Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2016-00059
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/25/2016
Parcel: 2S104AA90042
Jurisdiction: Tigard
Site address: 12666 SW KAREN ST 4
Project: BELLWOOD TERRACE LLC Subdivision: BELLWOOD TERRACE CONDO Lot: 4
Project Description: Replacing clothes dryer venting.
Contractor: RELIABLE HOME IMPROVEMENT INC Owner: BELLWOOD TERRACE LLC
PO BOX 230815 PO BOX 189
TIGARD, OR 97281 YAMHILL, OR 97148
PHONE: 503-481-0240 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Clothes Dryer Exhaust 01/25/2016 $33.39
Type of Use: MF 12%State Surcharge-Mechanical 01/25/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 01/25/2016 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to foll the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y u may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.8
Issued By:G''/�/ SCC Permittee ignature:
Call 503.639.4175 by 7:00 a.m.for the next available in/spec n date.
This permit card shall be kept in a conspicuous place on the job site unti ompletion of the project.
Approved plans are required on the job site at the time of ch inspection.
Mechanical Permit Application
Received
City of Tigard at/ y ;5-, Penni(No.:
q).--1,% D L,c?
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By:
Plan Review
Date/By:
Inspection Line: 503.639.4175 Date Ready/By: Juris 0 See Page 2 for
Phone: 503.718.2439 Fax: 503.598.1 Other Permit:
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
_9A
OF
Mechanical pennit fees*are based on the value of the work
❑ New construction &Pr ition/altera iTient perforined.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition El Other: mechanical materials,equipment,labor,overhead,and profit.
f 71 Value:$
"n EQVIPMENrl,SYSTEMS
4k,
-M
All--and 2-family dwelling E]Commercial/industrial E]Accessory building For special information use checklist.
Fj Multi-family El Master builder ❑Other: Description Qty. Ea. Total
A Heating/cooling:
Air conditioning 46.75
Job site address: /Z Ica Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 7'1. 6 9712- -Furnace 100,000+BTU(ducts,vents) 54.91
Heat pump 61.06
Project name:
Suite/bldg./apt.no.: 4 1 Duct work 23.32
Cross street/directions to job site: Hydronic hot water systern 23.32
Oat Residential boiler(radiator or
KAV_ si 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 I WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.3 1
Chi mney/liner/flue/vent 23.32
Other: 23.32
OP1EItTY OWNER OTENANT.
Environmental exhaust and ventilation:
Name: Z Range hood/other kitchen
Aequipment 33.39
Address:
Clothes dryer exhaust 33.39 33- 31
City/State/ZIP: YAIR&11( Z2 2 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone: ax: Attic/crawlspace fans 23.32
=PERSON Other: 23.32
WCONTAq
Business name: AFuel piping:ow tf ewl 4C*-- $14.15 for first four;$4.03 for each additional
Contact name: AN 7- /Z AFurnace,etc.
Address: Gas heat pump
D. U fo Wall/suspended/unit heater
City/State/ZIP: 1)4.764X#0,4 I Po7, Water heater
Phone:40�) 1 Fax:I/fr/ ft Y& I Fireplace Range
E-mail
hr-L• A-13L. s Barbecue
xJ i III: Clothes dryer(gas)
rA�1 _1
Business name: Other:
N
"'r axlut
Address: Subtotal V 1�
City/State/ZIP: Minimum permit fee($90.00) ill.,
Plan review(25%of permit fee)
Phone: Fax: State surcharge(12%of permit fee)
CCB lic.: TOTAL PERMIT IFEE0,71 W.
This permit application expires if a permit is not obtifinth N�thin 180
days after it has been accepted as complete.
Authorized signature: Fee methodology set by'Fri-County Building Industry Service Board
Print name: 4hwp� Date: 1-25—zafa
1:Building Permits MEC Perm il�A 440-46171(i t 02 COM WEB)
PP0401 1 Idoc
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total valuation: ` rik ?'ee ....
$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.
L\Building\Pennits\M EC_PennitApp_040113.doc 2