Permit (66) {
CITY OF TIGARD MECHANICAL PERMIT
2.. . COMMUNITY DEVELOPMENT Permit#: MEC2016-00759
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/01/2016
T fGATT,
�1 R° g Parcel: 1 S 134C D01300
Jurisdiction: Tigard
Site address: 11955 SW 116TH AVE
Project: NOEL Subdivision: LERON HEIGHTS NO.3 Lot: 48
Project Description: Gas furnace replacement.
Contractor: CYGNATURE HEATING&AIR INC Owner: NOEL, CAROL M
PO BOX 823006 11955 SW 116TH AVE
VANCOUVER,WA 98682 TIGARD, OR 97223
PHONE: 360-977-0041 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 11/01/2016 $46.75
Type of Use: SF Minimum Fee Adjustment-Mechanical 11/01/2016 $43.25
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 11/01/2016 $10.80
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ,_2enz:e ___. ermittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE t SE O\L\
' I E ' Received
City of Tigard t (' + Date/By: #11/ Permit No.: d '/ r G
11 . 13125 SW Hall Blvd.,Tigard,OR 972 x`,( ,t' Plan Review U
I Phone: 503.718.2439 Fax: 503.598.1 Other Permit:
Date/By:
T I G A R U Inspection Line: 503.639.4175 1a\ Date Ready/By: See Page 2 for
Internet: www.tigard-or.gov >1,�,\a g) NoEN 121 tified/Method: Supplemental Information
TYPE OF WOri 1 (``' `I ION COMMERCIAL FEE* SUIR DULE 7 USE CHECKLIST ,
t, 3 - Mechanical permit fees*are based on the value of the work
El New construction Addition/alterk�,t�aCement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION , RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
land 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
JOB SITE INFORMATION AND LOCATION Heating/cooling:
,/ � �� Air conditioning 46.75
Job site address: (l t3 5,C S Li 1 1 L I L. ti... - Furnace 100,000 BTU(ducts/vents) I 46.75
City/State/ZIP: -� lr�X 0 r..... q7.)-,..)_3 Furnace 100,000+BTU(ducts/vents) 54.91
tJHeat pump 61.06
Suite/bldg./apt.no.: Project name: i/1/0 Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydropic) 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 r '*'' Gas fireplace/insert 33.39
Flue vent for water heater or gas
c'Q f le,cc 5/6 yk U2 fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
:0 OWNER .. :# 0 I'IrNANT
Environmental exhaust and ventilation:
Name: 64✓r)I IQ D e_ I Range hood/other kitchen
_ equipment 33.39
Address: ( (Ck S f�
� �(,) �-�._,._ Clothes dryer exhaust 33.39
City/State/ZIP:" �� )\ L Q7)43 Single-duct exhaust(bathrooms,
0 toilet compartments,utility rooms) 23.32
Phone:F*5 )`3 co--7 G 7�q Fax:( ) Attic/crawlspace fans 23.32
I'LIGANT 0 CONTACT`)rERSON
Other: 23.32
r ti
Fuelm
►
Business name yi-[-' „c s,Q- l 7ek'"7'1\ p p g
$14.15 for first four;$4.03 for each additional
Contact name: /-6-•-/\ Furnace,etc.
Address: P) 13o> S'71.66Gas heat pump
�/' Wall/suspended/unit heater
City/State/ZIP: WVl.t4`c)Ct✓'ez, Li 4 '( ; Water heater
Phone: Fax:: Fireplace
Range
E-mail:(�y,f 1. , .,,,_e_ 0 vi tttcyz a tl 2,� Barbecue
__ - , .. "CO CTOR' _ = . Clothes dryer(gas)
Business name: rw L Other:
MECHANICAL PERMIT FEES'
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lit.: a i 03 4(3 074 TOTAL PERMIT FEE lO a,,g-o
/ 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: !'�� .�Q
C d- (c,v_i Date: i I_'_
I:\Building\Permits\MEC_PermitApp_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.
I:\Building\Permits\MEC_PermitApp_040113.doc 2