Permit (82) , CITY OF TIGARD MECHANICAL PERMIT
IR
rig COMMUNITY DEVELOPMENT Permit#: MEC2019-00367
Date Issued: 06/04/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134CA00514
Jurisdiction: Tigard
Site address: 11120 SW 119TH AVE
Project: DOZIER Subdivision: PANORAMA NO.2 Lot: 25
Project Description: Mini split heat pump installation.
Contractor: DONS AIR CARE INC Owner: DOZIER, CALEB &VANESSA
PO BOX 6408 11120 SW 119TH AVE
ALOHA, OR 97007 TIGARD, OR 97223
PHONE: 503-642-5844 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Heat Pump 06/04/2019 $61.06
Type of Use: SF 12%State Surcharge-Mechanical 06/04/2019 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 06/04/2019 $28.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not st ed within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you t. - low the rules opted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-cI90. ,ou may obtai a copy of the rules
or direct questions to OUNC by calling 503 41i •: or 1.800.-3-3-2
Issued By: Permittee •• •. •. -•
..e- _ / ./.,e4.11.,At
V ?' r
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Arproved plans ere rocpirv'i-or the job site ttac rine,c€o^cb-insp"tia.
Mechanical Permit Application FOR OFFICE 1 SE OyLv
CityIIIII in Of Tigard Date/By: �� PermitNo.: %�_
13125 SW Hall Blvd.,Tigard,OR 97223 Received Plan Review
Phone: 503.718.2439 Fax: 503.598. ED Date/By: Other Permit:
1.1 C,A R 1) Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov J Notified/Method: Supplemental Information
2�1
JUN ® 4 J
lin
?E '.w ,OF.TtWIO„'" COMMERCIAL FEE* SCBED TLE VSRC Felai T
❑ Addition/alter � at'�i�l�lt�N Mechanical permit fees*are based on the value of the work
New construction ent performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPI1 El+t`lr`/sYSTE11 FEES*
E 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 INFORMATIONAND LOCATION Heating/cooling:
. Air conditioning 46.75
Job site address: /1/7i) Li // if.., Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: (lI t, d Od 97 12,3 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Heat pump / 61.06 (;,/ 4,Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
t Residential boiler(radiator or
/l5Y'f"6'a ��R.d�11c`.ti-i-a- 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
" Gas fireplace/insert 33.39
�/j �/ ,[ Flue vent for water heater or gas
S f `L/ it I" 10J le l'c 4.- - R.ZLIO fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39 ,
Wood fireplace/insert 23.32 ,
Chimney/liner/flue/vent 23.32 _
z. ;. PEItTi5 t "- " ❑ s..-g-'0''''',.= t* Other: 23.32
. TE
Environmental exhaust and ventilation:
Name: ( J,../7 .2Da 7 1 'u1- Range hood/other kitchen
t YGt equipment 33.39
Address:
11/-2-.0 S'IJ 1/ Clothes dryer exhaust 33.39
City/State/ZIP: % c2h r'/ 7 7 7,2-? Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( y 7�) X7 y �,,, 7 7 Fax:( ) Attic/crawlspace fans 23.32
APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name: {S'A ,QJ� & , 77-01 c. $14.15 for first four;$4.03 for each additional
Contact name:
ci4 Furnace,etc.
Address: ?01 10�l Gas heat pump
) / �,(
(1J`�' G
Wall/suspended/unit heater
City/State/ZIP: /"i f•,` 170 01 Water heater
Phone:({y ) (,., 7 S--8,44' Fax::( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: n t--
S{.i f�'— MECHANICAL'FERMI`FEES*..
Address: TT 111
Subtotal 6/-de.->.
City/State/ZIP: Minimum permit fee($90.00) 70, l✓IJ
Plan review(25%of permit fee) —Phone:( ) Fax:( ) State surcharge(12%of permit fee) /L)
CCB lic.: /g q TOTAL PERMIT FEE /t)c)..P.)
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: ,`/ / G .�—�
* Fee methodology set by Tri-County Building Industry Service Board
Print name: &v L P Goy t,es. Date: g/ //7 7
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 Valuation: ei mit, ee:
$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_PennitApp_040113.doc 2