Permit (53) IIIICITY OF TIGARD MECHANICAL PERMIT
4 . COMMUNITY DEVELOPMENT Permit#: MEC2016 00546
T f GA.R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/01/2016
Parcel: 2S103DA04300
Jurisdiction: Tigard
Site address: 10660 SW PARK ST
Project: Arreola Subdivision: FANTASY HILL Lot: 4
Project Description: Installation of a/c. Placement of a/c unit must comply with manufacturer's clearance requirements.
Contractor: OWNER Owner: ROSALES, LUIS ARREOLA
ARREOLA,JESSICA
10660 SW PARK ST
TIGARD, OR 97223
PHONE: PHONE: 503-890-8911
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 08/01/2016 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 08/01/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/01/2016 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct que, '• : OUNC b calling 503.232.1987 or 1.800.332.2344.
Issued B ' v , / Permittee Signature: k P //i��1i�� / / _ 4,,
Call 503.639.4175 by 7:00 a.m.for the next available inspectio date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
�w,� p
City of Tigard i' g 4 r z .''',;g:: "; Received
Date/By: q I ite" (.."---\,, Permit No.:H g.e.„90) -ex)5
13125 SW Hall
Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1 6
Q - 2016
111 e Plan Review iew
Other Permit:
'J�; i InspectionDate/By:t/BLine: 503.639.4175T It.,ARl)
Date Ready/By: kris: 65 See Page 2 for
Internet: www.tigard-or.gov Notified/Method:
'1.,J1 €'' t Supplemental Information
Mechanical permit fees*are based on the value of the work
❑New construction Q'Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
DI.-and 2-family dwelling ❑Commercial/industrial
❑Accessory building For special information use checklist.
❑Multi-family 0 Master builder ❑Other: Description P Qty. Ea. Total
E yjr i Heating/cooling:
.:. 0 I4: �" Air conditioning 1 46.75 14,15''
Job site address: \D(r,00 ) ---?:;WY s Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: v\(,\ 7"( i CD Ci---122--
---1- Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: 1 Project name:
Heat pump 61.06
Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
y� Residential boiler(radiator or
1\1 !�t v 1 x 0-At '( hydronic) 23.32
V\161--Y--1 S 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
;,;DE RI ION OF U4'O)l Gas fireplace/insert 33.39
1 l } e Flue vent for water heater or gas
151C,� ‘ A.0 P\C- QIC \�k. fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32 -
f ±f777 itiV O VNETi '• , , Other: 23.32
` �.. � Environmental exhaust and ventilation:
T=..
Name: \_ .e C
65.1 -C\ v''
- � Di\e !'A. Range hood/other kitchen
Address: J l 1� Ili equipment 33.39
' ��l P C\r _ �`,, Clothes dryer exhaust 33.39
City/State/ZIP:. \ , C, c(- ice}1) 017 . Single-duct exhaust(bathrooms,
l ' Zr?' toilet compartments,utility rooms) 23.32
Phone:( �j - Fax:( ) Attic/crawlspace fans 23.32
+ Other:
,. g,.. ,. s.> I•�. ,. ._.x. ,u `t tCAA 1' .t., c • 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
Range
E-mail:
Barbecue
Clothes dryer(gas)
Business name: V/, )J/ ) E Other
Address: � fir. 1®x, w :PE IIr ?kE °
Subtotal .7
City/State/ZIP: Minimum permit fee($90.00) C?6c)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) /O•gt)
CCB lic.: TOTAL PERMIT FEE /e6.
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized sig re: * Fee methodology set by Tri-County Building Industry Service Board
: --.4
Print nam / r '
F �✓ „z-..-; l _Date. '-'
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I:\Building\Permits\M _PermitApp_040113.doc 440-4617T(1 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi Family Fee Schedule:
$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.
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