Permit (2) .1IhCITY OF TIGARD MECHANICAL PERMIT
_ ' COMMUNITY DEVELOPMENT
e Permit#: MEC2023-00286
T f G A P.r' 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/24/2023
Parcel: 2S107AA22800
Jurisdiction: Tigard
Site address: 16673 SW DARWIN LOOP
Project: Polygon at Roshak Ridge, Lot 228,A/C unit Subdivision: ROSHAK RIDGE Lot: 228
Project Description: A/C unit installed after C of 0
Contractor: PRO HEATING AND COOLING INC. Owner: TAYLOR MORRISON NORTHWEST LLC
2095 NW ALOCLEK DR, SUITE 1103 703 BROADWAY ST STE 510
HILLSBORO, OR 97124 VANCOUVER, WA 98660
PHONE: 503-443-5692 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 04/24/2023 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 04/24/2023 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 04/24/2023 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to foil the/rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You/4'64 Lain apy of the rules
Issued By: .7,....‘trvi t/A Permittee Signatur .'
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received t r /I
Date/By: I ' i, t
III • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Other Permit:
Inspection Line: 503.639.4175 Date/Ry:
1-I(�n I:I I Date Ready/By: laris. ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST
.KNew construction 0 Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
g.
1-and 2-family dwelling ❑ Master
Commercial/industrial 0 Accessory building
Multi-family ❑ Master builder ❑Other: For specinl information use checklist
Description Qty. Ea. Total
JOB SITE INFORMATIONTIpQ AND LOCATION Heating/cooling:
i3 Job site address: 1 ' SvJ 1_ , 4Ait ON Air conditioning 46.75 1((e
\'�•-,e""' Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 1`4A.AP r op— c'a,'lTZ. Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name:Pj, M Q b b �9,,)(4 a Heat pump 61.06
J W W 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: Lot no,: '1,7� Other: 23.32
- V Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTIONM OF WORK Gas fireplace/insert 33.39
1 ?�\fit'`' NL WNQ t n it Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER ❑ TENANT Other: 23.32
Name: '� Z Ke/ Environmental exhaust and ventilation:
IVALO �f7.. .) Range hood/other kitchen
Address: ` b'S zt-16♦�� Cu; git RA 0 equipment 33.39
,.n / Clothes dryer exhaust 33.39
City/State/ZIP: �LJ
�4�co,,,uL7� l (Ax' CA6Cb Single-duct exhaust(bathrooms,
Phone:( ) Fax:( )
toilet compartments,utility rooms) 23.32
Attic/crawlspace fans 23.32
APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: A l.V � 'Fuel piping:
Contact name: ett)(1A � w'%rZ�s 514.15 for first four;S4.03 for each additional
Furnace,etc.
Address: SAYLL1 Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
Phone:( ) -gt-5 41tt(ft Fax: :( ) Fireplace
"
E-mail: -r&gitr c' .rd z4s 1 O +in IK"we.;S o.L. cola Range
_-- CONTRACTOR Barbecue
Clothes dryer(gas)
Business name: ?>:z) �..No... + Ct --5.A tl Other:
Address: �'L� :r-' 1.L,btac. `'1. . 12017 MECHANICAL PERMIT FEES*
JU !� 1� 't W Subtotal
City/State/ZIP: '.ItLkA,S,ipQ.o I ex- 4? I 71.f Minimum permit fee(S90.00)
Phone:( ") I, -A_ 6l61 Fax:( `) � Plan review(25%of permit fee)
CCB lie.: State surcharge(12%of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is sot obtained within 180
Authorized signature: days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry Service Board
Print name: Out.(o Date: (A bit 27)
1:\BuildmgtPermits1MEC_PertnitApp_082520.doc 44046 7T(11/2/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.
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