Permit CITY OF TIGARD f. MECHANICAL PERMIT
114 ti' COMMUNITY DEVELOPMENT Permit#: MEC2016-00196
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439Date Issued: 03/23/2016
T I GA g -4411.1414/ Parcel: 2S103BB11700
Jurisdiction: Tigard
Site address: 12160 SW ANN PL
Project: Travis Subdivision: YE-OLDE WINDMILL Lot: 36
Project Description: Duct work to convert attic space into habitable loft area.6/1/16,REPRINTED to add vent fan
Contractor: DELUXE HVACR LLC Owner: TRAVIS, CRAIG B&TANAE
1013 NE 62ND AVE 12160 SW ANN PL
PORTLAND, OR 97213 TIGARD, OR 97223
PHONE: 503-287-6688 PHONE: 406-544-6750
FAX: 503-287-0614
FEES
Specifics: Description Date Amount
Duct Work 03/23/2016 $23.32
Type of Use: SF Single Duct Exhaust(Bathrooms,Toilet, 03/23/2016 $23.32
Class of Work: ALT Type of Const: Utility Rooms)
Occupancy Grp: Minimum Fee Adjustment-Mechanical 03/23/2016 $43.36
Stories: 12%State Surcharge-Mechanical 03/23/2016 $10.80
Misc Administration Fee 06/01/2016 $45.00
Fuel
Fuel Types:
Gas Pressure:
Total $145.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notifi e . Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct estions to OUNC by ca ' • 503.232.1987 or 1.800.332.2344.
Issued By: ✓ /' joie ; Permittee -'.nature: ,' e.
Call 503.639.4175 by 7:00 a.m.for the next available i pection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application 1 01(OFFI( l. tSU:O\I.\
City of Tigard Received
Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223Pl
Date/By: —6/l (p
Phone: 503.718.2439 Fax: 503.598.1960 an Review
Date/By: Other Permit:
D
I I c I,I Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
R } res ys Mechanical permit fees*are based on the value of the work
❑New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
❑ Demolition ❑Other:
3 a,§�a, �t'� . ✓,Pryrwm'r k,..rEr t. . ;: w .., ..'S sem.,.Y.z,y, mr#';.r.Y Ma ._ ... �Value:$
. ' . t . At4.44 ,
aHe*Pw1 H .�.�ar'�.
❑ 1-and 2-family dwelling ❑ Commercial/industrial 0 Accessory building For special information use checklist.
❑ Multi-family 0 Master builder ❑ Other: Description I Qty. I Ea. I Total
per, _ Heating/cooling:
" '° Air conditioning 46.75
Job site address: l//,), I�.L, f�� /17‘..)/J/17‘..)/JP�, Furnace 100,000 BTU(ducts!vents) 46.75
City/State/ZIP: � t—,z � 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: 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: I Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
SCRIP'll'ION{3F.°WORK , Gas fireplace/insert
D 33.39
' , • "" •"" " • Flue vent for water heater or gas
AP' "9-Ai .)`t-/-/gc/j// -�j9-1•.) `T—� 1�/l f}S j fireplace 23.32
Log lighter(gas) 23.32
'/4-7—H Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
1 .sa , ; 4 Other: 23.32
� ',Y :5,2.x.,M, "3t'� 5� Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) -y 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
ttS £n'e�t ,�Y K a Other: 23.32
Business name:
Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Gas heat pump
Address:
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
,2i".$ fi
• Clothes dryer(gas)£ 4
Other:
Business name:
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( )
State surcharge(12%of permit fee)
CCB lie.: TOTAL PERMIT FEE
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: P c Jr, Date:&//4.2.6?lee
1:Building Permits MEC_PermitApp_0401 13.doc 440-4617T(I 1.02-COM WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi Famil Fee Schedule:
Total (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.
1:\Building\Permits\MEC_PermitApp_0401 13.doc 2
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2016-00196
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/23/2016
Parcel: 2S103BB11700
Jurisdiction: Tigard
Site address: 12160 SW ANN PL
Project: Travis Subdivision: YE-OLDE WINDMILL Lot: 36
Project Description: Duct work to convert attic space into habitable loft area.
Contractor: DELUXE HVACR LLC Owner: TRAVIS, CRAIG B&TANAE
1013 NE 62ND AVE 12160 SW ANN PL
PORTLAND, OR 97213 TIGARD, OR 97223
PHONE: 503-287-6688 PHONE: 406-544-6750
FAX: 503-287-0614
FEES
Specifics: Description Date Amount
Duct Work 03/23/2016 $23.32
Type of Use: SF 12%State Surcharge-Mechanical 03/23/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 03/23/2016 $66.68
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 qu- . OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: PermitteeSignature:
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 Appli •
EIVEP F.OF. l: FSI.:0\I.\
City of Tigard Received 2z
Date/By: DJ �3 t/ Permit No.:H ...e6A ...e6`g/n
•
ill 11111 13125 SW Hall Blvd.,Tigard,OR 97223 w
S Plan Review
Phone: 503.718.2439 Fax: 503.59lj.��6t��jj t 2 3 Date/By: Other Permit:
I I.i�1 I:1) Inspection Line: 503.639.4175 MM 2016 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
01 Y 01. 116ARD
t � � r -vim
:S. ] Com si�,eltE sc
Mechanical permit fees*are based on the value of the work
❑New construction
ddition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
,_. Value:$7.1 .,. .• . , • e0*.: 11, OF CO 4161. U016N �
, RESIDENTIAL EQIlIPMENT•J SYSTEMS FEES*
and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑ Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
son srrE INFORMATION AND LOCATION, Heating/cooling:
Air conditioning 46.75
Job site address: le ((„0 s-,,,„ 4_,0 p L.-- Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:�u,� �_ 9.7 0&n , , Furnace 100,000+BTU(ducts vents) 54.91
r? Heat pump 61.06
Suite/bldg./apt.no.: Project name: Avv C-_-. _ Duct work 4 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
r Residential boiler(radiator or
I �A �}t�) .� I'�-..J.� (�_ 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
AVID 5 (,,,1 0 iJEt%) Lam_-' fireplace 23.32
A^QE� Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
OPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: n �- Range hood/other kitchen
( '����„ f �d�v_-- equipment 33.39
Address: /Z /G c. 5 e- 'PL.. Clothes dryer exhaust 33.39
City/State/ZIP: �^ Single-duct exhaust(bathrooms,
y t�j Z� toilet compartments,utility rooms) 23.32
Phone:(I10C) 5-4 tf -6, l s t) Fax:( A.)Pt- Attic/crawlspace fans 23.32
-lit APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name: erc (70,3 . WGC 5=00 L4:c__
$14.15 for first four;$4.03 for each additional
Contact name: Er_ All psi_C� Furnace,etc.
Address: I-tp/L Gas heat pump
�b V h ��c:. Wall/suspended/unit heater
City/State/ZIP: .p.t_�.T7"--s.) p R 70(0 -t-- Water heater
Phone:(Cl iru) 33e. - 8 Z 4 Fax: :( ) Fireplace
�
Range
E-mail:
O5�y Cc e (SMA:,C_. CQ...„__ Barbecue
COf4OR Clothes dryer(gas)
Other:
Business name: d ,e ,,,xC We.f7 *Coe) MECHANICAL PERMIT FEES*
Address: 013 NI' 62 N 4t/C Subtotal 4?6•
City/State/ZIP: RA ar,J Oje 9 '�i Minimum permit fee($90.00)
Phone:( ro3) .283--66 g Fax:(So� ) Plan review(25%of permit fee) �""
State surcharge(12%of permit fee) fD•W
CCB lie.: Zc1O103 TOTAL PERMIT FEE /00,��
This permit application expires if a permit is not obtained within 180
r- „% days after it has been accepted as complete.
Authorized signature: , raj. * Fee methodology set by 77i-County Building Industry Service Board
Print name: ryt4ejt_ 5 cG-•./4-e4._;4-4 Date:3'11 =ox V .
t:Building Permits MEC PermitApp_040113.doc 440- 617T(I 102 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:vBuildingPennitsyMFC_PennitApp_040113.doc 2