Permit (18) INCITY OF TIGARD MECHANICAL PERMIT
. . COMMUNITY DEVELOPMENT
Permit#: MEC2016-00628
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/30/2016
Parcel: 2S 103CA02400
Site address: 11900 SW JAMES CT Jurisdiction: Tigard
Project: Hartley Subdivision: TRAVPORT PARK
Project Description: (3)bathroom exhaust fans and(1)hood vent. Lot: 4
Contractor: HARTLEY INVESTMENTS LLC Owner:
9516 SW CT US BANK NATIONAL ASSN TR
PORTLAND,JONATHAN 97219BY CHAMPION MORTGAGE CO
8950 CYPRESS WATER BLVD
COPPELL,TX 75019
PHONE: 503-708-5976 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 08/30/2016 $33.39
Type of Use: SF Single Duct Exhaust(Bathrooms,Toilet, 08/30/2016 $69.96
Class of Work: ALT Type of Const: Utility Rooms)
Occupancy Grp: 12%State Surcharge-Mechanical 08/30/2016 $12.40
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $115.75
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct ion OUNC b calling 503.232.1987 or 1.800.332.2344.
4111
Issu d By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. ,
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE O\L\'
City of Tigard Received r _
13125 SW Hall Blvd.,Tigard,OR 97223 " ► ". Date/By: 1 hi Permit No.: 1
Phone: 503.718.2439 Fax: 503.598
Plan Review14 II it
��A� Date/By: Other Permit: / -' / 1. ,0,-,T I G A R D Inspection Line: 503.639.4175 \
Internet: www.tigard-or.gov Date Ready/By: fur See Page 2 for
. 1. Notified/Method:
61, .f.*i � Supplemental Information
t
TYPE OF woz ' co r '� � 5 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction peormed.Indicate the value(rounded to the nearest dollar)of all
El Demolition gAddition/aIteraP?acement
Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
1-and 2-family dwelling 0 Commercial/industrial
0 Accessory building For special information use checklist
❑Multi-family 0 Master builder
0 Other: Description I Qty. I Ea. I Total
JOB STTE INFORMATION AND LOCATION " '' Heating/cooling:
Job site address: . 1100 �U. j ' �� Air conditioning 46.75
-.2-S Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Ti„criA v'' (Z 17 r9`s Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Heat pump 61.06
�fn I`� G� �/j4/ Duct work 23.32
Cross street/directions to job site: ir
�'W ��.� + �p„tt 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
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
1401J ?
12`, h t.S' fireplace 23.32
nA-ic'� ( 4eooi \AvC\--- Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
V PROPERTY OWNER :0 TENANT Other: 23.32
Name: ft t� Environmental exhaust and ventilation:
tv, i v,v ns Ll-c; Range hood/other kitchen
Address: l �� j �� n ,� equipment / 33.39 j3"-si
�if C/[ • Clothes dryer exhaust 33.39
i
City/State/ZIP: ° C12_ 9 ,.�l41 Single-duct exhaust(bathrooms,
` s� toilet compartments,utilityrooms) ,3
23.32 6,ff.�t'
Phone:(c ' ) '?0 g' - j--.) 6 Fax:( ) Attic/crawlspace fans 23.32
ntir 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: S ''kK, Gas heat pump
City/State/ZIP:
Wall/suspended/unit heater
Water heater
Phone:( ) Fax::( ) Fireplace
E-mail: 3 J 2 �1G''L`�-I,Q" Range
�-Pr^, Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: Other:
Address: MECHANICAL PERMIT FEES*
ccCV%-,'`.—"" Subtotal /63. 3i--
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( )
State surcharge(12%of permit fee) 1.2kO
CCB lic.: ( O 1 a $'-C- 74s-4 g TOTAL PERMIT FEE -'I, 23'
4 This permit application expires if a permit is not obi ned within 180
days after it has been accepted as complete.
Authorized signature: S�..." * Fee methodology set by Tri-County Building Industry Service Board
Print name: v.e_ Icik, .) Date: S/36/,
1:/Building\Permits\MEC_PermitApp_0440113.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.
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