Permit CITY OF TIGARD MECHANICAL PERMIT
2. . COMMUNITY DEVELOPMENT Permit#: MEC2017-00370
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/25/2017
T A "�� '�� 9 Parcel: 1 S 133CA05300
Jurisdiction: Tigard
Site address: 11367 SW HALLMARK TER
Project: Cleveringa Subdivision: BARROWS ROAD ESTATES Lot: 2
Project Description: Installation of a/c unit. Placement of a/c unit must comply with manufacturer's clearance requirements.
Contractor: OWNER Owner: CLEVERINGA, KEITH BRIAN
KEITH CLEVERINGA 11367 SW HALLMARK TER
11367 SW HALLMARK TERRACE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 408-518-6980 PHONE: 480-518-6980
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 05/25/2017 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 05/25/2017 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 05/25/2017 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct ques' to OUNC b calling 503.232.1987 or 1.800.332.2344.
Issued By: Co -�LI�Q"� Permittee Signature:
k --'-'777
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applica Po iCEj% J'R
FOR OFFICE USE ONLY
City of Tigard Received / PermitNo.:
13125 SW Hall Blvd.,Tigard,OR 97223
M*I
rA Af Date/By: 5 OSS' /7Fife�!j/ 00376
Phone: 503.718.2439 Fax: 503.598.19 A 2 5 2017 Plan Review
Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Read/B hills:
Internet: www.tigard-or.gov CITY yy��g Ready/By: I El SeePage2 for
i,f' fIGARl.) Notified/Method: Supplemental Information
TYPE WORRK ' ' COMMERCIAL jFEE".SCIitEDIJLE 4..USECIIECIOJST`
Mechanical permit fees*are based on the value of the work
0 New construction El Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition El Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESTDENTIALEQU 'J EI /SY T r S*
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
0 Multi-family El Master builder
0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 1 46.75
Job site address: S'*fyt As ri, tly 0v/.,� /116,7 Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: �1�/ (/_� ,, ,L./��K4. Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: T��''' ' Heat pump 61.06
J C�v>2���4-- Duct work 23.32
Cross street/directions to job site: _,(Clf)&�S / 4tcDy � Hydronic hot water system 23.32
b� 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: -S ten ie S -' Lot no.: Other: 23.32
/' a Vf Other fuel appliances:
Tax map/parcel no.: �d t 3 4_
Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
—_ ` Flue vent for water heater or gas
&I_- Ciyv t)jV71 J& Win) c74 / fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER ❑ TENANT Other: 23.32
Name: Environmental exhaust and ventilation:
��6'iral-&( ;(._I/)61.�. Range hood/other kitchen
Address: I ^�_ C I I t/ �f�
equipment
-'!'�T .v� IA/41,1_17174,:,,/"' !� 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: -774' A O ( q 223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ta) 51 g 4?8 to Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT „❑;CONTACT,PERSON 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:
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: s �� Ow IJ I_()-- Other:
MECHANICAL PERMIT FEES*
Address:
Subtotal
City/State/ZIP: Minimum permit fee($90.00) 90
Phone: Plan review(25%of permit fee)
( ) Fax:( ) State surcharge(12%of permit fee) Q
CCB lie.: TOTAL PERMIT FEE Inv •
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: Date:
I:\Building\Pcrmits\MEC_PermitApp_040113.doc 440-4617T(I I/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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11367 SW HALLMARK TER, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Mechanical MEC2017-00370
Inspection Type: Inspector:
699 Mechanical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor