Permit (26) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT I Permit#: MEC2016-0
0748
T I i ,'s It!7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ��/� Date Issued: 10/27/2016
Parcel: 2S114BA01200
Jurisdiction: Tigard
Site address: 16145 SW GRIMSON CT
Project: MONROE Subdivision: PICK'S LANDING NO.2 Lot: 127
Project Description: (3)supply runs for new 578 sq.ft.addition.12/5/16REPRINTED to add gas fireplace,gas piping&(2)vent fans.
Contractor: EVERGREEN HEATING&COOLING Owner: MONROE, CONNIE LEE
1046 11TH AVE 16145 SW GRIMSON CT
ALBANY, OR 97321 TIGARD, OR 97224
PHONE: 541-971-2455 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Duct Work 10/27/2016 $23.32
Type of Use: SF Gas Fireplace 12/05/2016 $33.39
Class of Work: ALT Type of Const: Single Duct Exhaust(Bathrooms,Toilet, 10/27/2016 $46.64
Occupancy Grp: Utility Rooms)
Stories: Fuel Piping 10/27/2016 $14.15
12%State Surcharge-Mechanical 12/05/2016 $14.10
Misc Administration Fee 12/05/2016 $45.00
Fuel
Fuel Types:
Gas Pressure:
Total $176.60
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir questions • +UNC by calling 503.232.1987 or 1.800.332.2344.
lss d By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Ah k 1i)Nla1jfl
l�d:�l.l 1�11;? FOR()File E. USE()NIA of Tigard Received ` it .
13125 SW Hall Blvd.,Tigard,t X72 Date/By: f10.1 Permit No.:N6e,Q!/_� �/
7r
1111 I Phone: 503.718.2439 Fax: 50 19 0 �" Plan Review rP
Inection Line: 503.639.41 Date/By: Other Permit:
TI G A R D p �' Date Ready/By: Juris:
® See Page 2 for
Internet: www.tigard-or.go
Notified/Method: Supplemental Information
TYPE OF WORK
COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction 0 Addition/alteration/replacement
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling 0 Commercial/industrial
0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder
0 Other: Description I Qty, I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: I S -
Air conditioning 46.75
w �"1 Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: I 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: I Lot no.: Other: 23.32
Tax map/parcel no.:
Other fuel appliances:
Water heater 23.32
DESCRIPTION bi WORK Gas fireplace/insert 1 33.39
-/ 1--,1=' 10,...0Flue vent for water heater or gas
tes)_LA:,‘.._42-1\016.-e_121 t 1 _. `t5 1 _ fireplace 23.32
cQ \.)....e....,...3-1 � �-- J n Log'lighter(gas) 23.32
�" pa a`tA. t={ Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY,OWNIER �`�' Other:
I� " ENANT,. 23.32
Name: Environmental exhaust and ventilation:
Range hood/other kitchen
Address: equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
Phone: toilet compartments,utility rooms) a 23.32
( ) Fax:( ) Attic/crawlspace fans 23.32
APPLICANT.:. `0 CONTACT PERSON Other: 23.32
Business name: Fuel piping:
Contact name: $14.15 for first four;$4.03 for each additional
Furnace,etc.
Address: Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
Phone:( ) I Fax::( ) Fireplace /
E-mail: Range
Barbecue
CONTRACTOR` Clothes dryer(gas)
Business name: 1,,2Q 1 ,r-` Cl .(...„4„,_r, Other:
Address: CJ ' MECHANICAL PERMIT FEES*
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) 1 Fax:( )
State surcharge(12%of permit fee)
CCB lic.: TOTAL PERMIT FEE P 73•
I This permit application expires if a permit is not obtained within 180
Authorized signature: li days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry Service Board
Print name: £II. Tp; ,, I Date: 12/57/6 I
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(I 1/02/COM/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.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
CITY OF TIGARD MECHANICAL PERMIT
Permit#: MEC2016-00748
- 2; COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/27/2016
Tf �k Parcel: 2S114BA01200
Jurisdiction: Tigard
Site address: 16145 SW GRIMSON CT
Project: MONROE Subdivision: PICK'S LANDING NO.2 Lot: 127
Project Description: (3)supply runs for new 578 sq.ft.addition.
Contractor: EVERGREEN HEATING&COOLING Owner: MONROE, CONNIE LEE
1046 11TH AVE 16145 SW GRIMSON CT
ALBANY, OR 97321 TIGARD, OR 97224
PHONE: 541-971-2455 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Duct Work 10/27/2016 $23.32
Type of Use: SF 12%State Surcharge-Mechanical 10/27/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 10/27/2016 $66.68
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
i
Issued By: `//'L P_ermittee Signature:
41/
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application ,_., FOR OFFICE USE ONLy
City of Tigard "-IFAN Date/By:Received
Plan Review ®/( / Permit No.: r J_„.. -
III e 13125 SW Hall Blvd.,Tigard,OR 9722 1 0.1. l 1r? '
Phone: 503.718.2439 Fax: 503.598.19 Date/By: Other Permit: if go
7,
I I C,A R t) Inspection Line: 503.639.4175 q 10\ Date Ready/By: H See Page 2 foo+r
Internet: www.tigard-or.gov QC1 fi Notified/Method: Supplemental Information
r >'.sem ''e •�'i OI' ,,', i �' c (' s:i 3 l�I 4/ i R ✓ '% "k.IST'
mss.
F, ,., , Mechanical permit fees*are based on the value of the work.
❑New construction ®Addition/alterati I •,1a ent performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
f
oAtikia R �
▪ 1-and 2-family y dwellin g 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
IOB S1TIa� (3R11I �(� l: CATL011 ' ,
�, Heating/cooling:
,,,, Air conditioning 46.75
Job site address: 16145 SW GRIMSON CT. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:TIGARD/OR/97224 Furnace 100,000+BTU(ducts/vents) 54.91
^ ` � Heat pump 61.06
Suite/bldg./apt.no.: Project name: 1\e A(6v Duct work 1 23.32 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: f�:.Cs Z Lot no.: 'Z7 Other: 23.32
1 Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
„ h r 'i b I=' tQ �' Gas fireplace/insert 33.39
tea. <.,, . ...,.. ' Z for water heater orgas
vent
ADDITION OF(3)SUPPLY RUNS TO NEW ADDITION OF HOME 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
porvjay { 1r#8 ,
., ., . : , ,., . ,,. ,,,
Environmental exhaust and ventilation:
Name: d` Range hood/other kitchen
COilv\
lY e equipment 33.39
Address: I611S sLV ( rirM50-s G%. Clothes dryer exhaust 33.39
City/State/ZIP: r4m,,.d o 4 C�7 j7. Single-duct exhaust(bathrooms,
l toilet compartments,utility rooms) 23.32
Phone:(.SIJ 5) $0 Li $O 4(I Fax:( ) Attic/crawlspace fans 23.32
CI' APPLICANT,. . ®' t N'1f;ACC P 'iN Other: 23.32
Business name:EVERGREEN HEATING AND COOLING Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:CHRISTOPHER SHUFELBERGER Furnace,etc.
Address: 1046 11TH AVE SW Gas heat pump -
Wall/suspended/unit heater
City/State/ZIP:ALBANY/OR/97321 Water heater
Phone:(541)971-2455 Fax::( ) Fireplace
Range
E-mail:
Barbecue
B. 1 C y� i,;;.
Clothes
dryer(gas) ,
Other: 1
Business name:EVERGREEN HEATING AND COOLING ii/o .ma ✓r0'Q4 i,I y
! Subtotal
I . yn� ,
a Ii
Address: 1046 11TH AVE SW 23.32
City/State/ZIP:ALBANY/OR/97321 Minimum permit fee($90.00) 90
Plan review(25%of permit fee)
Phone:(541)971-2544 Fax:( ) --
State surcharge(12%of permit fee) L L7+ cif)
CCB lie.:200810 TOTAL PERMIT FEE /CV, TO
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: v * Fee methodology set by Tri-County Building Industry Service Board
Print name: t fr` 17p/'h,t1Date:10/26/2016
[\Building\Permits\MEC_PermitApp_040113.doe 440-4617T(11/02/COM/WEB)