Permit CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: MEC2016-00036
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/14/2016Parcel: 1 S134BD07008
Jurisdiction: Tigard
Site address: 11380 SW COTTONWOOD LN
Project: Moore Subdivision: ENGLEWOOD NO.3 Lot: 233
Project Description: Replace furnace with like kind
Contractor: DONS AIR CARE INC Owner: MOORE,VINCENT J & KATHLEEN STRA
PO BOX 6408 11380 SW COTTONWOOD LN
ALOHA, OR 97007 TIGARD, OR 97223
PHONE: 503-642-5844 PHONE: 360-904-5734
FAX
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 01/14/2016 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 01/14/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 01/14/2016 $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 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
or direct questions�to7 OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By
Permittee Signature:
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 Viect.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit A lie ' 1 I �T�
City of Tigard TRIVET,J Received p
g Date/By: /y /� Pernalls.4 I�0f�16—�Q3
13125 SW Hall Blvd.,Tigard,OR 97223 r l
Plan Review
Phone: 503.718.2439 Fax 503.598.1960x; 14 Date/By: Other Penon:
Inspection Line: 503.639.4175 Date Read/B : mdx.
Internet: www.tigard-or.gov ` pr, Notified/Method: ® See Page.for
Supplemental Inlarmation
,.: - '�r TYPE:.: COMMERCLlI,, FEES,547�F•DI�+.�>k:dJSE,.� IO.YST. :...
Mechanical permit lees'"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 profft.
.: Value $
T�CORYOF CQNSTRUCTIOPI .. RESIDENTIAL EQUIPMENT/SYS'tEA1SFEES•
RI-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family ❑ Master builder ❑Other: Description Qty. I Ea. Total
JOB STM Tt4FORMATION AND LOCATION
Heatin coolin
Air conditioning 46.75
Job site address:— - Furnace 100,000 BTU(ducts vents) 46.75
City/State/ZIP: �! Furnace 100,000+BTU(ducts vents) 54.91
Heat um 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: H dronic hot waters stem 23.32
Residential boiler(radiator or
6 h dronic) 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: Lo[no.:
Other: 1 1 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 2332
DESCRIPTION OF.WORK.. Gas fireplace/insert 33.39
Flue vent for water healer or gas
I - Q fireplace 23.32
Log li htei ( as) 23.32
Wood/pellet stove 33.39
Wood fire lace/insen 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
OPERTY OWNER TENANT Environmental exhaust and ventilation:
Name: Moyee Rangehood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) _ Fax:( ) Attic/crawls ace fans 23.32
.a ' * s -❑ CONTACT PERSON Othec 23.32
Business name: Fuelpiping:
�� $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/sus ended/unit heater
City/State/ZIP: J7 n OZ Water heater
Phone:(-'Z�?) 5/2,-sg Fax: :( ) Fireplace
Range
E-mail: dOQ'/Y'
yh$
�. �ti� - �L�. Barbecue
Clothes dryer(gas)
Business name:
Other:
.; ME(TIANtCAL PERh1,lT
Address: - Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) ,�Q
CCB he.: 62 19q TOTAL PERMIT FEE To
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: _7) b11S' Zr-9 Date: f �j
I BuildingPennhs NEC PermilApp_040113,doc 440-4617T(11 02 COM WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-F mily 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.
]:,Building,Pennits\M EC_PennitApp_040113.doc 2