Permit CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit#: MEC2013 00708
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/25/2013
Parcel: 2S103CA00201
Jurisdiction: Tigard
Site address: 13235 SW HOWARD DR
Project: McGoffin Subdivision: WOODCREST NO.2 Lot: 15
Project Description: Radon mitigation,subslab depressurization
Contractor: XAVIER ENVIRONMENTAL INC Owner: MCGOFFIN,JAMES L&G M
11300 SW CAHALIN RD 13235 SW HOWARD DRIVE
SHERWOOD,OR 97140 TIGARD, OR 97223
PHONE: 503-236-3796 PHONE: 503-403-8905
FAX: 503-682-9506
FEES
Specifics: Description Date Amount
Other,ExhaustNentilation 11/25/2013 $23.32
Type of Use: SF 12%State Surcharge-Mechanical 11/25/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 11/25/2013 $66.68
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, S - - of OR. Specialty Codes and all other
applica. r : . ll work will be done in accordance with approved plans. This permit will - pire work is not started within 180 days of
is Dance, or if wor ' suspended for more the 180 days. ATTENTION: Oregon law require: you to follow adopted by the Oregon
tility Notification Cente. Th. rules are set forth in OAR 952-001-0010 through OAR 9 -001-009x. Yo. - o stain a cosy of j e rules
or direct questions to OUNC ,f calli r r •03.232.1987 or 1.800.332.2344. I I I
r
Issued By: / s Permittee Signature: I i,'I I
Call 503.639.4175 by 7:00 a.m.for the next available inspection d.te. ' 11,
This permit card shall be kept in a conspicuous place on the job site until compl= ion • the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application 1:01(OFFICE USE ONLY
City of Tigard Fl DateBy: p�5, Permit No.: '&' AV _�7Ot
° 13125 SW Hall Blvd.,Tigard,OR 1,7? T Plan Review
C ' Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 NO V 2 5 2013 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPE O D Inc''i6" I COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees'are based on the value of the work
New construction ❑Addition/alteration replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES"
LJ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
f� ! r/ - Air conditioning 46.75
Job site address: `zJ6 , Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: it,
Furnace 100,000+BTU(ducts/vents)
Heat pump 54.91
- 'J7 61.06
Suite/bldg./apt.no.: I Project name: Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
qt • Residential boiler(radiator or
C - � � � -
Residential
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: I 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
�„J fireplace 23.32
• 5�' / /�f, Log lighter(gas) 23.32
lip A n`� ii. i`��� Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER I ❑ TENANT Other: 23.32•
n Environmental exhaust and ventilation:
Name: \-31111 q_G- l r/c_ %t. )'\f Range hood/other kitchen
Address: (3/____:7 -5(,''° 41 1'1 'Y equipment 33.39
� `wv k / ! Clothes dryer exhaust 33.39
City/State/ZIP: 'Ail ' `� Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
� ��
Phone:( O,a Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT�(�(� Y ❑/CONNTACT PERSON Other: 23.32
`�®\,ta,a c�1 f 1 VL 1 C Fuel piping:
Business name: Jl(�
$14.15 for first four;$4.03 for each additional
Contact name: ' '�/rte,� �' Furnace,etc.
I1 Gas heat pump
�
Address: / I� � ' 1,��=�,aim I '
Wall/suspended/unit heater
City/State/ZIP: ' L��f jl,��;. hi Water heater
Phone: k• i, Fireplace •
` , ''� i�lW, Range
E-mail: k� lU�qj CO/111 Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:
Other:
MECHANICAL PERMIT FEES"
Address: Subtotal /�
City/State/ZIP: dil\W Minimum permit fee($90.00) /,1•�Phone:( ) :( ) Plan review(25%of permit fee)
_ I� & State surcharge(12%of permit fee) /p-�(�
CCB lic.: �-`, i u„ TOTAL PERMIT FEE /4j. --0
,��—,`' a This permit application expires if a permit is not obtained within 180
/��' sly 1, days after it has been accepted as complete.
:I� r Authorized signature: . i- I/ i • Fee methodology set by Tri-County Building Industry Service Board
Print name: ildirt 1;�•W ice• I Da ` j'rM'SI
I:\Building\PermibUlEC_PermitApp_040113.doc 440-461 (11/0 OM/WEB)
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.
1:\Building\Permits\MEC_PermitApp_0401 I3.doc 2