Permit CITY OF TIGARD MECHANICAL PERMIT
1I COMMUNITY DEVELOPMENT Permit#: MEC2014-00660
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/08/2014
T f�' K D 9 Parcel: 2S112BA03600
Jurisdiction: Tigard
Site address: 14085 SW 80TH CT
Project: Madsen Subdivision: WAVERLY MEADOWS Lot: 19
Project Description: Replace furnace
Contractor: PHILEO CONSTRUCTION Owner: JOANNE MADSEN
13155 SW WORCHESTER PL 14085 SW 80TH CT
TIGARD, OR 97223 TIGARD, OR 97224
PHONE: 503-830-5827 PHONE: 503-547-7300
FAX:
FEES
Specifics: Description Date Amount
Furnaces< 100K BTU 12/08/2014 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 12/08/2014 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 12/08/2014 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules as opted by the Oregon
Utility • ' •• --.ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090, You m y obt. of the rules
or• -ct questions to OU" by . ing 503.232.1987 or 1.800.332.2344. 7
ssued By: -AI: I �L Permittee Signature: k
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applica4 CEIVEJ) FOR OFFICE USE ONLY
Received ) /
City of Tigard Permit No.:
III
41 13125,SW Hall lvd.,Tigard,OR 9722 Q
Date/By: f 2 ,� y��� �t7 (O(P�
Phone: 503.718.2439 Fax: 503.598.19 F C 8 2014 Plan Review Date/By: Other Permit:
I I G\R I) Inspection Line: 503.639.4175 Date Ready/By: 3uris gI See Page 2 for
Internet: www.tigard-or.gov v
CITY(I(1 f I/ A R 1 Notified/Method: Supplemental Information
BUILDINC DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ ZQotc
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
b+a '-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 19�t3 5- s,,, E O t'" G4- Furnace 100,000 BTU(ducts/vents) / 46.75
City/State/ZIP: 1 -Tt It°t1-4 ?Og-- 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: 500 j;.0‘ 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
elpiu r-wy►-(.i a 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 l ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: -3 t7 A nn e. ryi d S Range hood/other kitchen
1 equipment 33.39
Address: ` 40 Lb S 5■1.1 0% CA- Clothes dryer exhaust 33.39
City/State/ZIP: T'(Y4 42-D 13 R- Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) . 23.32
Phone:( 5123) 9- --7-2)0 n p Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$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)
Business name: tVal (-0.0S1- JO B
Other:
MECHANICAL PERMIT FEES*
Address: , '3I Sc SvJ kAi ore_he s.-e _ P( Subtotal (}
City/State/ZIP: Minimum permit fee($90.00) 7r�.[3C
T\� l 0� �j72Z �/ Plan review(25%of permit fee)
Phone:( 5-1*)ej 30 .-sot 7 Fax:( ) State surcharge(12%of permit fee) /40.e0
CCB lie.: 18,43 I t /0i1i 1l& TOTAL PERMIT FEE _Me), 0
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized Signature Q • Fee methodology set by Tri-County Building Industry Service Board
Print name: z( ,,fin v K.L. Q b Date: (Z-0"14
1..l:uilding\Permits\MEC_PermittApp_0401I3.doc 440.46171(I1/02/COM/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
14085 SW 80TH CT, TIGARD, OR, 97224
Residential - Mechanical
699 Mechanical final
PASS - No C of O
December 16, 2014 at
12:52:44 PM
MEC2014-00660
David Young
Violation Summary:
Inspector Contractor