Permit (70) CITY OF TIGARD;IN MECHANICAL PERMIT
''. COMMUNITY DEVELOPMENT Permit#: MEC2017-00643
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/28/2017
Parcel: 2S 103 B D 10800
Jurisdiction: Tigard
Site address: 11710 SW WALNUT ST
Project: FURLOTT Subdivision: 2003-045 PARTITION PLAT Lot: 1
Project Description: Mini split heat pump installation.
Contractor: MPS HEATING&COOLING LLC Owner: FURLOTT, RYAN C
PO BOX 5597 KATO,ALYSHA C
BEAVERTON, OR 97006 11710 SW WALNUT ST
TIGARD, OR 97223
PHONE: 503-319-7798 PHONE:
FAX: 503-746-6117
FEES
Specifics: Description Date Amount
Heat Pump 08/28/2017 $61.06
Type of Use: SF 12%State Surcharge-Mechanical 08/28/2017 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/28/2017 $28.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001'10•I. You may ob ain a spy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / /
Issued By: 41:_., • �'•
401140J10 Permittee Signature: / 116
,
Call 503.639.4175 by 7:00 a.m.for the next available inspe.-ion date.
This permit card shall be kept in a conspicuous place on the job site until .mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application REI y FOR OFFICE USE ONL1
City of TigardAA,i LI "•aeived
Date/By: i � l '/ Permit No.: .0 �'
13125 SW Hall Blvd.,Tigard,OR 97223 a 4
Plan Review Phone: 503.718.2439 Fax: 503.598.1960 ��f8 2Z01 Date/By:
Other Permit:A p 1 r . .Inspection Line: 503.639.4175
Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard-or.gov +r ttfied Method:
,g, iA s{ TI :'T.� Supplemental Information
TYPE OF WOR01ILDJNG DIVISION ISI` COMMERCIAL FEE* SCHEDULE USE CHECKLIST
IS New constructionMechanical permit fees*are based on the value of the work
El Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-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 Heating/cooling:
Job site address: (0 C �G\ ( Air conditioning 46.75
C� V U t Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: j��� C oza7-5 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Heat pump ( 61.06 .tic:,
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
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
`t `"` I>ESCRII''ITON OF,WORI{ A` A, fi
Flue Gas vent forreplace/insert water heater or gas 33.39
"1 V CCkk\ o w� \ Spi //-e ?uwC. replace 23.32
y 9� - Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
44.x 7if0 23.32
Pl# Pi `b .m t TEN ., Other:
' x. T'"` "l '- , ',, Environmental exhaust and ventilation:
Name: Range hood/other kitchen
Address: equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax ( )
Attic/crawlspace fans 23.32
R. �PC ;. 41 CC m
�. � �. .,� 0ER. NN :' 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
E-mail: Range
Barbecue
It ' 'WI' ' =4 4,, , ` w,wQ „ R „ rClothes dryer(gas)
Business name: \ c....06\A 0, c Otho
'1 .
�� V\ �� � "' 11�C(EI.AI�ICAL PERMIT PEES*
Address: pc, b5, '� •
Subtotal w�;.
City/State/ZIP: b,c \trY\ov\ U 6V- c ( Minimum permit fee($90.00) CO,a)
Phone: 6 -- C U 1t Plan review(25%of permit �
fee) 11:
7--Fax:( )
G t State surcharge(12%of permit fee) i 0 ;u
CCB lic.: 9 1-1o(� f� 5
`fl / TOTAL PERMIT FEE tt 3
\ This permit application expires if a permit is not obtained wain I80
- days after it has been accepted as complete.
Authorized signature: 111
* Fee methodology set by Tri-County Building Industry Service Board
Print name: (•(A l(kV-\IQ 9Stc ° Date: 15 /2,.S(/
5 //)�� 17_
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4 17T M/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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