Permit Support Document Mechanical Permit Application FOR OFFICE USE ONLI
City of Tigard Received
Date✓By Permit No.: �C�ZJ t -
III s • 13125 SW Hall Blvd.,Tigard,OR 97223 Review t
Phone: 503.718.2439 Fax: 503.598.1961 ECEIVED DPlan By:
Date/By: Other Permit:
1 I G A R I) Inspection Line: 503.639.4175 Date Ready/By: . kris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
OCT 24 2022
TYPE OF WORK..ITV nF TIGARD COMMERCIAL FEE' SCHEDULE — USE CHECKLIST
�(iiNEER�i�IC= Mechanical permit fees*are based on the value of the work
0 New construction ❑Addition/alte it17Q 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*
❑ 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:
' Air conditioning 46.75
Job site address: E 5 T1 3 5 S%Jl OAK i`t`� O W L t•—) Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 11,RN 0'0 Olt. 9 7 2 L`F Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: v,1. c.Nt r.3 4 N O t/N7r o..i 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
( .C-jir- 4 fireplace 23.32
" Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
OthPROPERTY OWNER 0 TENANTS' 23.32
Environmental exhaust and ventilation:
Name: OA P l Sl. Uttcu4414 WI x".rA.1 t Range hood/other kitchen
Address: i E �3 G $wl Qt�WL Mt'. et. d YJ t.1.4 equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Tv t` 1'7?2 4*/' Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(5 D3) 7 99—t `_1 1 Fax:( ) Attic/crawlspace fans 23.32
APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name: .e , c.,f a TN� $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Gas heat pump
Address:
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
Range
E-mail: Barbecue
Clothes dryer(gas)
Business name: 7 4 M Sr.ALdti:.ts Other:
MECHANICAL PERMIT FEES*
Address: 9 24 0 w t. I 4-1-2.1% tv`I2 Subtotal
City/State/ZIP: JA,at.pv c..-L 01.. 9dCS Minimum permitfee($90.00)
Phone:(34.o) 2_Co�j - 5 4....... OO Plan review(25%of permit fee)
Fax:( ) State surcharge(12%of permit fee)
CCB lie.: t $$ 5 9 5 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:b )F�L weaste,N Wt�LlAMi Date:
tQ_Z t--2O22.
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(1 I!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:\13uilding\Permits\MEC_PermitApp_040113.doc 2