Permit CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENTIN
Permit#: MEC2019 00013
TfGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/27/2019
Parcel: 2S 103B B10000
Jurisdiction: Tigard
Site address: 12060 SW 122ND CT
Project: MASON Subdivision: YE-OLDE WINDMILL Lot: 21
Project Description: (1)bathroom exhaust fan.
Contractor: OWNER Owner: MASON, MATT& MEREDITH WINDSOR
MATT MASON & MEREDITH WINDSOR 12060 SW 122ND CT
12060 SW 122ND CT TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 209-769-4715 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Single Duct Exhaust(Bathrooms,Toilet, 06/26/2019 $23.32
Type of Use: SF Utility Rooms)
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 06/26/2019 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 06/26/2019 $66.68
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.;.• .2344.
/
Issued By: �j ��. l .- -ermittee Signature: e E
ie-
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required-on the job site et-the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City g of Tigard RECEIVE® Received
Date/By: t' »
Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ItiI
' S Phone: 503.718.2439 Fax: 503.598.1960Date/By: Other Permit:
TIGARD
Inspection Line: 503.639.4175 JAN 7 ;, 2019 Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: IM Supplemental Information
CITY OF TIGARD
INGtCNGINCCRING if.,iw au ` 'si:claciawr-
Mechanical permit fees*are based on the value of the work
0 New construction L Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition D Other: mechanical materials,equipment,labor,overhead,and profit.
'z '` CATEGORY OCONSTRUCTION
1
Value:$
,,4..v�� '; ,-, a. RESIDENTIAL EQUIPMENT? 'STEMS FEES*
10 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMA K AND LOCATION Heating/cooling:
.2% µ„, " = Air conditioning 46.75
Job site address: 12066 j 3 ('LZ )J 6) Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 'l(rA6f.-h O lZ 9 7 Z 7_„j Furnace 100,000+BTU(ducts/vents) 54.91
I Heat pump 61.06
Suite/bldg./apt.no.: Project name:/7-24.6 eP-+ 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
H'' it •ION QF WORK ' Gas fireplace/insert 33.39
. � ,, "v ,,- Flue vent for water heater or gas
ADDifl J Of '6*A I-4A OST TA 1.-1 L/ Co A46,0 fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
23.32
en
PRQPER -°w•,ri.,,' 'i 1] TENAN
, Environmental exhaust and ventilation:
Name: ) ,,, Range hood/other kitchen
/ �'`�� ,, equipment 33.39
Address: /2_0(;(7 5 v✓ /22_ ,x),-,;. (� Clothes dryer exhaust 33.39
City/State/ZIP: 97 22Single-duct exhaust(bathrooms,
6As-� toilet compartments,utility rooms) 1 23.32 ),3 ,301
Phone:(2p7) 76" #7/5 Fax:
( ) Attic/crawlspace fans 23.32
Pat,, APPLICANT ,, ! ;,fix CONTACT e k viii Other: 23.32
. -',',1,7;, _,......t. a . " ,4-a„. .
Business name: /y) /y�✓`' Fuel piping:
/ °'� t " �� $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
J / Range
E-mail: ? S n ( .frve. .L C,-p yl� Barbecue
L er® 1i y Clothes dryer(gas)
' I�� Other:
Business name: d WNN c,✓- Mtt,:=
ECHAT4AL , A x wn, ,;
Address: Subtotal ,Y3., .
City/State/ZIP: Minimum permit fee($90.00) le„Jo
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) e0.0
CCB lic.: TOTAL PERMIT FEE /(j() l'i,1
This permit application expires if a permit is not obtained withi 180
days after it has been accepted as complete.
Authorized signature:
* Fee- methodology set by Tri-County Building Industry Service Board
�/ly
Print name: 17- ���� Q� Date: J/
I:\Building\Permits\MEC_PermitApp_0401I3.doc 440-4617T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Family Fee Schedule:
Total Valuation: Permit Feei w,
$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