Permit (52) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017 00181
t aARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/14/2017
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Parcel: 2S1106D07900
Jurisdiction: Tigard
Site address: 14728 SW 117TH PL
Project: ORFIELD Subdivision: 1995-015 PARTITION PLAT Lot: 1
Project Description: Gas furnace and A/C installation. Placement of A/C unit must comply with manufacturer's installation
requirements.
Contractor: WILLAMETTE HEATING&AIR CONDITIONING INC Owner: ORFIELD, KELLY ALLEN&TAMARA LY
4760 SW HAMILTON 14728 SW 117TH PL
PORTLAND, OR 97221 TIGARD, OR 97224
PHONE: 503-284-3740 PHONE:
FAX: 503-284-2821
FEES
Specifics: Description Date Amount
Air Conditioning 03/14/2017 $46.75
Type of Use: SF Furnaces<100K BTU 03/14/2017 $46.75
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 03/14/2017 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-A9B--Yvn—Naayobtain a co. .f the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: • ittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE l SF Otil.l
'PICity of Tigard Date;Bed _ • ,
Y �1. Permit No.: t
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
_ Phone: 503.718.2439 Fax: 503.598 1960 ,L
Date/By: Other Permit:
Inspection Line: 503.639.4175 �a" .';
T I G A R D p R Date Ready/By: See Page 2 for
Internet: www.tigard-or.gov .,,.1 Notified/Method: SupplementalII!All Information
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t� 1 4 4�'�1
TYPE OF WORII~�HK iO COMMERCIAL FEE* SCHEDULE -:USE CHECKLIST
‘` rNIMechanical permit fees*are based on the value of the work
❑New construction Addition/alterat ie it t e liCkt.-F performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other:
}11 ``r t,., mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF.CONSTRUC"L'ION 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. 1 Total
Heating/cooling:
JOB SITE INFORMATION AND,„LOCATION
ra , Air conditioning / 46.75 qt,, 7
Job site address: /1/"ie? �(. 9” I /7 �t�/ . 1,›. .,
Furnace 100,000 BTU(ducts/vents) / 46.75 c )�
City/State/ZIP: �-.eil C!G. OQV- qFurnace 100,000+BTU(ducts/vents) 54.91
'i 11 FHeat pump 61.06
Suite/bldg./apt.no.: I I roject 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: Other: 23.32
Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
� x DESCRIPTION OF VOIIC 4=5' % . x
Gas fireplace/insert 33.39
- >r z
Flue vent for water heater or gas
/it�"' �0 - tfi'/C— fireplace 23.32
(j� Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
4iµ 0 PROPER6 OWNER. I kms, a TENANT .. Fx,s
.£. "tu , Environmental exhaust and ventilation:
Name: /f � 4- , ,,-q 0 ' Range hood/other kitchen
v` equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) 'Fax:I ) - Attic/crawispace tans 2332 - -
❑ APPLICANT" 0 C t4TACT PERSON" '. Other: 23.32
Fuel piping:
Business name:
$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:( ) I Fax: :( ) Fireplace
Range
E-mail: Barbecue
v,.
CONTRACTOR Clothes dryer(gas)
Business name: Other:
�---t..- MECHANICAL PERMIT FEES*
Address: i)6 C / „�"... Subtotal 5-V
City/State/ZIP: J c-,/C/ Minimum permit fee($90.00) ---
Plan review(25%of permit fee)
Phone:( ), ,* " 7 yd Fax:( ) State surcharge(12%of permit fee) //'.,):),,
CCB lic.: 7 7 3 a-/�i/�� TOTAL PERMIT FEE 1�flth 7,L
e/ Z This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: G„i--" AP ) * Fee methodology set by Tri-County Building Industry Service Board
Print name: (-. C__ ,f'4L, '0.�*,(� Date: /y / '
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I:\BuildingPermits\MEC_PermitApp_040113.doc A 440-4617T(11//02/CO B)
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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