Permit (47) CITY OF TIGARD MECHANICAL PERMIT
sPermit#: MEC2017-01013
COMMUNITY DEVELOPMENT Date Issued: 12/21/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S1 1/2017 600
Jurisdiction: Tigard
Site address: 12175 SW MERESTONE CT
Project: Hartshorn Subdivision: MERESTONE Lot: 5
Project Description: Relocate laundry room;install new laundry vent,(2)bathroom fans and move heat register.
Contractor: OWNER Owner: HARTSHORN,THOMAS W
12175 SW MERESTONE CT 12175 SW MERESTONE CT
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-268-3918 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Duct Work 12/21/2017 $23.32
Type of Use: SF Clothes Dryer Exhaust 12/21/2017 $33.39
Class of Work: ALT Type of Const: Single Duct Exhaust(Bathrooms,Toilet, 12/21/2017 $46.64
Occupancy Grp: Utility Rooms)
12%State Surcharge-Mechanical 12/21/2017 $12.40
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $115.75
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4 y Permittee Signature: I G'l.'Vf0✓t1�— I k f
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application, FOR OFFICE USE ONEv"
City of Tigard }it
R _ Received`
13125 SW Hall Blvd.,Tigard,OR 97223 "' N Date/By:Review vt/ ��� Permit No. �7,_0/6/3
Phone: 503.718.2439 Fax: 503.598.1960 r Plan Review
2Date/By: Other Permit:
Inspection Line: 503.639.4175 r �- 1 20,7
T I G A R D p 1 I Date Ready/By: Juris: See Page 2 for
Internet: www.tigard-or.govr -,) Notified/Method: Supplemental Information
F s i_', X 9 a.',3
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TYPE t OF WORK. },' 1 v T..315„iN COMMERCIAL FEE*SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
0 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family 0 Master builder
0 Other: Description Qty. Ea. Total
JOB.SITE INFORMA1t'ION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 1 21-•1 5 .5 1,1 Yv) Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: `1rQ..3 fr:�'l q-[ �•Z Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: ii J Heat pump 61.06
�1 U-4-'174- vva,/1 Duct work 23.32 23.
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
" O o womc Gas fireplace/insert 33.39
Flue vent for water heater or gas
(4-) \N•-c./\,f �� i-- fireplace 23.32
l Log lighter(gas) 23.32
YOC w1 P0-0 5 Wood/pellet stove 33.39
k e3 \•- "re ) • ••e `co Y cw,(.-)�c r� Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
fl imN
Ci nizit z : Other: 23.32
� :
Environmental exhaust and ventilation:
Name: -"net Q rel YA5 ra...( h,c3 r,,..._ Range hood/other kitchen
Address: \ yl -I S s f��Y2 6 equipment 33.39
Clothes dryer exhaust j 33.39 -3)
City/State/ZIP: �—� C� 9•ZZ Z3 Single-duct exhaust(bathrooms,
1 toilet compartments,utility rooms) a 23.32 Li .6„1,1
Phone:(S C 3) .Z i�c� _ s q , b Fax:( ) Attic/crawlspace fans 23.32
0 APPL;ICAN , .k. Other:
CONTACT;PEI�ON 23.32
Business name: y Fuel piping:
../ 1/ 1-
V'_ "CS 1Yv( $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
' ON'IRA'CT(JR Clothes dryer(gas)
Business name: (./N�1"- Other:
Address: MECHANICAL PERMIT FEES*
Subtotal 10 3,-3 5-
City/State/ZIP:
City/State/ZIP: Minimum permit fee($90.00)
Phone: Plan review(25%of permit fee) —
( ) Fax:( ) State surcharge(12%of permit fee) /, J-10
CCB lit.: TOTAL PERMIT FEE
lls0
This permit application expires if a permit is not obtained withinn1180
f f days after it has been accepted as complete.
Authorized signature: liLA
v.-7 f � "'kw * Fee methodology set by Tri-County Building Industry Service Board
Print name), +'� Fye ' ).u0 I Y� Date: '
I:\Building\Perm is\MEC_PermitApp_0401 I3.doc 440-46117T(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