Permit (45) 114CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017-00395
T[a A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/05/2017
Parcel: 2S104AD06700
Jurisdiction: Tigard
Site address: 12879 SW PARKDALE AVE
Project: Olson Woods,Lot 3 Subdivision: OLSON WOODS Lot: 3
Project Description: Installation of a/c unit. Placement of unit must comply with manufacturer's clearance requirements.
Contractor: WINDWOOD CONSTRUCTION INC Owner: WINDWOOD CONSTRUCTION INC
12655 SW NORTH DAKOTA 12655 SW NORTH DAKOTA ST
TIGARD, OR 97223 PORTLAND, OR 97223
PHONE: 503-625-6526 PHONE: 503-780-4375
FAX: 590-7606
FEES
Specifics: Description Date Amount
Air Conditioning 06/05/2017 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 06/05/2017 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 06/05/2017 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uti' Notificatio enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
•'direct questions to • NC b .fling 503.232.1987 or 1.800.332.2344.
ssued By: <-.4—,,,
- 1m . Permittee Signatur I.
/ J2-1
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
MSS`---2-0/6-_ ,0,2_2
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received /_ / �j�
IN = a Date/B : CCS !! Permit No.: G/1 alis/7 oO Q�'j�
13125 SW Hall Blvd.,Tigard,OR 97223 c c Qc/! ✓/
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175
Internet: www.tigard-or.gov Date Ready/By: Juris: El See Page 2 for
Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE USE CIiECKLIST
ew construction Mechanical permit fees*are based on the value of the work
❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
' .. CATEGORY OF, CONSTRUCTION ':
Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
)'1'and 2-family dwelling 0 Commercial/industrial ❑Accessorybuilding g For special information use checklist
❑Multi-family 0 Master builder
0 Other: Description Qty. Ea. Total
JOB`S1TE-3NFORMATION-AND LOCATION Heating/cooling:
Job site address:]) 6 '2 9 p�^"k!� / , N47��~- Air conditioning / 46.75
f-C fT /'� Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 7:47 '/z/1. ) 1,L - i-,-/-7;2 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: i /% f -) -/ Heat pump 61.06
` Duct work 23.32
Cross street/directions to job site: 1,,'i..% 1' / 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
�� , ..-)---'4%(i (2,...,,,,,i+;:),,:.:)/:-,i; 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
r1 I fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
OPERTY OWNER ❑ TENANT Other: 23.32
Address: Environmental exhaust
xhaust a
nd ventilation:Name: , L ' ''( Range hood/other kitchen 1.-)- J i I c ,, t / , , , equipment
33.39 Clothes dryer exhaust 33.39j
City/State/ZIP: r f)- t . Single-duct exhaust(bathrooms,
7 �,�' �lrt�"� 4,r � g
toilet compartments,utility rooms) 23.32
a �- 7-
Phone: ) lf Fax:( �.. ) ) /U-7 Attic/crawlspace fans 23.32
;;APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: ___15::: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: 1/ {,7,7?",/,,, /,
,� //r- z.,,,":" , �j�� i Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: : ( ) Fireplace
Range ivJ ^ ' vUc C- f'.04i -"!"✓c- , (.7-7 - f0 „. ,
t,//',,,,,i. Barbecue
CONTRACTOR
Clothes dryer(gas)
Business name: W- l f;)z,::— Other:
Address:
MECHANICAL PERMIT FEES*
Subtotal
City/State/ZIP: Minimum permit fee($90.00) ;'.Q.oc'
Phone: Plan review(25%of permit fee)
( ) Fax:( )
State surcharge(12%of permit fee) le•
CCB lie.: -‹ —/�l .5-78- /7' TOTAL PERMIT FEE 70(), g'd
l This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized Sign * Fee methodology set by Tri-County Building Industry Service Board
Print name::z7., r`j Date: '3/��//jk;
I:\Building\PermitsWEC_PermitApp_040113.doe 440-4617T(11/02/COM/WEB)
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