Permit CITY OF TIGARD MECHANICAL PERMIT
4
COMMUNITY DEVELOPMENT Permit#: MEC2016-00023
13125 SW Hall Blvd.,Tigard OR 97223 503 718 2439 Date Issued: 01/12/2016
2S110BA06600
Jurisdiction: Tigard
Site address: 12102 SW WILDWOOD ST
Project: Smith Subdivision: SHADOW HILLS NO.2 Lot: 49
Project Description: Replace(2)exhaust fans in bathrooms
Contractor: OWNER Owner: SMITH,VISTON &SUSANN
VISTON SMITH REVOCABLE LIVING TRUST
12102 SW WILDWOOD ST BY VISTON/SUSANN SMITH TRS
TIGARD, OR 97224 12102 SW WILDWOOD ST
TIGARD, OR 97224
PHONE: 503-620-5416 PHONE: 503-620-5416
FAX
FEES
Specifics: Description Dale Amount
Single Duct Exhaust(Bathrooms,Toilet, 01/12/2016 $46.64
Type of Use: SF Utility Rooms)
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 01/12/2016 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 01/12/2016 $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 Cade, Stale 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
issuanceor 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 diCcI ,,onso NC calling 503.232.1987 or 1.800.332.2344.Issu Permittee Signature:
iii(((itttlVVV
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 Appdia'd1 IVj
City of Tigard ' Dae,'By: 1 11 16, PennoNo.:M��6t&-6WA3
13125 SW Hall Blvd..Tigard,OR 97223 Plan Review VV vv
Phone: 503.718.2439 Fax: 5(13.698, 9 q � Other Permit
- G 7 tt 1 Date'Re:
Inspection Linc 503.639.4175 Dam Ready By ,a.i.' ® see Page 2 for
Internet: www.ligard-or.gov NotifedlMethi Supplemental Information
U I Y 011 1 i(YARD
x- COMMERCIAL FU* KNEDULE—USE COCWST-:
Mechanical pxmmn fees•are based on the value of the work
❑ New construction �XAddition/alteration/replacement performed. Indicate the value(rounded to the nearest dollar)ofall
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
CA -Y,OFCONSTRUCTION
t•%: .>,"t s '� .. RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family ❑ Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATIONAND LOCATION Heating/cooling:
, ` Air conditioning 46.75
Job site address: 12-IC-1- s x-0 W x J 1 Furnace 100,000 BTU Noels cents) 46.75
City/State/ZIP: -T- f 2 Z Furnace 100,000+BTU(ducts vents) 54.91
Heat pump 61.06
Suitelbldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: H dronic hot water system 23.32
Residential boiler(radiator of
h dronic) 23.32
Unit healers(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 fin laceinsert 33.39
��f Flue vent for water heater or gas
fireplace 23.32
W - � a f �J - lighter(gas) 23.32
7�C�— WW ood/pelleller stove 33.39
Wood fireplace/insert 23.32
Chimneydiner/tluevent 23.32
'.PROPERTY OWNER ❑ TENANT.. Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood other kitchen
equipment 33.39
Address: O • �x ( S Clothes d er exhaust 33.39
City/Stale/ZIP: Z� Single-duct exhaust(bathrooms.
i toilet compartments,utility rooms) 2, 23.32
Phone:6D3 �j�j e. f�b Fax:( ) Attic,crawls ace fans 23.32
APPLICANT ❑ CONTACT PERSON Other: '3.32
Fuel piping:
Business name: _
$14.15 for first four;$4.03 for each additional
Contact name: y X7.9 yl S _ Furnace.etc.
Address: Gas heal pump
Wall/sus enduVunit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fin lace
Range
E-mail:
Barbecue
5, CONTRACTOR - _ Clothes dryer(gas)
Other:
,Business name: I Sly S
MECRANICAL PERMIT FEIS•
Address: xS Subtotal
City/State/ZIP:
Minimum permit lee($90.00)
Plan review(259h of permit feel
Phone:( ) Fax:( ) State surcharge(12%ofpermit fee) 10. O
CCB tic.: TOTAL PERMIT FEE ICO.gO
This permit application expires Ka permit Is not obtained within 180
drys after it has been accepted as complete.
Authorized Signature: 1 ` I'cc methodology set by 7 ri-('ounty Building Industry Sen ice Board
Print name: t Date:
1.Building Pannitx 11-C PmniNPp 040111 Orr 44-Jl+l9 111 02 CUM WEm
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.
C Building'.Permits.MEC_PcnuitApp_0401I3.duc 2