Permit Support Document Mechanical Permit Application
Ci of Ti and Received t
`J b Daffy, (.,2/]I:'1 ja +,Q' Permit No.: 1,062.L. 1, ),..eic, 1 1
f!`, 13125 SW ball Blvd.,Tigard,OR 97223 Plan Review
�C Jv t�ES(
_ ` Phone:503.718.2439 Fax.503.598.1960 Date/By: Other Permit:
(i D Inspection Line: 503.639.4175 Date Ready/By: J.O. 0 See Pqe 2 for
Internet www•tlgard-or•gov Notified/Method: I Supplemental loformatioe
TYPE OF WORK * COMMERCIAL FEE"SCHEDULE-USE CHECKLIST
Mechanical permit fees•are bawd on the value of the work
❑New construction 0 Additio alters' n/replace eat performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition LUrer: ,k M ..-mechanical materials,equipment,labor,overhead,and profit.
�`�,\ _� Value:$
CATEGORY OF CONSTRU. I RESIDENTIAL EQUIPMENT/SYSTEMS FEES.
kja‹..and 2-family dwelling 0 CommerciaUindustrial Accessory building For special information ase chechfist
❑Multi-family ❑Master builder 0 Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: M Air conditioning 46.75
_ Furnace 100,000 BTU (ducts/vents)
46.75
City/State./ZIPI.T; ii/� ul,'.," Furnace IW,WO+"BTU(ducts/vcntr) 5491
�� �t a
Suite/bldg./apt.no.: �jectnann , s 43E,t` Heat pump
Ha work 23.3W2
Cross street/directions to job site: �1'} 1 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
DF.SCRIPT N OF WOc'L )
CCC Gas fireplace/insert 33.39
(� / Flue vent for water heater or gas
l-se-fh S 91Ck fireplace 23.32
1[,'`''`�v-(�" a.��n�yy� Log lighter(gas) 23.32
Y A d`t" k Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
er
ROPERTY OWNER 0 TENANT _ Environmental exhaust and ventilation: 23.32
Name. - lAaRtet ) , Range hood/other kitchen
equipment 33.39
Address. 1,. clii3 .. PA!.... Clothes dryer exhaust 33.39
City/State/ZIP: ri Single-duct exhaust(bathrooms,
1 toilet compartments,utility rooms) 23.32
Phone: Il'A•- Fax:( ) Atlic/crawlspece fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: _—_ 23.32
Business name: Fuel piping:
S14.15 for first four;34.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( , ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
�1 //11;; Other.
Business name::E,1►. iip C 1"M" 4 i L f,� MECHANICAL PERMIT FEES`
Address: ` P A�"�'�`4 c ( :\C)5
( \� Subtotal 41,G(C
City/State/ZIP t Minimum permit fee($90.00)
—> p-.z,c, J�1 J, o Plan review(25%of pcmtit fee)
Phone:(113A Fax:l' State surcharge(12%ofpermi[fcc) .
CCH lie.:=1,kR TOTAL PERMIT FEE
�+ This permit application¢spires if•permit is oat omatned within 180
4..
days after it has been accepted as complete.
Authorized siR store:j t - * Fee methodology set by In-County Building industry Service Board
Print name:,(/�alr'^�t 'I4 Date:
t:taaadug\Permits IE Perm=` Itl.doc ll.." an-4617T(I�COM,Wru) p t �� c Q