Permit CITY OF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit#: MEC2020-00171
TIGAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/15/2020
Parcel: 1S136DD03800
Jurisdiction: Tigard
Site address: 11675 SW 66TH AVE
Project: CITY COUNTY INSURANCE Subdivision: WEST PORTLAND HEIGHTS Lot: 4-8&27
Project Description: Adding (1)single zoned ductless air conditioner to a mechanical room.
Contractor: TEMP CONTROL MECHANICAL SERVICE Owner: CITY COUNTY INSURANCE SERVICES
29755 SW BOONES FERRY RD 1212 COURT ST NE
WILSONVILLE, OR 97070 SALEM, OR 97301
PHONE: 503-285-6139 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 04/30/2020 $254.98
Class of Work: ALT Type of Const: VB Plan Review 04/30/2020 $63.75
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Mechanical 04/30/2020 $30.60
Stories: Info Process/Archiving-Sm$0.50(up to 04/30/2020 $3.00
11x17)
Project Valuation: $6,700.00
Fuel Air Handlers
Fuel Types: Electricity Units< 10000 cfm:
Gas Pressure: Units> 10000 cfm:
Furnaces Boilers&Compressors
Furnaces< 100K BTU: 0-3 HP:
Furnaces>= 100K BTU: 3-15 HP:
Floor Furnaces: 15-30 HP:
Unit Heaters: 30-50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump: 1
Appliances
Vent Fans: Vent Systems: Total $352.33
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: (0_7`f Permittee Signature: 62i✓ lit.,
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application C ` FOR OFFICE USE ONLY
City of Tigard Cj I V +•.t:rya: 3„ ) �!Z
lig �� Permit No.: _
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie V lxt�e
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: .1'.j S? Other Permit:
TIGARD Inspection Line: 503.639.4175 MAR 2 3 2020 Date Ready y:B Juris: EaSee Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TlGAR4 �'Y E-
TYPE OF WORK COMMERCIAL FEE* SCHEDULE —USE CHECKLIST.-
Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed. Indicate the value(rounded to the nearest dollar)of all
0 Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ 6,700.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling KI Commercial/industrial LI Accessory building For special information use checklist.
❑ Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 11675 SW 66th Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Tigard, OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
SL„, ^ Heat pump 61.06
Suite/bldg./apt.no.: I Project name: B •6 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: l 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
Add a single zoned ductless air conditioner to a mechanical room fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
❑ PROPERTY OWNER I 0 TENANT Other:
exhaust and ventilation:
Name: 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
iii APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name: Trotter and Morton Facility Services $t4.15 for first four;$4.03 for each additional
Contact name: Roger Ediger/Annabelle Larson Furnace,etc.
Gas heat pump
Address:
29755 SW Boones Ferry Rd. Wall/suspended/unitheater
City/State/ZIP:Wilsonville, OR 97070 Water heater
Phone:(503)285-6139 Fax: :(503)7353690 Fireplace
Range
E-mail: rediger(a�tmlgroup.com /alarson@tmlgroup.com Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: - T62(41" &v./772.-c tia rnehit..--- MECHANICAL PERMIT FEES*
Address: ." e-70_ er�-44./fe...gc Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lie,: 103165 _ TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
`7�], days after it has been accepted as complete.
Authorized signature: rj ® r. _ * Fee methodology set by Tri-County Building Industry Service Board
Print name: Roger Ediger Date: 3/16/2020 •
1:`.Building'PermnsNEA_PermitApp_040113.doc 440-4617T(Il/02/COM/WEB)