Permit CITY OF TIGARD MECHANICAL PERMIT
:.: i COMMUNITY DEVELOPMENT Permit#: MEC2020-00143
' r Date Issued: 03/12/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 c�r r I parcel: 2S104AA04500
Jurisdiction: Tigard
Site address: 12400 SW 127TH AVE
Project: TRINITY SERVANTS LLC Subdivision: BELLWOOD Lot: 21
Project Description: Exhaust fan installation in bathroom.
Contractor: PACIFIC PRIME CONSTRUCTION LLC Owner: TRINITY SERVANTS LLC
45683 NW HARTWICK RD 8645 SW MULEDEER DR
BANKS, OR 97106 BEAVERTON, OR 97007
PHONE: 503-869-3392 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Single Duct Exhaust(Bathrooms,Toilet, 03/12/2020 $23.32
Type of Use: SF Utility Rooms)
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 03/12/2020 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 03/12/2020 $66.68
Investigation Fee 03/12/2020 $90.00
Stories:
Investigation Mechanical 12%State 03/12/2020 $10.80
Surcharge
Fuel
Fuel Types:
Gas Pressure:
Total $201.60
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.
t f
Issued By: Permittee Signature: �iL4
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.
CITY OF TIGARD MECHANICAL PERMIT
'�'! '2 r COMMUNITY DEVELOPMENT Permit#: MEC2020-00143
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/12/2020
Parcel: 2S104AA04500
Jurisdiction: Tigard
Site address: 12400 SW 127TH AVE
Project: Bathroom Subdivision: BELLWOOD Lot: 21
Project Description: Exhaust fan installation in bathroom.
Contractor: PACIFIC PRIME CONSTRUCTION LLC Owner: TRINITY SERVANTS LLC
45683 NW HARTWICK RD 8645 SW MULEDEER DR
BANKS, OR 97106 BEAVERTON, OR 97007
PHONE: 503-869-3392 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Single Duct Exhaust(Bathrooms,Toilet, 03/12/2020 $23.32
Type of Use: SF Utility Rooms)
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 03/12/2020 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 03/12/2020 $66.68
Stories: Investigation Fee 03/12/2020 $90.00
Investigation Mechanical 12%State 03/12/2020 $10.80
Surcharge
Fuel
Fuel Types:
Gas Pressure:
Total $201.60
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 rule adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You obta. a py of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: '/ _ ' Permittee Signature:
—.. e>
Call 503.639.4175 by 7:0D 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
City of Tigard RECEIVEEIN
13125 SW Hall Blvd.,Tigard,OR 97223 a 'f� e r
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 MAR
AA 1 Date/By: Other Permit: r. , ,,,,;...Air_113/
IYIHUU
Line:
` Inspection 503.639.4175 n 1 2 2020 Date Ready/By: MI 65 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGAR II Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE 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:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
0 I-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
eh site address: 10cjo 3z......) 471.--->aArt Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 1. ' R....,1 t y,Pa. Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: 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 OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
5X r 7 - rN5'j�/(u fireplace 23.32
'Tl Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
CIPROPERTY OWNER 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
Address: equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Single duct exhaust(bathrooms,
1.
toilet compartments,utility rooms) I 23.32 2-3..30Z
Phone:( ) Fax:( ) Attic/crawispace fans 23.32
;) 0 APPLICANT ❑ CONTACT PERSON Other: 23.32
s name: �/"`' /^� —{ Fuel piping:
li (1 ( C K i/\A..t_ �dti.sw C /�tr^ $14.15 for first four;$4.03 for each additional
CAL name: S)e^ c C r Sjite ' ' Furnace,etc.
\Address: ys '7 /(/yi - l- l (`e'i_ Gas heat pump
/ - �` t c Wall/suspended/unit heater
oty/State/ZIP: Gln /C/ o 7/0 (a Water heater
Phone:($'QT 719-4..4 Q Z Fax::( ) Fireplace
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
N Business name: Other:
'Z 0, MECHANICAL PERMIT FEES*
V Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00) oiv�c0
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) /U ,k-ri
CCB lie.: Z2 0 t 0 1/3../� )TOTAL PERMIT FEE f ,S,-0
l This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
prized Signature * Fee methodology set by Tri-County Building Industry Service Board
name: C,n tc_t--- r71 --',Z ZO Z. C fi(.Ll Fr77_
I:1Building\Permits,MEC_PermitApp_040113.doc 440-4617r(I1/02/COM/WEB) r7V I A.°
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
Total Valuation: Permit Fee:
$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