Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Permit#: MEC2018-00807
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2018
TIGARDParcel: 2S110DD11200
Jurisdiction: Tigard
Site address: 15550 SW 109TH AVE
Project: HUBBS Subdivision: SUMMERFIELD NO.13 Lot: 682
Project Description: (2)new bathroom exhaust fans and(1)range hood.
Contractor: OWNER Owner: DAVID HUBBS
DAVID HUBBS 15550 SW 109TH AVE
15550 SW 109TH AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE PHONE: 503-720-0012
FAX:
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 10/10/2018 $33.39
Type of Use: SF Single Duct Exhaust(Bathrooms,Toilet, 10/10/2018 $46.64
Class of Work: ALT Type of Const: Utility Rooms)
12%State Surcharge-Mechanical 10/10/2018 $10.80
Occupancy Grp:
Minimum Fee Adjustment-Mechanical 10/10/2018 $9.97
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Cod-, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit wil expire if w: is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law require• •u to fol• the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-11.1-0090. • may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.3 .
1
Issued By: ' -- • ee Signature: AI , � ."
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
INCity of Tigard Date/By:Receid •
I I1) Permit No.: .ti'W i r
13125 SW Hall Blvd.,Tigard,OR 972 1, I f,,:i E Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit „ • �,-
TI G A R ll Inspection Line: 503.639.4175 i 1 C"' I. 0 Z018 Date Ready/By: Jure la See Page 2 for
Internet: www.tigard-or.gov V Notified/Method: Supplemental Information
CITY Ui- i i(A D
TYPE OF ',�, ' DING D1UiSI�
COMMERCIAL FEE*SCHEDULE ESE CHECKLIST ._.
Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
_ ., �. Value:$
CATEGORY'OF CONSTRUCTION. ;; .., „"
, _ "." ..,.- n" ., RESIDENTIAL EQUIPMENT/SYSTEMS"FEES*
r4 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
Heating/cooling:
,, JOB SITE INFO'' TIO1N 01) L ATION
Air conditioning 46.75
Job site address: /55,e27 t]Lnj /0 C i1 Aili_l_ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: • //V'� Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: /y' ' Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
� / 1 Residential boiler(radiator or
V�A(/L C) /a' 771---- hydronic) 23.32
r 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
` "7" DE PTION;OF a .w
RK ": , Y' Gas fireplace/insert 33.39
'I?: Flue vent for water heater or gas
frO6
r' t/, r71 ih j fireplace 23.32
Log lighter(gas) 23.32
() e7,0.vaf/Z ',''f-'771- Wood/pellet stove 33.39
2\ J/�(..._" C z_05. -7--- Wood fireplace/insert 23.32
. ✓ Chimney/liner/flue/vent 23.32
23.32
/400/ 41\4.2 •�Gr'� � '� *;�4 Other:
~' PROPERTY OW31 Ei2 _ WNAN'1<` hir
.. Environmental exhaust and ventilation:
Name: p
/.////)
',�V/7/) .6/3 5
Range hood/other kitchen
equipment ( 33.39 33,
Address: /5S-SZ) � 'L,t/ /e)q /41/ -.. Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
�(>"�1' •/ toilet compartments,utility rooms) �- 23.32 Ito-(y}
Phone:(L,713 7. ) i20)'Z_ Fax:( ) Attic/crawlspace fans 23.32
!(AI'PI I b1T ''',1-'4.' :j e 'CT P X O1N ', Other: 23.32
Fuel piping:
Business name:
S47V-V.- CvS ..�, eije $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
, 'y
, ", RACOR yt
Clothes dryer(gas)
n .k. , ,40 _ k ,
Other:
Business name: �t/!V'��'
MECHANICAL FES
FE" '. v {
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00) t).&L
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) /0,,(jt
CCB lic.: TOTAL PERMIT FEE /,.,7:) ."--Z)
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: '-._, -�- / * Fee methodology set by Tri-County Building Industry Service Board
Print name: 71 y�jI) .� . j4j ,5 Date: /Q7/(p//
\P \
I:\BuildingermitsMElCC_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 Valuation: w Permit Fee: a4 :w
$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
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15550 SW 109TH AVE, TIGARD, OR, 97224 January 16, 2019 at
9:45:19 AM
Record Type: Record ID:
Residential - Mechanical MEC2018-00807
Inspection Type: Inspector:
699 Mechanical final David Young
Result:
PASS - NoCofO
Comments:
Rough in inspection checked during electrical rough by Jeff Grove.
Violation Summary:
Inspector Contractor