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Permit (11) CITY OF TIGARDMECHANICAL PERMIT P 2: COMMUNITY DEVELOPMENT Permit#: MEC2017 00612 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/14/2017 �f'O Parcel: 2S108DB03400 Jurisdiction: Tigard Site address: 15172 SW THAMES CT Project: Liles Subdivision: POLYGON AT BULL MOUNTAIN Lot: 32 Project Description: Install NC unit. Placement of A/C unit must meet manufactures installation requirements. Contractor: FORD FOUNDATION LLC Owner: LILES, SUSAN 13810 SW 100TH AVE 15172 SW THAMES CT TIGARD, OR 97223 TIGARD, OR 97224 PHONE: 503-680-0471 PHONE: 503-267-7492 FAX: FEES Specifics: Description Date Amount Air Conditioning 08/14/2017 $46.75 Type of Use: SF 12%State Surcharge-Mechanical 08/14/2017 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/14/2017 $43.25 Occupancy Grp: Stories: Fuel Fuel Types: Gas Pressure: Total $100.80 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may o copy of the rules or direct questions to OUNC by calling 503 32.1987 or 1.800.332.2344. Issued By: ,ii/(4„,‘ ' --"A"'' Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE t SE ONLI City of Tigard tC I EU) Received � /Date/By: //L//7 /nv Permit No. 44 v jt —.0%42_ III � 13125 SW Hall Blvd.,Tigard,ORRE. ® Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Date/By: Other Permit: T(G A R U Inspection Line: 503.639.4175 AUG 14 2017 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information CITY OF TIGARD TYPE 140 R1CG DIVISION COMMERCIAL FEE* SCHEDULE- USE CHECKLIST Mechanical permit fees*are based on the value of the work ONew construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. . Value:$ w, CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* th-and 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 g/cooling: Air conditioning i 6.75 Job site address: /5/7,2— �/„/ zS c-T-- Furnace 10 , 46.75 City/State/ZIP: p1,- 7 Z Z 7 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: I Project name: L i ` Heat pump 61.06t�s Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 � T Residential boiler(radiator or S-10 /515-77- A-1/e___ ^ G -Ci////1W) 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 Other: 23.32 Subdivision: Lot no.: J j ►Q.� Other fuel appliances: Tax map/parcel no.: Water heater 23.32 Gas fireplace/insert 33.39 �4 DESCRY)<'C[�N QF w.„6, mi :' •. Flue vent for water heater or gas /) Pu rt_ Q , . ,A/ffireplace 23.32 T 1i�� Log lighter(gas) A. 23.32 /S( �i1 `a // Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 i lt'!ROF RT Y OWNER 1 TENANT.c Other: 23.32 Environmental exhaust and ventilation: Name: S7 J ti/C S Range hood/other kitchenequipment 33.39 Address: /S-7 7,- —7-7 te_S CT— Clothes dryer exhaust 33.39 �1c Single-duct exhaust(bathrooms, City/State/ZIP: 5d / �Z r toilet compartments,utility rooms) 23.32 Phone:(5 ) 2-F67 '7 `n(�_"-' Fax:( ) Attic/crawlspace fans 23.32 r. ''t /41:1ALANT 0,CONT `.-+ER N Other: 23.32 '` Fuel piping: Business name: A�'�/6 # G/ 4 D y�i�4 'S��� $14.15 for first four;$4.03 for each additional Contact name:",// ,e ) Furnace,etc. Gas heat pump Address: /:? F/O cid f zoo77, 4*-z- Wall/suspended/unit heater City/State/ZIP: —p i6 0/t' 9 7 223 Water heater Phone:�(�} gO v 7 � Q v7/ Fax: ( ) Fireplace Range E-mail: 4147-44, ( ak_ott-i _ Barbecue NTRACTOR Clothes dryer(gas) Other: Business name: MECHANICAL PERMIT FEES* Address: Subtotal Minimum permit fee($90.00) City/State/ZIP: Plan review(25%of permit fee) Phone:( ) / Fax:( ) State surcharge(12%of permit fee) CCB lic.: 7-0Z 6 yTOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signatu /re: f(7� * Fee methodology set by Tri-County Building Industry Service Board Print name:is:// Date: W/7 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. 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