Permit (64) CITY OF TIGARD MECHANICAL PERMIT
-III0--- Permit#: MEC2018-00457
. COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/14/2018
T I i. k II D9 Parcel: 2S111 DB01500
Jurisdiction: Tigard
Site address: 15480 SW ALDERBROOK CIR
Project: BRUMBAUGH Subdivision: SUMMERFIELD NO.8 Lot: 443
Project Description: Replacing gas pack with new furnace and A/C. Placement of the A/C unit must comply with manufacturer's
requirements.
Contractor: PORTLAND INDUSTRIAL SERVICES INC Owner: BRUMBAUGH, NANCY W
7715 NE 21ST AVE 15480 SW ALDERBROOK CIR
PORTLAND, OR 97211 TIGARD, OR 97224
PHONE: 503-208-3840 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 06/14/2018 $46.75
Type of Use: SF Furnaces<100K BTU 06/14/2018 $46.75
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 06/14/2018 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC b calling 503.232. s87 or 1.800 332 2344.
Issued By: 1 /,1" -' • / /, Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next availa inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard --,, - - --, Received
/ ' Permit No
, III 13125 SW Hall Blvd.,Tigard,OR 97223 ' ' , ,1 Date/By:
' 3 Phone: 503.718.2439 Fax: 503.598.1960 JL.",) J ,..! "OO UPI Plan Review
Date/By: A
Other Permit:
Inspection Line: 503.639.4175 1 ,z t.LU1U
TIGARD Date Ready/By: furls: Et See Page 2 for
Internet: www.tigard-or.gov r Notified/Method: Supplemental Information
L.. , .
eografteria FE '4'sefigiblite.':-L-tist ctttur-gt--
TYPE OF WORK '
Mechanical permit fees*are based on the value of the work
0 New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition El Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
cATE(19#xpF coNsilkucTIOIr
'iEsin. '',:-' '.*QUIPMENT/SYSTEMS FEES*
Xr 1-and 2-family dwelling El Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
lf
JOBHeating/cooling:
si .:„. .9,121kIATION AND fi?OcAL.TION
Job site address: / S'/s 0 6'a) A Ile, -c,k ef e C../c
.41= Air conditioning / 46.75
Furnace 100,000 BTU(ducts/vents) / 46.75
City/State/ZIP: 7), ...et, 0/? Furnace 100,000+BTU(ducts/vents) 54.91
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
Other: 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
f DESCRIPTION ,,,t , - Gas fireplace/insert 33.39
Flue vent for water heater or gas
Reiede?ee 64'S ,P 1-- i-t) p eui r,-,vv•4 cc
4 C-N. fireplace 23.32
Coe- If C. Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY OWNER TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Aja,v 3 ro it?? h.tu) C. Range hood/other kitchen
equipment 33.39
Address: 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
0 APPL?' 0 corsrrAriiiiI,f, Ce. Other: 23.32
,',,z',5' -- ,,-.., ..;,-' .a•5-. ' ,..- , - , ',, '..i...
Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Gas heat pump
Address:
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue ..
CONTRA9'0# Clothes dryer(gas) .
Other:
Business name: /.13,..--71Ary 1 271/ 50.."I,( 4,5 / '1 C— ' 177::': MECHANICAL FEk141.7 T FEES*
Address: /7/7/ S A.) E 2 / . '" "ffre Subtotal
City/State/ZIP: 1.-?0,1,.--,42.,6/ e7(? fq 21/ Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(p3) 61)Li/ 3 075— Fax:( ) ___
State surcharge(12%of permit fee)
CCB lie.: Z 6 C.) e'-/7 Z.- TOTAL PERMIT FEE /0 1-/. 7 L.
Authorized signature: - . it,----------Q-----
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry Service Board
Print name: Z. ,:,«•••--,1 Date: 6 _ /4/-/s
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:
Tot �Iuation: Permit, e e:
$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