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Permit (40) 74 a, CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit#: MEC2016-00581 T f{la}g D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2016 Parcel: 2S110BA05600 Jurisdiction: Tigard Site address: 11865 SW WILDWOOD ST Project: ANDERSON Subdivision: SHADOW HILLS Lot: 9 Project Description: (1)mini-split heat pump,(2)wall inverter units Contractor: Owner: ANDERSON, KELCIE L 11865 SW WILDWOOD ST TIGARD, OR 97224 PHONE: PHONE: FAX: FEES Specifics: Description Date Amount Heat Pump 08/15/2016 $61.06 Type of Use: SF 12%State Surcharge-Mechanical 08/15/2016 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/15/2016 $28.94 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 oti€ieatie�>\enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or 'ect questions to •<NC .; callin• $3.232.1987 or 1.800.332.2344. I sued By: , j , Permittee Signature: /, 119 Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE USE ONI.I' Cl of Tigardill C�K alb EIVED Received ) g Date/By: �`b/ /� Permit No.: D/� 13125 SW Hall Blvd.,Tigard, Plan Review p urg e Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: `V ST�I� AUG 1 6 2016 Date/By: ���5 I I( ARI) Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information CITY OF T1UARD }v 1. , i 6 a ` DIVISI ►� , tri 1 14-141E* •!.? -' C Mechanical permit fees*are based on the value of the work ❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$sAJ1C© I' ti; . u=" "."; S 4 ,, cp . . 2 II g tUpr T{ ESx A1-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist. ❑ Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total Heating/cooling: � 5 "' � I� SIT +IFO � `Ul�l•", o "LC1t:*AiI<�1V `� „,,,„4„,„,i," '>� �` "'` •' Air conditioning 46.75 Job site address: I(C"?L" '���� )( Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: I i3t,scX t D� (',�7,a 3 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 1 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 Subdivision: Lot no.: Other: 23.32 Other fuel appliances: Tax map/parcel no.: Water heater 23.32 DESIIPTION OF= :WOR( Gas fireplace/insert 33.39 OOne, 501). Flue vent for water heater or gas ne r91 h 1 `_t i-L}' ,///^^^��'c -110 fireplace 23.32 Log lighter(gas) 23.32 t..)('7 0(k\1 I rkle, '1C1 S i.-1 11 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 PROPERTY"• OWNER " Other: 23.32 �� n Environmental exhaust and ventilation: Name: ion Range hood/other kitchen equipment 33.39 Address: g h S . ti 0,0,3,1 Si, Clothes dryer exhaust 33.39 City/State/ZIP: it 0G F(9. ()IS C1��a') Single duct exhaust(bathrooms, 1T toilet compartments,utility rooms) 23.32 Phone:(G)t 9) .->-2,2,,cit.a / Fax:( ) Attic/crawlspace fans 23.32 ©"AP LICAlv1 "":CQNTACT PLR Oj�, . . .': 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 Range E-mail: Barb"_, . , u,.... nS. 44cue 11.E: +COlNITI c'I'c ; „%.'..P b Clothes dryer(gas) Business name: Qom' O --/Z- Other Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) 90.E Plan review(25%of permit fee) ---------- Phone:( ) Fax:( ) State surcharge(12%of permit fee) / •$60 CCB lic.: TOTAL PERMIT FEE /60. $O This permit application expires if a permit is not obtained within 180 `r days after it has been accepted as complete. Authorized signature, .a,/, * Fee methodology set by Tri-County Building Industry Service Board Print name - hb/L\� /N�pn�n Date: 5/1 C� /I/_ 1:\Building\Permits\\MEC`_PermitApp_0401 13.doc 440--4617T(111/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-Family Fee Schedule: ytalaluition; WWI% 7:mit .. . $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:\Building\Pennits\MEC PennitApp_040113.doc 2