Permit CITY OF TIGARD MECHANICAL PERMIT
2:'' COMMUNITY DEVELOPMENT
Permit#: MEC2017-00763
Date Issued: 10/05/2017
t t GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S110BA05600
Jurisdiction: Tigard
Site address: 11865 SW WILDWOOD ST
Project: ANDERSON Subdivision: SHADOW HILLS Lot: 9
Project Description: Micro hood installation and gas piping for range.
Contractor: GO DUCTS Owner: ANDERSON, KELCIE L
253 N OLIVE ST 11865 SW WILDWOOD ST
YAMHILL, OR 97148 TIGARD, OR 97224
PHONE: 971-226-9504 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 10/05/2017 $33.39
Type of Use: SF Fuel Piping 10/05/2017 $14.15
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 10/05/2017 $42.46
Occupancy Grp: 12%State Surcharge-Mechanical 10/05/2017 $10.80
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- Q. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ttee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONL\'
Received
City of Tigard /' `°` > ,...f,,,, Date/By: 10 Permit No.:L _ 40
-
u 13125 SW Hall Blvd.,Tigard,OR 9 r r x i
C Phone: 503.718.2439 Fax: 503.598.196O' Plan Review
Date/By: Other Permit
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: tuns: Ed See Page 2 for
Internet: www.tigard-or.gov ll 11 C.1 5 ?Olt
Ol/ Notified/Method: Supplemental Information
TYPE OI&WSdid) ' I( ` ,) COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction NI Addition! Mtxpiaemer4 s a.", performed.Indicate the value(rounded to the nearest dollar)of all
CI Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
S 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: r,)loS 5wtJJ,16 on ti C_.-I. Furnace 100,000 BTU(ducts/vents) 46.75
Ci /State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91
ty " 1 LJ C�T ( �� Heat pump 61.06
Suite/bldg./apt.no.: Project name: 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
DESCRIPTION OF WORK: „, Gas fireplace/insert 33.39
` v- Flue vent for water heater or gas
t'1(�A CIES 1tf 100 'r CI v,Cy_ h
1nskG1` am-= Vt5 l,t-ro ��°Or/ fireplace 23.32
J Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
_Other: 23.32
, t "'
® y;OWNER �.'g NANT`
Environmental exhaust and ventilation:
Name: Ranequipment /other kitchen ' 33.39 33.34t
Address: 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
, .fi"rt.' Other: 23.32
Fuel piping:
Business name: C) -s-)`+t i..) $14.15 for first four;$4.03 for each additional
Contact name:jive,(A4v\‘'Q icACC\A V\\ Furnace,etc.
Address: r 0 -6 0 k L---) Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Yo W1 h \, 0 9—1 I`11 Water heater
Phone: -0)5 0 t. Fax:: Fireplace
Range ( . /I. i5-
E-mail: Barbecue
,.. _ CONT cTo `iM Clothes dryer(gas)
Other:
Business name: C-) -v\C_j�
r� NICAL PERMIT FEES
Address: 7"Q ?C-X L:� f} Subtotal
City/State/ZIP: + AN ,\' o)4Cl r Minimum permit fee($90.00) 610.I.It..
r � Plan review(25%of permit fee)
J p
Phone:(C1 22.E . 9 S'~o l Fax:( ) State surcharge(12%of permit fee) 1 t;,
CCB lic.: 1v L7er TOTAL PERMIT FEE jt,1,-
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized si natur jJ A e�V
g � � �"'c ! --��_� * Fee methodology set by Tri-County Building Industry Service Board
Print name:1/41 2y^c 1 �Z re)t� -in , Date: i 0 -5. j--1
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.
Note: All new commercial buildings require 2 sets of plans.
I:\Building\Permits\MEC_PermitApp_040113.doc 2