Permit CITY OF TIGARD MECHANICAL PERMIT
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COMMUNITY DEVELOPMENTAL
Permit#: MEC2019 00786
Date Issued: 11/07/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S103DA04300
Jurisdiction: Tigard
Site address: 10660 SW PARK ST
Project: ARREOLA Subdivision: FANTASY HILL Lot: 4
Project Description: Mini split system installation for Garage conversion to a bedroom.
Contractor: OWNER Owner: ROSALES, LUIS ARREOLA
LUIS&JESSICA ARREOLA ROSALES ARREOLA, JESSICA
10660 SW PARK ST 10660 SW PARK ST
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-475-0892 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Heat Pump 11/07/2019 $61.06
Type of Use: SF 12%State Surcharge-Mechanical 11/07/2019 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 11/07/2019 $28.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Yot;!,,rrjay obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: C. �__Penhiie Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
UPICl of Tigard Received
g Date/By: /7 Permit No.:,�/1 �� p�„
in 13125 SW Hall Blvd.,Tigard,OR 97223 y i / l t f>
S Plan Review
Phone: 503.718.2439 Fax: 503.598.1960RECEIVED) Other Permit: r,
Inspection Line: 503.639.4175 Date ��y
l I G A l:t) p Date Ready/By: 3uris: � See Page 2 for
Internet: www.tigard-or.gov NOV 7140 Notified/Method: Supple mental Information
TYPE OF WORKKITY OF TIGARD COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction X Addition/alteration/re laceriien`t l ° l�/f
P performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
R1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: /ggII Jf
6 b Vi r > eJf Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: ! a r cl ®IS q 7Z S Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump / 61.06 6(, L
Suite/bldg./apt.no.: Project name: 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
Gas fireplace/insert 33.39
M Flue vent for water heater or gas
/ 7/;V _�m- sr�� ,--1 /�.3/('`/lot (") fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Oth
❑ PROPERTY OWNER ❑ 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) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional
Contact name: i�.) (s, ./S•1 ,(a Furnace,etc.
Address: (D 6 00 e;(A) �( 5 - Gas heat pump
.. ��,,Uf Wall/suspended/unit heater
(City/State/ZIP: a/ 0 722 Water heater
Phone:(5O. 5 08Q Fax::( ) Fireplace
age
E-mail: ky,l.�':I ' 3(
;Lit, . (inM . Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: Other:
d)w./Acci, MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00) etC
Phone:( ) Fax:( ) Plan review(25%of permit fee) —
State surcharge(12%of permit fee) to„Th
CCB lic.: TOTAL PERMIT FEE Icti,10
This permit application expires if a permit is not obtainedwithin 180
days after it has been accepted as complete.
Authorized signature: ,, U is ymcc p, . * Fee methodology set by Tri-County Building Industry Service Board
Print name: — >., Date: l /' !7-/ f A�
t
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(I l/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.
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