Permit (209) CITY OF TIGARD MECHANICAL PERMIT
: COMMUNITY DEVELOPMENT Permit#: MEC2016-00851
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/21/2016
TIGARD 9 Parcel: 2S111CC06800
Jurisdiction: Tigard
Site address: 15925 SW GREENS WAY
Project: SCHIESS Subdivision: SUMMERFIELD NO.2 Lot: 95
Project Description: Replacing(2)bathroom exhaust fans,(1)clothes dryer exhaust,and(1)range hood.
Contractor: QUALITY HOME SERVICES Owner: SCHIESS, ELLEN
2019 SE QUAIL CIR 15925 SW GREENS WAY
HILLSBORO, OR 97123 TIGARD, OR 97224
PHONE: 503-758-8779 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 12/21/2016 $33.39
Type of Use: SF Clothes Dryer Exhaust 12/21/2016 $33.39
Class of Work: ALT Type of Const: Single Duct Exhaust(Bathrooms,Toilet, 12/21/2016 $46.64
Occupancy Grp: Utility Rooms)
Stories: 12%State Surcharge-Mechanical 12/21/2016 $13.61
Fuel
Fuel Types:
Gas Pressure:
Total $127.03
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONE
City of Tigard Received _
g
Date/By: 7 1 Permit No.:
IN 3 a 13125 SW Hall Blvd.,Tigard,OR 97223 �� �� �1`� t�� �
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Date/By:
T l G A R D Inspection Line: 503.639.4175 O Fj Date Read/B Juris www.tigard-or.govli:VVVCV° o`�1 y y' ® See Page 2 for
fled Method: Supplemental Information
IS)I
TYPE OF WORK ` COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
A`�� Mechanical permit fees*are based on the value of the work
❑New construction [T Addition/alteration/repl �i�� performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: 6 mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: `` 1n7 Air conditioning 46.75
1512-'S J C'cc!ev' 1:::
'y Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: T`Gau rCk I 09._ 9 Z29. Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: 3�,L j (y.10,-) �`e..A ,,e_ 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
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
f- 3 ckt-2 2- bc.4\1 Cclr-t) c,,-,e,k „•2,A\ice- , \)eyn‘-- fireplace 23.32
(`'1f y e.r(el eckf,C..) Ora (-cloy_ h C)t Cw�. rZ v Log lighte (gas) 23.32
[� � Wood/pellet stove 33.39
k7.T \n r)c-1/4-.) i V0` v-e�8c5 . Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
E,X,PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
Name: 1 i en 5 \'-i 'E 55 Range hood/other kitchen
equipment I 33.39 3:3.3e)
Address: (5-Ct 25 rJ'.1/41.2) C'c r e.Y1 ,' Clothes dryer exhaust � 33.39
_ ^, ^-� 3 3`-J
City/State/ZIP: G ,rCl Oc t /'ZZi� Single-duct exhaust(bathrooms,
( i toilet compartments,utility rooms) 2- 23.32 'a6.6,4
Phone:(6O ) 5(0O 2_eg 3(o Fax:( ) Attic/crawlspace fans 23.32
( i APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: Fuel piping:
Q� `v ��vrv� ��c��Le 5 $14.15 for first four;$4.03 for each additional
Contact name: I\DCkk-in Ct,r.N c-f i e.Ckf i Furnace,etc.
Address: 2_o\ck, 5 -_ a,..,„,\ L\C 0e Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: k..\\.\ r-c., 0 q'"1 r Z-j Water heater
Phone:(5o ) '75e. 5--7-7c\ Fax::( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: �" " Other:
`X::0.\ j r�C�'v J Q.r U'.C `] MECHANICAL PERMIT FEES*
Address: LU\S 3 1 \' /' , cot Subtotal ;tiff /2
City/State/ZIP: \k .' 4j\ c),-.0 0 C(.1 1 2 '3 Minimum permit fee($90.00) -
Plan review(25%of permit fee) ---
Phone:6-03) '75 7.7 Fax:( ) State surcharge(12%of permit fee) l 3,i.6 1
CCB lie.: 19 I-781 1//0 ifif TOTAL PERMIT FEE ' 7 03
U This permit application expires if a permit is not obtained within 180
! days after it has been accepted as complete. •
/!�
Authorized signature: ycp...._ k-r)__`-__,.. * Fee methodology set by Tri-County Building Industry Service Board
Print name: 0.VV1 air\ I•i e ct f-,C Vl Date:(all((2O 1(49
I:\Building\Permits\MEC PermitApp_040113.doe 440-4617T(11/02/COM/WEB)