ZZ
\ 'gnature of Permit Applic r Date
Permit#: . F
Address: l't��u U '�
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.
a�
Issued by: Date:
This Copy for Permit Offices