Permit Support Document CITY OF TIGARD MECHANICAL PERMIT
IIII •
COMMUNITY DEVELOPMENT ? Permit#: MEC2019-00591
Date Issued: 08/09/2019
T I G A Et..[7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243 �1 Parcel: 1 S135DD04000
Jurisdiction: Tigard
Site address: 11770 SW 90TH AVE
Project: IBI Remodel Subdivision: None Lot: None
Project Description: ductwork extension and relocate existing NC. 11/20/19: REPRINT to add(2)single duct exhaust fans.
Contractor: LAKESIDE HEATING&COOLING Owner: CUFFEL, CHRISTOPHER&AMBER
PO BOX 327 11770 SW 90TH AVE
LAKE OSWEGO, OR 97034 PORTLAND, OR 97223
PHONE: 503-635-5253 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 08/09/2019 $46.75
Type of Use: SF Duct Work 08/09/2019 $46.64
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 08/09/2019 $11.21
Occupancy Grp: Single Duct Exhaust(Bathrooms,Toilet, 11/20/2019 $46.64
Stories: Utility Rooms)
12%State Surcharge-Mechanical 11/20/2019 $5.59
Fuel
Fuel Types: Gasoline
Gas Pressure:
Total $156.83
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth i OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.23 .1 87 or 1 00. 2.2344.
Issued By: / / - Permittee Signature:
/l.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application 7`"- FOR OFFICE USE ONLY
City Tigard Ti and Received
Date/By: l ( fl 4fr..' -oW t 7 _oo;?)
II II 13125 SW Hall Blvd.,Tigard,OR 97223 N O V n 0 2019 Plan Review
8 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 . , Date R a e • Juris: ® See Page 2 for
Internet: www.tigard-or.gov P 1 ; ' Notifies ri z Supplemental Information
TYPE OF WORK 1/', COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
,v., .
Mechanical permit fees*are based on the value of the work
❑New construction ( .Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
D Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
421 1--and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
,p Air conditioning 46.75
Job site address: / j 7 S(.c/ 7 el l//'ti-e__ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 'pool'l (` r� CJI 7 7 Z 3 Furnace 100,000+BTU(ducts/vents) 54.91
n- a _ Heat pump 61.06
Suite/bldg./apt.no.: Project name: %3� V�, 'OCh/ 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
Other: 23.32
Subdivision: Lot no.:
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
11.00- L jjc:A 1, 'C! uen, -1 --�'tj �).t',-,.,zit. , fireplace 23.32
�'0.�2-c F_ �S 7 / Log (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Oth
❑ PROPERTY OWNER 0 TENANTS' 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
Address: equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) Z 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: / e Fuel piping:
�"��"� � east``1 $14.15 for first four;$4.03 for each additional
Contact name: Zyrx-,/ (9i64(f s Furnace,etc.
Address: 707( SLR ',Arc_ Z w 49,...
Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: tIGe 0SL.,lP 9 74 „ S''- Water heater
/ ep
Phone:Kz ) 7 v0_ ei 0C Fax::( ) Fireplace
7 jJ,,-1/L- G-
Range
E-mail: �� ,""i (�J Le„e Sl4'� , 0/-Yl Barbecue
// CONTRACTOR Clothes dryer(gas)
Business name: lat -S tE1� Other:
MECHANICAL PERMIT FEES*
Address: 7 d-2-/ S(A) /fiC.F btfexe Subtotal
City/State/ZIP: /A,,KQ,D su' c-) , 9703 Minimum permit fee($90.00)
Plan review(25%of permitrmitfee)
Phone:(5?3 )L,"?5*--s 2�' Fax:( ) State surcharge(12%of permit fee)
CCB lie.: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: " &E y/a j Date: //4_04
I:\Building\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:
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.
1:\Building\Permits\MEC_PermitApp_040113.doc 2