Permit (50) 1101
CITY OF TIGARD MECHANICAL PERMIT
1, COMMUNITY DEVELOPMENT Permit#: MEC2023-00602
T I G A A ID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7l24l2023
Parcel: 1 S134CD00800
Jurisdiction: Tigard
Site address: 11795 SW KATHERINE ST
Project: Headskog Subdivision: LERON HEIGHTS NO.3 Lot: 78
Project Description: Mechanical for remodel:(2)bathroom exhaust fans, (1)laundry exhaust fan,and(1)range hood.
Contractor: AMERICAN CONTRACTING Owner: HEADSKOG, CAITLIN Y
18469 SW BROOKMAN RD HEADSKOG, ELIOT A
SHERWOOD, OR 97140 SKOGLAND, MARILYN YOUNG ET AL
11795 SW KATHERINE ST
TIGARD, OR 97223
PHONE: 503-407-8538 PHONE:
FAX: 503-244-9556
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 07/24/2023 $33.39
Type of Use: SF Single Duct Exhaust(Bathrooms,Toilet, 07/24/2023 $69.96
Class of Work: ALT Type of Const: Utility Rooms)
Occupancy Grp: 12%State Surcharge-Mechanical 07/24/2023 $12.40
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $115.75
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection ate.
This permit card shall be kept in a conspicuous place on the job site until comp) ' n oft roject.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLI
City of Tigard Received
y '•rmit No.:
III q 13125 SW Hall Blvd.,Tigard,OR RECEIVED DateB : 7 I k/�3 / �t l fj( j�3 _(�(`�ot�z
Plan Review
Phone: 503.718.2439 Fax: 503.5 Date/By: Other Permit:`t'1 t 7„23 tido
TIGARD Inspection Line: 503.639.4175 Date Ready/By: mds: la See Page 2 for
Internet: www.tigard-or.gov JUL 2 4 2023 Notified/Method: Supplemental Information
7ti
TYPE OF we 'OF TIG�/A`RD COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
El New construction ❑ Addition alt At510N Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist
0 Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: I r .I 616 S.J kill In 4:7 )'1-C S/ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Ti j a V C( Qfr- el 7 oz 3 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: C.VLeiz.. !pgl,t(iCAp-�.•� Q Duct work 23.32
Cross street/directions to job site: Pj/jtSjy(,(�(�(vf" h�4:N✓Fd/WI 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 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
�/�^ Flue vent for water heater or gas
l_) b4 Ae.A.-sj-* /.1}N (f) LLt•_..ef j�„4....,p( fireplace 23.32
` -1➢� Log lighter(gas) 23.32
. z C^y� C I) /der f'LUC Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen �� ��
equipment I 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,toilet compartments,utility rooms) . 23.32 G1 •Z L
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: Fuel piping:
nuArs_� $14.15 for first four;$4.03 for each additional
i
Contact name: \lcilaI, v, y Uvk Cl//1 l�Cf Furnace,etc.
Address: 11-7 0 S 1? �,/ l 0 n\,. Dt JS� Gas heat pump
7 Y(;1 0 �Y'�LZ� Water ended/unit heater
City/State/ZIP: Water heater
Phone:(2.Q6) 2-14-el()6,6:1 Fax: :( ) Fireplace
Range
E-mail: L)1....01' 0S I I v I e, l (0 �l Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: f1 Yl_^C (�(l() r a 0 (0�-Vac ' /A 1 t Vn/ Other:
I C— MECHANICAL PERMIT FEES*
Address: I€L % SW `Rveol<W j �/ Subtotal i/f3. 33
City/State/ZIP: SIN.�1 /t IV VD n 11"I-40 Minimum permit fee($90.00)
Y V `J` Plan review(25%of permit fee) �}Phone:( j31 0� _ ffi Q Fax:( ) State surcharge(12%of permit fee) / - J
CCB lic.: f 6'2�q SJ V TOTAL PERMIT FEE /!5 5—
1 ( This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board
Print name: 5 2 j„r 'II tDate: 4/W,3
1:16 m ui1dineetits\MEC Pemut 113. c �C• 440-46617T(I l/021COM/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 S2,608.71 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:1Building\Permits\MEC_PermitApp_0401 I3.doc 2