Permit (35) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2016-00403
TGART) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/06/2016
Parcel: 1 S 134ACO2648
Jurisdiction: Tigard
Site address: 11060 SW COTTONWOOD LN
Project: McKibbin/Donahue Subdivision: ENGLEWOOD NO.3 Lot: 214
Project Description: (1)range exhaust fan,gas line from new meter to within 5 of gas insert in fireplace.
Contractor: OWNER Owner: BONACKER, GERALD N JEAN E
MCKIBBIN/DONAHUE 11060 SW COTTONWOOD LN
11060 SW COTTONWOOD LN TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 720-244-5930 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 06/06/2016 $33.39
Type of Use: SF Fuel Piping 06/06/2016 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 06/06/2016 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 06/06/2016 $42.46
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued ByCji3Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical PermitApplicatic g FOR OFFICE USE ONLY
City of Tigard '
Date/By:ed (tr((p 14, ( k 'per Perm No.:f�(,n ,).,1/_66(/03
13125 SW Hall Blvd.,Tigard,OR 97223 �--�/ t c ofiJ (D
= Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 JUN 6 2 016Dale/By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov
Notified/Method: Supplemental Information
ITV OF MA
TYPE OF Wb LOING DIVISION
COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑ New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
'l-and 2-family dwelling 0 Commercial/industrial ❑ Accessory building For special information use checklist.
O Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: //D 4'0 SW colpit it mod Lrt Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: T4"tipd 972 Furnace 100,000+BTU(ducts/vents) 54.91
/� Heat pump 61.06
Suite/bldg./apt.no.: Project name: /1 /c O bill Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
/ Residential boiler(radiator or
//5; /V Co#Aft.1/4.)e eel 1—,t 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: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater _ 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
f/1 o / Flue vent for water heater or gas
Z&S // / f /.Ytt ( 4( /!CctJ�y D/ (E it?e7e✓s fireplace 23.32
C/V lit) /c' Yh4J4/) f D ti.,11'Y•t r U ,S ' t. /J11" Aser Log lighter(gas) 23.32
.9 Wood/pellet stove 33.39
lf:- 0/4 GQ-- Wood fireplace/insert 1 23.32
/r �Q �� Chimney/liner/flue/vent 23.32
H. 4 ov a iN- Q —/'4K� I_ Other: 23.32
`PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
Name: e 11.4GX 4 r k Range hood/other kitchen f
p t equipment 33.39
Address: O D 5 it) �,tdz a. gin LK . Clothes dryer exhaust 33.39
City/State/ZIP: liFe tved`Joh ®A ,r7oo� Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(7Zea .%/1/ - S l3t9 Fax:( ) Attic/crawlspace fans 23.32
APPLICANT 0 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 I
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
1,, 1 Other:
Business name: W N) MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00) 9'61 .COD
Plan review(25%of permit fee) ---
Phone:( ) Fax:( )
State surcharge(12%of permit fee) /e2,SCp
CCB lic.: TOTAL PERMIT FEE /DO-
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: /� ""t * Fee methodology set by Tri-County Building Industry Service Board
Print name:e G �/�j�k Date: S"/4 /i6
1:,Building\Permits\MEC ermitApp_040113.doc 440-4617T(11/02/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.
1:\Building\Permits\M EC_PennitApp_040113.dnc 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
11060 SW COTTONWOOD LN, TIGARD, OR,
97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2016-00403
Jeff Grove
Violation Summary:
Inspector Contractor