Permit y �� CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2013 00627
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/21/2013
Parcel: 2S104CA09000
Jurisdiction: Tigard
Site address: 13427 SW 136TH PL
Project: Brousseau Subdivision: HILLSHIRE Lot: 90
Project Description: Replacing(1)exhaust fan and installing(1)new fan
Contractor: OWNER Owner: BROUSSEAU, ERIC M
BROUSSEAU, ERIC&NICOLE 13427 SW 136TH PL
13427 SW 136TH PL TIGARD,OR 97223
TIGARD,OR 97223
PHONE' 612-384-8239 PHONE: 612-384-8239
FAX"
FEES
Specifics: Description Date Amount
Single Duct Exhaust(Bathrooms,Toilet, 10/21/2013 $46.64
Type of Use: SF Utility Rooms)
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 10/21/2013 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 10/21/2013 $43.36
Stories:
Fuel
Fuel Types
Gas Pressure
Total $100 80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No• • on ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obtain a copy of the rules
or dire• questions to 0 C b • in. 503.232 1987 or 1.800.332.2344.
Iss ed By: ' /, 1 / Permittee Signature: y- i g,6 /J f&60?"i
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. /L "
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Appli } o Ii i rt FOR OFFICE USE ONLY
tl u g, l J.- `..,'
City of Tigard t Date/Bed jI, Permit No /-/ , ,/3_00 6,17
v 13125 SW Hall Blvd.,Tigard,OR 97N3 T 2 1 2013 Plan Review
i C: Phone: 503.718 2439 Fax: 503 598 1960 Date/By Other Permit
T I G A R D Inspection Line: 503.639 4175 CITY OF TIGAR D Date Ready/By Tuns El See Page 2 for
Internet: www tigard-or gov Supplemental Information
BUILDING DIVISIOI i
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
01-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. Ea I Total
JOB-SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: \ 2- t<50.... \?J--'E c)L Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP \r� i CK 0'� C\-7 2-2 3 Furnace 100,000+BTU(ducts/vents) 54 91
`'`} Heat pump 61 06
Suite/bldg./apt.no.: Project name: Duct work 23 32
Cross street/directions to job site: Wia\�v-\ V7..S ) 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
^ � Other 23.32
Subdivision: \`��`"�'^C rX Lot no.: 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
n ^
1 0\QC -, \ 24(\ 3 -e r fireplace 23 32
n ` \ n \ ����1) - -e�n Log lighter(gas) 23.32
{ C-�C� Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23 32
%ROPERTY OWNER ❑ TENANT Other: 23 32
Environmental exhaust and ventilation:
Name: Q`C(l Q -M Iz x�v Range hood/other kitchen
\��2^1 S' ^, 1� Clothes dryer 33.39
Address: `7�,,-' � Clothes d er exhaust 33.39
�� \ 0 o,—)22 � Single-duct exhaust(bathrooms, /)
City/State/ZIP: �� v\ v toilet compartments,utility rooms) A, 23 32
Phone:(( 2) ,7_3/ Fax:( ) Attic/crawlspace fans 23 32
❑ APPLICANT . ❑ CONTACT PERSON Other 23.32
Fuel piping:
Business name: $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
Range
E-mail: Barbecue
'CONTRACTOR ' Clothes dryer(gas)
O/) - )
Business name: /✓ Other. MECHANICAL PERMIT FEES" ,
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00) 90.06
Plan review(25%of permit fee) —
Phone:( ) Fax:( ) State surcharge(12%of permit fee) /0. Q
CCB lic.: TOTAL PERMIT FEE MO g'O
. This permit application expires if a permit is not obtained within 180
C days after it has been accepted as complete.
/ �
Authorized signature: P � 4 g_15 I • Fee methodology set by Tn-County Building Industry Service Board
-
Print name: y.
IV\f ifl\t? D1-513 SS'c'a v Date: l(A 211 \ -2D
I\Budding\Permits\MEC_PermitApp_040113 doc 440-46177(I 1/021COM/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 $2,608.71 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:Building\Permits\MEC_PermitApp_040113.doc 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13427 SW 136TH PL, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2013-00627
George Heimos
Violation Summary:
Inspector Contractor