Permit CITY OF TIGARD MECHANICAL PERMIT
II COMMUNITY DEVELOPMENT Permit#: MEC2015-00545
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/11/2015
TIGARD 13125 2S101AA02300
Jurisdiction: Tigard
Site address: 12190 SW 69TH AVE
Project: Tran Subdivision: WEST PORTLAND HEIGHTS Lot: 22
Project Description: Add(2)exhaust fans in new bathrooms.
Contractor: OWNER Owner: TRAN, GINA
12190 SW 69TH AVE
TIGARD, OR 97223
PHONE:
PHONE: 503-421-8628
FAX:
FEES
Specifics: Description Date Amount
Single Duct Exhaust(Bathrooms,Toilet, 08/11/2015 $46.64
Type of Use: SF Utility Rooms)
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 08/11/2015 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 08/11/2015 $43.36
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 44009' � Permittee Signature: -�
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit APPli I[TEjI F()It c)rrlc 1i rsl: c)�I.i
City of Tigard 11''�i 1 1``
Received f <. Permit N o.�H C czaci,e9,0 5
;� • 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.�96O 1 1 2015 Plan Review
Date/By: Other Permit:
i i, , 1,i, Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov CITY UFTIGAkU Notified/Method: Supplemental Information
Mechanical permit fees'are based on the value of the work
❑New constructionddition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
pi=and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total
Heating/cooling:
� ) Air conditioning 46.75
Job site address: 12( l? W 6' 4,,,..._ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: ,,2 6� _f 7 Furnace 100,000+BTU(ducts/vents) 54.91
Tj V- Heat pump 61.06
Suite/bldg./apt.no.: Project name1 Duct work 23.32
Cross street/directions to job site: I 1 /1.kV,� 11 5/ Hydronic hot water system 23.32
1 J 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: (8..),e_11— / ,'1i_ .) J,(Q1 k 1 5 Lot 21?-2.2._ der: I 1 23.32
/1 I 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
kV Q,,`..1– " t .� –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
❑ TENANT Environmental exhaust and ventilation:
Name: 6)`'(f x.J-- u �r�c, '1-6:40"•--� Range hood/other kitchen
�` L6 O �` � equipment 33.39
Address: Z1 �f ��� Clothes dryer exhaust _ 33.39
City/State/ZIP: -r` Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( Z .2(--- Fax:( a Attic/crawlspace fans 23.32
Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
WalUsuspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail:
Barbecue
Clothes dryer(gas)s Other:
Business name:
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00) el e, , ere
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) l dr
d ` g
CCB lic.: TOTAL PERMIT FEE /de , D
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board
Pont name: I Date:G�.{r_
is-
I:\Building\Permits\MEC_PermitApp_040113.doe 440-4617T(I1/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Famil Fee Schedule:
total Valuation: Permit
$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