Permit Support Document CITY OF TIGARD MECHANICAL PERMIT
lig �� COMMUNITY DEVELOPMENT ., Permit#: MEC2020-00261
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 VAS Date Issued: 05I1112020
Parcel: 251036C03200
Jurisdiction: Tigard
Site address: 12270 SW ALBERTA ST
Project: Gaskins Subdivision: CANOGA PARK Lot: 6
Project Description: Install 2 new supply ducts. 615/2020:Reprinted permit to include range hood.
Contractor: EVERGREEN GAS Owner: GASKINS, BRIAN &LINNEA ASHLEY
16385 SW LANGER DR 12270 SW ALBERTA ST
SHERWOOD, OR 97140 TIGARD, OR 97223
PHONE: 503-407-9542 PHONE:
FAX: 503-344-6345
FEES
Specifics: Description Date Amount
Duct Work 05/11/2020 $46.64
Type of Use: SF Range Hood/Other Kitchen 05/11/2020 $33.39
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 05/11/2020 $9.97
Occupancy Grp: 12%State Surcharge-Mechanical 05/11/2020 $10.80
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 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.
r r ,
Issued By: G� ermittee Signature:
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 ApplicationRECE!VE FOR OFF ICE rsi;ON1.\
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ve ecei
City of Tigard Received
, ! ��
II ei 13125 SW Hall Blvd.,Tigard,OR 97223 MAY 2 G 2020 Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
Inspection Line; 503.639.4175 CITY (.)a i I Gf1Fi i' Date Ready/By: Jws. ® See Page 2 for
i I�'',I`1> Internet: www.tigard-or.gov a fIL.DING D S!'`,' Supplemental Information
(, �V�J r,'�Jotitkd/MNhod: PP
TYPE OF WORK COMMERCIAL ENE*SCHEDULE--USE CHECKLIST
Mechanical permit fees'are based on the value of the work
0 New construction pfr Addition/alterationiaeQalFept�y p,n performed.Indicate the value(rounded to the nearest dollar)of all
Other: mechanical materials,equipment,labor,overhead,and profit.
❑Demolition ❑ 3� Value:S
CATEGORY OF CONSTRUCTION,/ 1.- RESIDENTIAL EQUIPMENT/SYSIEMSFEES*
01-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For specialinformarion use checklist.
❑Multi-family 0 Master builder 0 Other:
Description I Qty. I Ea. I Total
Heating/cooling:
JOB SITE INFORMATION 1 SAND LOCATION
. Air conditioning 46.75
Job site address: I h 7--1 u LS W n t►o e rf a S-i-- Furnace 100,000 BTU(ducts/vents) 46.75
G n /7 Furnace 100,000+BTU(duets/vents) 54.91
City/State/ZIP: ��f� r I ') 1 h h Heat pump 61.06
Suite/bldg./apt.no.: J Project name: Duct work 23.32
Hydronic hot water system 23.32
Cross street/directions to job site: 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
Other: 23.32
Subdivision: 11-01 no.: Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
Gas fireplace/insert 33.39
DESCRIPTION OFWORK Flue vent for water heater or gas
t4 d il -I-D ex 1 S l i n -e r m 1 + fireplace 23.32
�j q Log Wood/pellet
stove
23.32
M F( 2.020— 0 V S�t.n I . Ven f h v o L o lighter
ight r(stove 33.79
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
oPROOPERTY OWNER( .I :0.TENANT - Environmental exhaust and ventilation:
Name: f$r1Qn C7AS ‹ ` y�' f S Range hood/other kitchen `
equipment 1 33.39
Address: Clothes dryer exhaust 33.39
Single-duct exhaust(bathrooms,
City/SlaidZlP: toilet compartments,utility rooms) 23.32
Phone:(q}1)LID g - 55 55 I Fax:( ) Attic/crawlspoce fans 23.32
{1
APPLICANT - ❑ CONTACT PERSON Other: 23.32
G /I r e pp /� Fuel piping:
Business name:G ye_r9 .en (i4 S 514.15 for first four;S4.03 for each additional
Contact name: ;'R� !1 �)e I O Q 4() Furnace,etc.
v Gas heat pump
Address:'10 3 $5 I S W Lan 0 tAe- 7) r f a heatpemicd unit healer
City/State/ZIP: S h-e rW U c)d 0 '_ q—4- I`(1 0 Water heater
�I Q (,J Fireplace
Phone:(SON 4 O T I S t Fax::( )
n/� /f flange
E-mail: t 1 I I cD -NZr3 r €A `(�Ul s. n.P4- Barbecue
V co croakClothes dryer(gas)
n'/ n� Other:
Business name: E pv.e) 9 I� /' (la S MECHANICAL PERMIT FEES*
Address:t to.3 l� J `SJ v. La v1 e1 )r Subtotal
ty S h e rW o 0 d ' ["t j 0 Minimum
permit
fee(S90.00)
Ci /Slate/ZIP: Plan review 25%o(permit fee)
Phone:(5 D3)U Di- Cl S 1 2 Fax:( ) State surcharge(12%of permit fee)
15 g' 0 3 I TOTAL PERMIT FEE
CCB tic.: This permit application expires If a permit is not obtained within 180
days after II has been accepted as complete.
Authorized signature: /'� --.+ * Fee methodology set by Tri-County Building Industry Scrvice Board
IPrint name:V i l+ -8e I U" I Date: - z 1 - 2 0
t9BeiidingVPcrmbs\MEC Peril Apt 040113.doc 404617T(I 161VCOMiW60)
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
$I0,000.00.
$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.
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