Permit CITY OF TIGARD MECHANICAL PERMIT
! COMMUNITY DEVELOPMENT Permit#: MEC2016-00574
TEC;ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/11/2016
Parcel: 2S103CA05000
Jurisdiction: Tigard
Site address: 11530 SW TERRACE TRAILS DR
Project: nk Long Subdivision: TERRACE TRAILS Lot: 2
Project Description: Replacing kitchen hood fan duct.
Contractor: NEIL KELLY CO INC Owner: LONG, CHERYL L
804 N ALBERTA ST DELOZIER, PAUL E
PORTLAND, OR 97217 11530 SW TERRACE TRAILS DR
TIGARD, OR 97223
PHONE: 503-335-9240 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 08/11/2016 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 08/11/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/11/2016 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
�/ �-'
Issued By: j-6 / Permittee Signature: 410
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until corn 4 etion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
Date/By: , 8 /6 "Tar Permit No.:it+ - 7C
13125 SW Hall Blvd.,Tigard,OR 9722 011' ,"7l "(�(
Phone: 503.718.2439 Fax: 503 1 Plan Review
Date/By: Other Permit :�,. t-
Inspection Line: 503.639.41 O�� 1
T I GARD p Date Ready/By: E See Page 2 for
Internet: www.tigard-or.gov \ Notified Method:
P�G� �� �, Supplemental Information
,' 1IIII '' ,- "_ ,.k t t :A , i, yU 0, ,ii a .CO� Rtw'1Ai 1 * DUCE k IS
❑New construction Mechanical permit fees*are based on the value of the work
®Addition/al eplacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
IL ,y',-,_ r, _ 1. C`A-1It-0 -, �, , 'Iiv. . , a Value:$ ...
14 Q Ila NIRENTI EQl IPMENT'1, _ ENI` * r-1,',-"„.„-
[E] 1-and 2-family dwelling 0 Commercial/industrial ''
0Accessory building For special information use checklist.
❑Multi-family 0 Master builder
0 Other: Description Qty. Ea. Total
a
7-7.i'141, d l I A I r� 44
-4074,-,- it ,,'t *4Heating/cooling:
Air conditioning 46.75
Job site address:11530 SW Terrace Trails Dr.
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard,OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Heat pump 61.06
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: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
iii i , Il k:* {51 a l mt 1 iii Gas fireplace/insert 33.39
Flue vent for water heater or gas
Replace Kitchen Hood Fan Duct 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 Ili u = a i ...t.-"?.,,414,'",_ P'" 1 r
Environmental exhaust and ventilation:
Name:Paul Delozier&Cheryl Long Range hood/other kitchen
Address:11530 SW Terrace Trails Dr. equipment 1 33.39 33.39
Clothes dryer exhaust 33.39
City/State/ZIP:Tigard,OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503)443-2190 Fax:( ) Attic/crawlspace fans 23.32
"g - ®o . P*fit 4 ),,� ►� QNA 'i,i+,,lthoh 10.le-:,,'S Other: 23.32
Business name:Neil Kelly Company Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:Paul Louis Furnace,etc.
Address:804 N Alberta St. Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Portland,OR 97217 Water heater
Phone:(503)333-3022 Fax::( ) Fireplace
Range
E-mail:paull@neilkelly.com Barbecue
CON CTOIty�:r ;
�' I A, n Clothes dryer(gas)
Business name:Neil Kelly Company Other:
MECHANICAL PERMIT FEES", s,
Address:804 N Alberta St Subtotal 7
City/State/ZIP:Portland,OR 97132 Minimum permit fee($90.00) Cto Lt.,
Phone:(503)288-7461 Plan review(25%of permit fee)
Fax:(503)288-7464 State surcharge(12%of permit fee)
di3. ?e
CCB lic.:1663 TOTAL PERMIT FEE 1"G v 0
../� This permit application expires if a permit is not obta. ed within 180
days after it has been accepted as complete.
Authorized signature: — * Fee methodology set by Tri-County Building Industry Service Board
Print name:Paul Louis Date:8/10/16
I:ABuilding\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
,e4 erm1t e �
„Tc>�talVa1auat'<cr�i r�*
$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