Permit (106) IIIICITY OF TIGARD MECHANICAL PERMIT
2 ' COMMUNITY DEVELOPMENT Permit#: MEC2017-00672
T i OAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued; 09/05/2017
Parcel: 1 S 134B D07006
Jurisdiction: Tigard
Site address: 11360 SW COTTONWOOD LN
Project: Ramer Subdivision: ENGLEWOOD NO.3 Lot: 231
Project Description: (2)Exhaust fans and redo-exhaust ducting.
Contractor: CHRIS HOLMSGREEN CONST INC Owner: RAMER, DANA P/ELLEN M
17357 SW CODY ST 11360 SW COTTONWOOD LN
ALOHA, OR 97005 TIGARD, OR 97223
PHONE: 503-642-1440 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Single Duct Exhaust(Bathrooms,Toilet, 09/05/2017 $46.64
Type of Use: SF Utility Rooms)
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 09/05/2017 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 09/05/2017 $43.36
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 'G�`�Y` -KI-4-tj Permittee Signature: L ) 7/5//-
fi/40,,zici),e4414,4...._
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFI('i t si o'l.)
III City of Tigard Received /�/� /�' /
_ — ►
Date/By: /
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Permit No.:
Date/By: Other Permit: L
Z"I G rt K I) Inspection Line: 503.639.4175 U
Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE- USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction 0 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION 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:
Air conditioning 46.75
Job site address: //3 4,0 5( �/o yl AAXCI 47.
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 7)6 a`-f ( 7i /
7? Furnace 100,000+BTU(ducts/vents)
Heat pump 54.91
Suite/bldg./apt.no.: Project name: &Pv l�� e ,
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
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
., D cIIIaTIG of woRINC` �� eP
�, �,E _.sGas fireplace/insert 33.39
/' /h Flue vent for water heater or gas
l lcan 5 �« -^ C/'LGt.L25`T Zh�i,.(o/ fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
1 PRop .. ,.. ci ., : TE .,> Other:
23.32
4., _= '' T,, Environmental exhaust and ventilation:
Name: __ et. r � /64,4.81Z 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
u,.
z� U APPLICANT ` -O CONTA( ,PERSON t 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: ekty..i &+'L(.
J c'TIJ4 2. C J I. 1L Other:
MECHANICAL PERMIT FEES*
Address: /13 57 64), Cock'eL ,sr-. Subtotal
City/State/ZIP: 41.-.0 /fit/ 0,(,... g Z('f`? Minimum permit fee($90.00)
Phone:O5 3 ) 4,Ca.- t�c�p Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lit.: 4tY3ef5 gZ25.//� TOTAL PERMIT FEE lam,
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: 4‘1...."-".4,-,,,--• * Fee methodology set by Tri-County Building Industry Service Board
Print name: Date: lAii-7
I:\Build ng\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: t
$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:
11360 SW COTTONWOOD LN, TIGARD, OR,
97223
Record Type: Record ID:
Residential - Mechanical MEC2017-00672
Inspection Type: Inspector:
699 Mechanical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor