Permit (109) CITY OF TIGARD MECHANICAL PERMIT
"g�! I . COMMUNITY DEVELOPMENT Permit#: MEC2017-01018
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/26/2017
Parcel: 2S 104CA02400
Jurisdiction: Tigard
Site address: 13607 SW LAUREN LN
Project: Middleton Subdivision: HILLSHIRE Lot: 24
Project Description: (1)clothes dryer exhaust and(1)bathroom exhaust fan.
Contractor: OWNER Owner: MIDDLETON, NEWELL GRANT&MICHEL
NEWELL MIDDLETON 13607 SW LAUREN LN
13607 SW LAUREN LN TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-747-8959 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Clothes Dryer Exhaust 12/26/2017 $33.39
Type of Use: SF Single Duct Exhaust(Bathrooms,Toilet, 12/26/2017 $23.32
Class of Work: ALT Type of Const: Utility Rooms)
Occupancy Grp: 12%State Surcharge-Mechanical 12/26/2017 $10.80
Stories: Minimum Fee Adjustment-Mechanical 12/26/2017 $33.29
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4.,,,,00,e_ Permittee Signature: ,,,,,:r;---7- -------
,,,,: ��
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application , 0m )I I I( , , S, ()NI 1
City of Tigard - i
t" rA�� Permit No.: - r _>( _ ), „
13125 SW Hall Blvd.,Tigard,OR 97223 17 r ■.
II Phone: 503.718.2439 Fax: 503.598.1960 �d_ ev`ew
Date/By: �Permit: C1 7.., t7 ''Inspection Line: 503.639.4175itc, m)
. pate Ready/By: kris 0 See Page
2 forInternet: www.tigard-or.gov i�( 2 6 �U iNotified/Method: Supplemental
Information
TYPE OF WORK , �l'' OP` 1'I4J,� .L) COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
"r It Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alterationJr
y,. s l' 1 performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
® 1-and 2-familyRESIDENTIAL EQUIPMENT/SYSTEMS FEES*
dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family 0 Master builder ❑Other: Description
Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling;
Job site address:13607 SW Lauren Ln
Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard/OR/97223 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Heat pump 61.06
�l6l4 l'u J 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:Hillshire Lot no.:24 � 23.32
Other fuel appliances:
Tax map/parcel no.:2S104CA02400 Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
t Flue vent for water heater or gas
f--,r i'- '7. -VeC" �.Ir fireplace 23.32
rick,--,y-,-;)s--- �/.,y— c..) r R.
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY OWNER 0 TENANT SOth23.32
Environmental exhaust and ventilation:
Name:Newell Middleton Range hood/other kitchen
Address:13607 SW Lauren Ln equipment 33.39
Clothes dryer exhaust 1 33.39 '33, 3,4
City/State/ZIP:Tigard/OR/97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 1 23.32 ).-3 3).
Phone:(503)747-8959 Fax:( ) Attic/crawispace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: Fuel piping:
� o_ et ri $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
CONTRACTOR Clothes dryer(gas)
Business name: �
Q, � Other:
tieMECHANICAL PERMIT FEES*
Address:
Subtotal
City/State/ZIP: Minimum permit fee($90.00) 40„,,.
Phone:( ) Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee) jo.iv
CCB lic.:
TOTAL PERMIT FEE iiv.-
This permit application expires if a permit is not ob ed within 180
Authorized Sigtlature:,/ � days after it has been accepted as complete.
• Fee methodology set by Tri-County Building Industry Service Board
Print name:t cit.,.. rt* Date: 112/jL//, --
I.\BuildingTennits\MEC_PermitApp_040113.doc
-.I:\BuildinglPermits\MEC_PermitApp_040113.doc 440-461Tr(11/02/COM/WEB)