Permit (173) CITY OF TIGARD MECHANICAL PERMIT
R 4COMMUNITY DEVELOPMENT Permit#: MEC2017-00944
T( ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/30/2017
Parcel: 25111 DB05000
Jurisdiction: Tigard
Site address: 15227 SW ALDERBROOK PL
Project: GOULD Subdivision: SUMMERFIELD NO.7 Lot: 410
Project Description: Gas furnace and A/C replacement. Placement of NC unit must comply with manufacturer's installation
requirements.
Contractor: G L HEINTZ HEATING & COOLING Owner: GOULD, JANET ANDERSON LIVING TRU
20871 SW 216TH PLACE 15227 SW ALDERBROOK PL
SHERWOOD, OR 97140 TIGARD, OR 97224
PHONE: 503-625-6798 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 11/30/2017 $46.75
Type of Use: SF Furnaces<100K BTU 11/30/2017 $46.75
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 11/30/2017 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4014-eerz,__- e"-- -- Refnuttee Signature: .....
•'/ /
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONE\'
City of Tigard Received
' � �. Date/By: r3 ��
Permit No.:A� ... y
114 4 13125 SW Hall Blvd.,Tigard,OR 97223 1y /
Plan Review
Phone: 503.718.2439 Fax: 503.598.1 J ,1,3A Date/By: Other Permit:
TI G A K D Inspection Line: 503.639.4175 A �p Date Ready/By: See Page 2 for
Internet: www.tigard-or.gov rl `t Notified/Method: MI Supplemental Information
TYPE OF WORK, v'cism� \J :. COMERCIAL FEE* SCHEDULE-;.USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteratio a eepfX performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
❑Demolition 0 Other:
Value:$
CATEGORYAO
'OF CONS" UC3ION
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*-.
01-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description P Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
� � .. Air conditioning x 46.75 t1J •15
Job site address: I ✓^ Y��12 0C}..� L. Furnace 100,000 BTU(ducts/vents) X 46.75 L1(3.75
City/State/ZIP: ( ` A- 0.)1\ 91 ( Furnace 100,000+BTU(ducts/vents) 54.91
Ji� p� ` Heat pump 61.06
Suite/bldg./apt.no.: Project name: CP6rM'i1
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: Other: 23.32
Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
' Gas fireplace/insert 33.39
DES�ItIPTION,OF WQRK ep
.s< ' 4 ' Flue vent for water heater or gas
e c '71 A- GA5 Po retooCt fireplace 23.32
(C- Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
'a .0 PROPERTY OWNER T.: ❑ TENANT<
Other: 23.32
• z
Name: - Environmental exhaust and ventilation:
oiv A,tj„.4 J 6 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
'APPLICANT ❑-CONTACT"PERSON;, '' Other: 23.32
Business name: c. [ Fuel piping:
`� p��` "� _` �s $14.15 for first four;$4.03 for each additional
Contact name: a (.._,,e
` v-I-v V Furnace,etc.
Address: 1 vt I O SGas heat pump
A Wall/suspended/unit heater
City/State/ZIP: S ke Water heater
Phone: 3)) y...... , , ,y,i, Fax::( ) /iFireplace
OAZ- 1�Qel,k�'f" t-ti4 ( ( 1 1.. 3 Range
E-mail: Barbecue
CONTRACTOR
: ", "" '" Clothes dryer(gas)
Business name: 4_ce 1 V1-t-Z_ ` ` J�--a .,-Co I I ti�y Other:
Address: ��' MECHANICAL PERMIT'FEES* ,
Subtotal )l
City/State/ZIP: W n( 97 i LI-0 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone: 3) 31 3_5( Z?j Fax:( ) State surcharge(12%ofpermit fee) ( )-1.
] i
1�
CCB lic.: ( 62 en ( TOTAL PERMIT FEE /t)11, 7d
AThis permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized sign afire: Fee methodology set by Tri-County Building Industry Service Board
..____
Print name: (St 17 ul H r( g Date:t "---)_)1 /
I.\Building\Permits\MEC_PermitApp_ 113.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