Permit (71) CITY OF TIGARD MECHANICAL PERMIT
` 2 COMMUNITY DEVELOPMENT Permit#: MEC201 -
8 00092
T I GAR.R.i) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/07/2018
Parcel: 1 S 134C D06200
Jurisdiction: Tigard
Site address: 11680 SW SUMMER CREST DR
Project: Capelle Subdivision: BURLWOOD NO.3 Lot: 22
Project Description: Replacing gas furnace.
Contractor: NORTHWEST HEATING&COOLING INC Owner: CAPELLE, KEVIN&HOLLY
16523 NW SHELTERED NOOK RD 11680 SW SUMMER CREST DR
PORTLAND, OR 97231 TIGARD, OR 97223
PHONE: 503-593-6434 PHONE: 503-890-9745
FAX:
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 02/07/2018 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 02/07/2018 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 02/07/2018 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to O ' by calling 503.2 2.1987 or 1.800.332.2344.
7
Issued By: �� t Permittee Signature: /7-
,00 Et-
Call 503.639.4175 by7:00
a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applic n --Y b ,4 FOR OFFICE ESE ONE)
Cityof Tigard Received _ / per/MI
� g 20- Date/By: Permit No.� � �v/F-,✓1��
13125 SW Hall Blvd.,Tigard,OR 97223 r F Plan Review a !/
C Phone: 503.718.2439 Fax: 503.598.1960FL� `i �� o Date/By: Other Permit:
TI G A K D Inspection Line: 503.639.4175
Internet: www.tigard-or.gov t / I t Date Ready/By: kris: See Page 2 for
Supplemental
Notified/Method: SInformation
T 1 &i
diV ie a :r a COMMERCIAL FEE* SCHEDULE -'USE CHECKLIST
TYPE ilit�' -.
Mechanical permit fees*are based on the value of the work
0 New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
` CATEGORY QF CONSTRUCTION-, -
Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*,
11-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family El Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFO, AND LOCATI• Heating/cooling:
-_ t' K':,,. Air conditioning 46.75
Job site address: t L6 q 0 ` 51;✓yt,� - C re-5i- O�- Furnace 100,000 BTU(ducts/vents) 1 46.75
City/State/ZIP: c '`._,, .,�/�j�`� ,/Ct 72_ Furnace 100,000+BTU(ducts/vents) 54.91
�c �/tC ` 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 O WOT k -. ? Gas fireplace/insert 33.39
"^ Flue vent for water heater or gas
-- (4,fv.'h,r?�°i ("YtrTl�trvk4,jZ y1 fireplace 23.32
"� Log lighter(gas) 23.32
rt�J I4 �afe�` a� (/'""�j�� D'u4�C Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
,,.. Other: 23.32
""" ` PROTY OWER ?` TENANT Environmental exhaust and ventilation:
Name: 0/v{1.
-'V WcinRange hood/other kitchen
equipment 33.39
Address: to() c.,"'"n,
��•yr•�'17l/1r CN'egik`city- Clothes dryer exhaust 33.39
City/State/ZIP: 1,,- ,„0/-0R(0,..72.-73 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(` -� skA0 — CI 7q 5 Fax ( ) Attic/crawlspace fans 23.32
r. x, " APPLICANT -,1?";F''' 0 COlNT.AcT PERSON Other: 23.32
Fuel piping:
Business name:
$14.15 for first four;$4.03 for ea dditiomal
Contact name: `2e..--e_ 1 ,✓ Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
''L'' _ CONTRACTOR - ., Clothes dryer(gas)
Business name: Other:
�'
MECI�A.NICAL PERMIT FEES*. '-`
Address: 8735 a'1 . Subtotal
City/State/ZIP: ( .�,�., jr� /al 7si 0 Minimum permit fee($90.00)
Ll Plan review(25%of permit fee)
Phone:( �) G% e 610 Fax:( ) _ State surcharge(12%of permit fee)
CCB lic.: t-iS l Cj `7 77 TOTAL PERMIT FEE / 6,2,
it This permit application expires if a permit is not obtained within 1
days after it has been accepted as complete.
______,VAuthorized signature: „.. ` i, * Fee methodology set by Tri-County Building Industry Service Board
Print name: c / Date: '--7-1
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 aluation Permit Fees
$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_PernutApp_040113.doc 2