Permit Mechanical Permit Application
FOR OFFICE USE ONLY
City of Tigard RECEIVE I)'eceived
III 13125 SW Flail Blvd.,Tigard,OR 97223 Plan By: �j I�p �_ t Penult No.:H E 0�//_�605/a
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review CO (II
Inspection Line: 503.639.4175 AUG 2016 Date/By: Other Permit: ��pc,26r .66aa
T/GARD p HUIJDateRead /B t2 •
Internet: www.tigard-or,gov Ready/By: Juris: See Page 2 for
Notified/Method:
CITY OF TIGAR Supplemental Information
;", ;
TYPE)D tr,:+IL„DIMCU U1Vt CSI*Sfici FEES SCHEO . .- E
Mechanical permit fees*are based on the value of the work
0 New construction Addition/alteration/replacement
perfonned.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
❑Demolition Other:
CATIF OQ i QE {}1 S IZYI+3IF 1'. Value:$ 2-'7 �> 6,...)\ ,/,'
;' 1�ES1„I>fR1'IfiT. €�€3tPNiRIgT 1. Y� T1�+rMa I*� *
❑ 1-and 2-family dwelling Commercial/industrial �%a
0Accessory building
❑Multi-family ❑Master builderFor special information use checklist
❑Other: Description I Qty. I Ea. I Total
JOB.--4.E14O1'MMATIO}V Ai D LO ATiON; . Heating/cooling:
Job site address: bOO 5��} q� r�
�` Air conditioning 46.75
OW ) Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 11 VX) t p Pe6.0 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: O 0 I Project name: 'p�. ,- Heat pump 61.06
�Ve; S� QN 1�� 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: I Lot no.: Other: 23.32
Tax map/parcel no.: Other fuel appliances:
Water heater
'` / % t t� 23.32
;;',:-..,-4;-,:;',,-.'-,,/� � „ P"fT� 4 -; Gas fireplace/insert 33.39
"Lo ���\,t - u ei' U Lt-s fireplaceFlu
Log
for water heater or gas
_ p 23.32
N (--.1\1/(- ..-)C[� U 5 j �/� Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
� _1,Wr,F`I . U Y l2 % /,, 1. % %. 1 AIT'' Other: 23.32
Name: ESI&A ice'0 r O"e R2 Environmental exhaust and ventilation:
\� Range hood/other kitchen
Address: 906 J1V tik) 0,bdc equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: n ,tr\ fl ,Ki
fI G MSingle-duct exhaust(bathrooms,
Phone:( ) - toilet compartments,utility rooms) 23.32
Fax ( ) Attic/crawlspace fans
' ❑ APP I4CAIYT`; 23.32
E`CONTACT'J"E 4SO1 Other: 23.32
Business name: A;(2.3- s T t1" A Fuel piping:
Contact name: r �M�Su $14.15 for first four;$4.03 for each additional
Furnace,etc.
um Gas heat
�`( C Se. MCI.0Jt,'Aft-iiv ;3(ki0 p p
Address:
Mt �y Wall/suspended/unit heater
City/State/ZIP:
!V�t Lv"1kV k t D _E&oc" t72.2 2- Water heater
Phone:(ce) )
,2,3( -- q'i("} I Fax::(5'6' ) /�S 0 ,,.o i,Lt Fireplace
E-mail: Ran e
C 0 M(1SvA f 41-e t (c) I g
Barbecue
CONTRACTO
Clothes dryer(gas)
Business name: 54�,.� I1„�r Other:
Address: K��7 " , ,, ;1Y ECfIA N!&0.. 0A/t`i`i
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Phone:( ) Plan review(25%of permit fee)
Fax:( )
o State surcharge(12%of permit fee) y
CCB lie.:
60 /J7 rl l TOTAL PERMIT FEE 9�a. /
/O This permit application expires if a permit is not obtained within 180
Authorized signature: 7 /`�•�..- days after it has been accepted as complete.
�,� * Fee methodology set by Tri-County Building Industry Service Board
Print name: or_NrV\- Date:,e•j. I 6
F'Bu ilding/Pern its\MEC_PennitApp040!!3.do c
440-46I 7T(1 I 02 COM WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial &Multi-Family Fee Schedule:
-Total Valuation: Pekont Fee ,',
$0.00 to$500.00 Minimum fee$69.06
$500.01 to$5,000.00
$5,000.01 to$10,000.00
$69.06 for the first$500.00 and
$3.07 for each additional$100.00 or
fraction thereof,to and including
$5,000.00.
$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_040113.doc 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9600 SW OAK ST 400, TIGARD, OR, 97223
Commercial - Mechanical
699 Mechanical final
PASS - No C of O
MEC2016-00562
Chip Barnett
Violation Summary:
Inspector Contractor