Permit (15) CITY OF TIGARD MECHANICAL PERMIT
111
2, COMMUNITY DEVELOPMENT Permit#: MEC2023-00403
Date Issued: 5/25/2023
T f G AR O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S134CB03200
Jurisdiction: Tigard
Site address: 12360 SW SUMMER CREST DR
Project: Summer Crest Dr. Subdivision: SUMMER HILLS PARK Lot: 30
Project Description: (1)Gas furnace replacement,(1)new A/C unit,(1)gas line for barbecue,and(1)bathroom exhaust fan for
remodel. Placement of NC unit must comply with manufacturer's installation requirements.
Contractor: ANTON HEATING Owner: DEVINE, NANCY M
7816 SE 68TH AVE FASULO,JAMES
PORTLAND, OR 97206 12360 SW SUMMERCREST DR
TIGARD, OR 97223
PHONE: 503-380-1311 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 05/25/2023 $46.75
Type of Use: SF Furnaces< 100K BTU 05/25/2023 $46.75
Class of Work: ALT Type of Const: Single Duct Exhaust(Bathrooms,Toilet, 05/25/2023 $23.32
Occupancy Grp: Utility Rooms)
Stories: Fuel Piping 05/25/2023 $14.15
Fuel
Fuel Types:
Gas Pressure:
Total $130.97
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: ._Permittee Signature: id-6V\
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application iORR()FricE I SE Oyl.l
City of Tigard Received
F. DateBy: .�" ` I a1 Permit No.: 1 3
13125 SW Hall Blvd.,Tigard,OR 97223FIECEIVE
t � Plan Review
Phone: 503.718.2439 Date/By: Other Permit: 10
Inspection Line: 503.639.4175 ee ' J
I I G 1 R D 2,. a Dateed/Met Ready/By: Ell
S See Page 2 for
Internet: www.tigard-or.gov MAY 25202iNotified/Method: Supplemental Information
' eV TYPE OF woRICITY OF TIGARD" COMMERCIAL FEE*T SCHEDULE-USE CHECKLIST
❑New construction tI Addition/alteratigA Ce tenr''/I ' Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
;CATEGORY-OF CONSTRUCTION Value:$
'A 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building RESIDENTIAL Ft UIPM [ SYS :MS *
For special information use checklist
❑Multi-family 0 Master builder 0 Other:
Description Qty. Ea. Total
SOS SITE"IN1lORMATION AND LOCATION Heating/cooling:
Job site address: /Z 6 O J -5 u P9,41 P C ee Air conditioning v 46.75
�-7' �� Furnace 100,000 BTU(ducts/vents) v 46.75
City/State/ZIP: l I, ,, nit_ r ?2.2.3 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: 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
///��� DESC TION OF,WO Gas fireplace/insert 33.39
— < r' �: ) �y Clad )��,1 .^Q n� f o t<7i Flue vent for water heater or gas
X i+ I �X fireplace 23.32
,)
iy y t i 1 T G�Q S h ''1 O / Log lighter(gas) 23.32
,n� (Lja�\1�l lh it, Wood pellet stove 33.392
d" Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY OWNER CI TENANT. Other: 23.32
Environmental exhaust and ventilation:
Name:
Range hood/other kitchen
Address: equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust(bathrooms,
Phone:( ) Fax:( )
toilet compartments,utility rooms) 1 23.32
Attic/crawlspace fans 23.32
yr.: CI APPLICANT El CONTACT PERSON `.., Other: 23.32
Business name: Atc4o0 }-1 \ v\L\ .� fit t lit L -1d i T 1 t ll 1 vi. 2 f L Fuel piping:
, i $14.15 for first four;$4.03 for each additional
Contact name: + t 0 t7 AN -0 V 1 Furnace,etc.
Address: C5 U 4 ,, /q 2 Ac) ,l� E Gas heat pump
/'' Wall/suspended/unit heater
City/State/ZIP:
ro -4 O" 0 tA- �7-_; Water heater
Phone:(O?J ) ,40 , 1 3 I ( Fax::( c'Cd j) 77-9 -- 74 F 5 Fireplace
E-mail: 01/4V1Tll cr, t t�10 L✓C,(.9.1,1,1s-1 {/ 1Ovt Range
Barbecue t
CONTRACTOR
Clothes dryer(gas)
Business name: rr�� /'
/t/tC),G^0 cr�t v4, NI /� (,O"�1,,, Ll 1>�7 ( L. Other:
1 MECHANICAL PERMIT FEES*
Address: /'5 c t1 S E i CI 2.4-7J `1 0�.=. Subtotal
City/State/ZIP: j tLiL/C.J J C''(t 9 2 3 Minimum permit fee($90.00)
Phone:( d 3) 3 "c� _ /31 1 Fax:(Se., ) 774 - 7y i Plan review(25%of permit fee)
!, State surcharge(12%of permit fee)
CCB lie.: / 97 TOTAL PERMIT FEE t".O,ii.�
This permit application expires if a permit is not obtained within 180 7
Authorized signature: r y71 c4 days after it has been accepted as complete.
t ) * Fee methodology set by Tri-County Building Industry Service Board
Print name: L 1 V ii) /4 A�rc,,/) Date: 3/Z 5./2' .
1:\Building\Pennits\MEC_PermitApp_082520.doc 440-4617T( /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_PermitApp_082520.doc 2