Permit (181) CITY OF TIGARD MECHANICAL PERMIT
I . COMMUNITY DEVELOPMENT Permit#: MEC2018-00752
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/24/2018
Parcel: 2S114BB08900
Jurisdiction: Tigard
Site address: 16264 SW 104TH AVE
Project: Lange Subdivision: SWANSON'S GLEN Lot: 30
Project Description: Adding range hood,gas line for range and BBQ,and duct extension for remodel.
Contractor: OWNER Owner: LANGE, NIXON
NIXON LANGE 16264 SW 104TH AVE
16264 SW 104TH AVENUE TIGARD, OR 97224
TIGARD, OR 9724
PHONE: 971-333-1170 PHONE: 971-333-1170
FAX:
FEES
Specifics: Description Date Amount
Duct Work 09/19/2018 $23.32
Type of Use: SF Range Hood/Other Kitchen 09/19/2018 $33.39
Class of Work: ALT Type of Const: Fuel Piping 09/19/2018 $14.15
Occupancy Grp: 12%State Surcharge-Mechanical 09/19/2018 $10.80
Stories: Minimum Fee Adjustment-Mechanical 09/19/2018 $19.14
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: 2i y�'--.- -7 -. ,
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONL\'
Received
City of Tigard .ate/By: if��y h. ' -, 0 7
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 � �, _ ; O.�.r,r 2 P /1��'�0A
TI G A R D Inspection Line: 503.639.4175 P I Date Ready/By: Jurs: HV See Page 2 for
Internet: www.tigard-or.gov >F 1 pp8 2018 Notified/Method: Supplemental Information
:kms
�' C{�.IVIMERCIA EE* SCl�ll'ITI.E �� Sa ® CiCI.IS'i° ,�.
,......1. , TYPE OF WOIitJ1i fl ttio fl!\.i t ¢ Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
❑Demolition ❑Other:
= Value:$
= CATEGORY OF CONSIIi 'I'ION
.''''''l UIPMEM/SYSTEMS FEES*
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
3 ''. '''.:i:1'.' JOB SITE rRMATION ANI ATIOIHeating/cooling:
. y '±f„ ,.
Air conditioning 46.75
Job site address: ' 1 So I o 114 k Q.i t_ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: `� n G1�1 r)t Fv~ Furnace 100,000+BTU(ducts/vents) 54.91
ty 1 gC�f d ` !1 1 (ZZ J ` Heat pump 61.06
Suite/bldg./apt.no.: Q Project name: L^ �rl- OA. Duct work I. 23.32 113,j?
Cross street/directions to job site: IDt/l-lt, 4 Rai. 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 't
Other: 23.32
Subdivision: A"Ser% S GtA.-c1 Lot no.: 3
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
P" i It ` Gas fireplace/insert 33.39
D 'SCRIPTI o ® ; OR. ,
( j '" Flue vent for water heater or gas
ft_ f4`LNg -/\A. '7r1 fireplace 23.32
Y ►l _ r �� 3� Log lighter(gas) 23.32
��" n Wood/pelletepstovece/in 33.39
D��� .QAC_ 1 tales_ 7a�' ,r,¢�/1.�0 o_'p"`•�j/\ Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
a t Y; -04,,,,, Other: 23.32
',d,,.,;„ x, IQ
„, � - , ,p, 0 NA r t Environmental exhaust and ventilation:
Name: N IXo^ l_O.AQ�. Range hood/other kitchen O
a equipment i 33.39 C3•3 e
Address: /( W f{ std Co c././� aT", � Clothes dryer exhaust 33.39
City/State/ZIP: „" Single-duct exhaust(bathrooms,
r: 1 r
l i t 0 K 97 .2`f toilet compartments,utility rooms) 23.32
Phone:(CII I) 3 3.. i i'�0 Fax:( ) Attic/crawlspace fans 23.32
---. 4. Other: 23.32
�.�AP� I a 1!1'I'A�a 't
Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional
Contact name: NIkoA. y— Furnace,etc.
Gas heat pump
Address: cJ:"–.""
Wall/suspended/unitteater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail:
Barbecue j
4 ` -?..7„.F...1' -r,, I' OR ' k Clothes dryer as
co-;
(gas) /
Business name: Ilk O.'. � '1tt . la i ati 14IEdRANI T I+EE Jit
Address: .r. .,.. . ,, ,,. a' ���•
Subtotal 7e.37,
City/State/ZIP: Minimum permit fee($90.00) g ,i
Phone:( ) Fax:( ) Plan review(25%of permit fee) 0-
State surcharge(12%of permit fee) /t.''' '
CCB lic.: •
TOTAL PERMIT FEE /(r
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signattue: * Fee methodology set by Tri-County Building Industry Service Board
Print name: �1 1 k0,. Date: 8.28-l g
I:\Building\Permits\MEC_PermitApp_040113.doc 4404617T(1 I/02/COM/wEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial&Multi-Family Fee Schedule:
Total Val on: r ,.Per Y t Feet .34
$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