Permit (206) CITY OF TIGARD MECHANICAL PERMIT
I: COMMUNITY DEVELOPMENT Permit#: MEC2018-00067
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/25/2018
T E C s tt°L� g Parcel: 2S 103 B D07400
Jurisdiction: Tigard
Site address: 12575 SW 115TH AVE
Project: FAUTH Subdivision: HUNTER'S GLEN Lot: 30
Project Description: Replacing kitchen range hood.
Contractor: INTEGRITY AIR LLC Owner: FAUTH, BRIAN T&KATRINA M
16756 SW 72ND AVE 12575 SW 115TH AVE
PORTLAND, OR 97224 TIGARD, OR 97223
PHONE: 503-572-3594 PHONE:
FAX: 503-598-8498
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 01/25/2018 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 01/25/2018 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 01/25/2018 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.23 0.332.2344..3332344. r
110:
Issued By: ' -. •-=e Signature: i ��1 31 1 16' ,,:• -
Call 503.639.4175 by 7:00 a.m.for the next available inspection •ate.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFF1CL LSF oNLI'
City of Tigard . of ¢ ') al II Received
Received / Permit No.:
"s 13125 SW Ha11 Blvd.,Tigard,OR 9722 , r, a Date By: •yam f` - ..�
I Phone: 503.718.2439 Fax: 503.598.190 '` Plan Review
Date/By: Other Permit: 0 :s_
TI G A K D Inspection Line: 503.639.4175 c ♦+ , c)
Internet: www.tigard-or.gov ..i 18 Date Ready/By:
;. See Page 2 for
i L i , I i Notified Method: Supplemental Information
TYPE OF Wlig
Or I!(Aiti) COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
<< 1 11-.:: Mechanical permit fees*are based on the value of the work
❑New construction ^�.Addition/altil!lziefiaemet3tperformed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
❑'Demolition ❑Other:
' CATEGORY OF CONSTRUCTION Value:$
"
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
14.1-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:
Job site address: £25-1 5- 5(...jI ! ,(�,.
Air conditioning 46.75
1 C '`J' Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: "'17 6/(14 /J � 2.Z Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: l [ Project na(me: kt
Heat pump 61.06
Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
��v 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
i*` DESCRIPTION OF WORK " Gas fireplace/insert 33.39
'ffJ� -�-{ Flue vent for water heater or gas
1`�NA) 1 "I\hld (/C _ `,,L1) t 1 "L fireplace 23.32
AIS,J 6�.� U fe S \v` AA*„� i (i � Log (gas) 23.32
Vl Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER ,Q TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: 1311-cab 4449 fj' t:1w C1 G Range hood/other kitchen
eq1uipment33.39 3 3, `JAddress: (Zc? � l` ``s�� -- Clothes dryer
exhaust 33.39
City/State/ZIP: ' i ) 2-7......-9:' Single-duct exhaust(bathrooms,
[ T toilet compartments,utility rooms) 23.32
Phone:(L31:3) --,-(3L4) Fax:( ) Attic/crawlspace fans 23.32
APPLICANT CONTACT PERSON Other: 23.32
Business name: Fuel piping:
Di � 0 $14.15 for first four;$4.03 for each additional
Contact name: - Furnace,etc.
Address: 157 ( c s' C t r "K" 5J 1 CI Gas heat pump
�� b r4._e--,-, Wall/suspended/unit heater
City/State/ZIP: '-rz (.7+('-0 9 7•ZZy Water heater
Phone:(,7)T,) ---2.._.r.. / (p 3®l 1 Fax::( ) Fireplace
�.�:. �[ Range
E-mail: v ( n L `t--„,,„, 1_j..,,„A,...__. „..cov„,, Barbecue
CONTRACTOR ''' Clothes dryer(gas)
Business name: 1 1\11-- ---(4z.�try. � L� " Other:
( w MECHANICAL POZNIT'FEES*
Address: 73� I S� �S,Aft/ /— 5^,j( ,. -6, Subtotal (7
li�(J�{JI,C )U 333
City/State/ZIP: D x ( L21 t Minimum permit fee($90.00) ,i..)Phone: C t Plan review(25%of permit fee) '—
( 3) 0Q (P Fax:( ) State surcharge(12%of permit fee) id.61)
CCB lit.: l \ TOTAL PERMIT FEE ,l ,
This permit application expires if a permit is not obtained within 180
Authorized signature: ' ilk°!�'i days after it has been accepted as complete.
� _`� * Fee methodology set by Tri-County Building Industry Service Board
Print name: ` il -t 4 f���L ( Date: ( 'L51/ r
I:\Building\Pennits\MEC PermitApp_040113.doc 44/0-4617T(11/(02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
Total` aluation:; 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\Pernuts\MEC_PermitApp_040113.doc 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12575 SW 115TH AVE, TIGARD, OR, 97223 March 12, 2018 at 9:47:57 AM
Record Type: Record ID:
Residential - Mechanical MEC2018-00067
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor