Permit (10) CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: MEC2017-00296
* 1113125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/27/2017
Tt 4a 11 RD 13125 Parcel: 2S106DC10100
Jurisdiction: Tigard
Site address: 13776 SW 175TH AVE
Project: SUKHUN Subdivision:POLYGON AT WEST RIVER TERRACE Lot: 101
Project Description: A/C installation. Placement of A/C unit must comply with manufacturer's installation requirements.
Contractor: DONS AIR CARE INC Owner: SUKHUN, MUNZER&EMILY
PO BOX 6408 13776 SW 175TH AVE
ALOHA, OR 97007 SHERWOOD, OR 97140
PHONE: 503-642-5844 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 04/27/2017 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 04/27/2017 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 04/27/2017 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: r ignature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
V°
Mechanical Permit Application FOR OFFICE I.SE ONl.\
City of Tigard (�A Received _
u rt �"` Date/By: II / Permit No.: - :11 7 ��
lig 13125 SW Hall Blvd.,Tigard,OR 97223 p_ b
C Phone: 503.718.2439 Fax: 503.598.1960 V.R .` Y % t'y.; Other Permit:
T 1 G n R D Inspection Line: 503.639.4175 �, 0r 0 ate Read/B Juris:
Internet: www.tigard-or.gov �� Ready/By: See Page 2 for
Notified/Method: Supplemental Information
G` ®���
TYPE OF WORK `l COMMERCIAL FEE*"SCHEDULE -- USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
Heating/cooling:
JOB SITE INFORMATION AND LOCATION ;.`:.
Air conditioning f 46.75 ,I-16- 5--
Job
`Job site address: C U ) I 4"1"�
1? 7 7 jj�i S7� Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: C ti e,V^1V b J Ci-- n 7/ T z/;1 Furnace 100,000+BTU(ducts/vents) 54.91
q a l Heat pump 61.06
Suite/bldg./apt.no.: Project name: ]-
�c4 rwv, Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
�j Residential boiler(radiator or
e-/y �3` yArS- 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
ct Flue vent for water heater or gas
„ ,L �) 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
',(..PROPERTY OWNER " .�❑ TENANT Environmental exhaust and ventilation:
Name: Range hood/other kitchen
Er'ht t- c�
l ' �` k t t,! equipment 33.39
Address: /3 7 76 S("/ f"75+f1-- Clothes dryer exhaust 33.39
City/State/ZIP: 5-42 o'1er�-t )-- V 7/e,C0 Single-duct exhaust(bathrooms,
l ! toilet compartments,utility rooms) 23.32
Phone:(5r ) 4'/76 -- Ssg Fax:( ) Attic/crawlspace fans 23.32
APPLICANT 0 CONTACT PERSON " Other: 23.32
Business name: r- ) Fuel piping:
S .41'V eau- S; $14.15 for first four;$4.03 for each additional
Contact name: /rCi (-c1*./1 e Furnace,etc.
Address: , Gas heat pump
t Wall/suspended/unit heater
City/State/ZIP: fi/06,6 c 7 107 Water heater
Phone:(e.�/ ) 64 Z_� zit. f• Fax::( ) Fireplace
7 Range
E-mail:
Barbecue
CONTRACTOR "' Clothes dryer(gas)
Business name: S" r,�}1Fp "'
" Other:
MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( )
State surcharge(12%of permit fee)
CCB lic.: /C?2/8
4( TOTAL PERMIT FEE `tla•'�'T�
C1 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: �°� ulr) 2? ,y /r * Fee methodology set by Tri-County Building Industry Service Board
Print name: (Ar,- cir e, r
X�j Date: 4�77
I:\Building\Permits\MEC_PermitApp_0401 t3.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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