Permit 74 CITY OF TIGARD MECHANICAL PERMIT
l� COMMUNITY DEVELOPMENT Permit#: MEC2017 00579
Tf GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/07/2017
Parcel: 2S 111 DC00100
Jurisdiction: Tigard
Site address: 15580 SW ALDERBROOK CIR
Project: Perry Subdivision: SUMMERFIELD NO.8 Lot: 448
Project Description: Installation of gas furnace,a/c and gas piping for furnace and range.
Contractor: CORRECTLY DONE HEATING AND AIR CONDITIONII Owner: CAROL PERRY
168 NE 34TH CT 15580 SW ALDERBROOK CIR
HILLSBORO, OR 97124 TIGARD, OR 97224
PHONE: 971-506-1591 PHONE: 503-888-3205
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 08/07/2017
$46.75
Type of Use: SF Furnaces<100K BTU 08/07/2017 $46.75
Class of Work: ALT Type of Const: Fuel Piping 08/07/2017 $14.15
Occupancy Grp: 12%State Surcharge-Mechanical 08/07/2017 $12.92
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $120.57
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may o tain a copy of the rules
or direct qu- - • OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu . By: j/ /, Permittee Signature: ?‘ (f)-02.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONL
City of Tigard Received
111111 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: PermitNo.: �C /'OO 57
C Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
TI G A R D Inspection Line: 503.639.4175 Date/By: Other Permit:
Internet: www.tigard-or.gov Date Ready/By: Juris: ® See Page 2 for
Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE- USE CHECKLIST
0 New constructionMechanical permit fees*are based on the value of the work
0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ( ]Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
�
( dwellinRESIDENTIAL EQUIPMENT/SYSTEMS FEES*
rc� 1-and 2-family g 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 Heating/cooling:
Air conditioning 6 46.75
Job site address: 1 cc S 0
Furnace 100,000 BTU(ducts/vents) / 46.75
City/State/ZIP: A•\ r‘,30r-do ) 0.,i ,j-e__ Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Heat pump 61.06
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: Lot no.: Other: 23.32
Tax map/parcel no.:
Other fuel appliances:
Water heater 23.32
"" DESCRIPTION OF woi x Gas fireplace/insert 33.39
1� ' 'tiFlue vent for water heater or gas
>n ) GS ..-CO CA A SaeA ... CON 6. c nc 1;04 fireplace 23.32
kr.) Cl.7r IA ahCr 0..130 1� Log lighter(gas) 23.32
J Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
P ) �TYO R444.*:
Oth23.32
[ OE
u._ i 0 :s _ " ' Environmental exhaust and ventilation:
Name: r ,r.O\ ��{r- Range hood/other kitchen
Address: 1 'E,c j i AQ' coO k `0_(Q equipment 33.39
/ 6Ft Clothes dryer exhaust 33.39
City/State/ZIP: --r {� Single-duct exhaust(bathrooms,
sciPhone:( ) 3 2 S Fax ( ) toilet compartments,utility rooms) 23.32
v Attic/crawlspace fans 23.32
APPLICANT `• .' 4. , 4 'PER 4 Other:
n_. v .�' 23.32
Business name: ddnFuel piping:
Carre�� � e,��rt cvct Ar Ccocc(
' -
/ � $14.15 for first four;$4.03 for each additional
Contact name: pili r i'"1 • H �V'�. Furnace,etc. 1
1
Address: P6g (1 ? �� Q.0(..,rk
Gas heat pump
( Wall/suspended/unit heater
`
City/State/ZIP: , S or C C) jz
7/z V Water heater
Phone:(Cr?/) -'Q o/6 _f T 5( Fax::( ) Fireplace
E-mail: Range /
-It `t Ai ; CO„NTRA R;' 4 ,,,;, .' ` r 7 "
Barbecue
�,�, Clothes dryer(gas)
Business name: Other:
Address: ,., „ MEC$A*ICALPE * -
1Thn F E
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( )
State surcharge(12%of permit fee)
CCB lie.: ( g 1 �� TOTAL PERMIT FEE W ip ,'3-7
1 / '�/ This permit application expires if a permit is not obtained within 180
/ �� days after it has been accepted as complete.
Authorized signature:jj * Fee methodology set by Tri-County Building Industry Service Board
Print name: v� l t p C14,-14)%14-01-%, Date: 2,-7- r .7
I:\Building\Permits\MEC_PennitApp_040113.doc 440-4617T(I 1/02/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