Permit ' CITY OF TIGARD MECHANICALPERMIT
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I - COMMUNITY DEVELOPMENT Permit #: MEC2009 00625
!GARD k 13125 SW Hall Blvd., Tigard OR 97223 '503.639.4171. Date.Issued: 11/24/2009
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Parcel 1S133DA03800
Jurisdiction: Tigard
Site address: 12510 SWGLACIER LILY CIR
Subdivision: Lot: 0 .
Project: Montgomery
Project Description: Install heat pump, gas furnace with associated gas piping, and venting for water heater.
Owner: FEES
MONTGOMERY, SHAWN'K & BEVERLY Description Date Amount
12510 SW GLACIER LILY CIRCLE
TIGARD, OR 97223 Furnaces < 100K BTU 11/24/2009 .. $46.75
. Heat Pump 11/24/2009 $61.06
PHONE: Fuel Piping 11/24/2009 $14.15
12% State Surcharge - Mechanical 11/24/2009 $14.64
Contractor:
BULL MOUNTAIN MECHANICAL
13580 SW RHETT CT,
TIGARD, OR 97224
PHONE: 503 - 702 -2945
FAX: 503- 524 -6533
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
•
Fuel
Fuel Types: Natural Gas
Gas Pressue:
Total $136.60
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
q by 9 O6. You may obtain a copy of the rules
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -001b through OAR'952- 001 =01
or direct uestions to OUNC b calling 503.246.6699 or 1.800.332.2344. ll
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Issued By:
�i P,(,�IrI.Q �, V
Cali 503,639.4175 :by 7:00 a.m. for an inspection thatbusiness day.
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.timeof each inspection.
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Meelialnl<ca1 Permit;Appllcatio �' : l ;` � , .. , P , ; • 1 ..d ;: FOROF , FICE U SE ONLY ' :4'
Received
Clty Of �1gAI (1 EI\ Date /By: ), Permit No.: t • 0Q , '
131
F ax d ' 03598 1960 2.5 SW Hall Blvd_, T Plan Review
e t 503 639 4171 NOV N V q 9 Other Permit:. t� A ip
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IVO'Y �/ � �oOJ Date/By: al,! . • t 1 /►�
T I G A R D Inspection Line: 503.639.4175 " . • D ate ReadyBy: See Page 2 •for`; .
Internet: www tigard- or:gov Notified/Method: Supplemental Information
CITY F
0 TIGARD
9 LDING DIVISION _
'' "TYPEdOF WOR : - COIVIIVIERCIAL FEE SCHE - USEiCHECKLISt•
❑`New- construction , tAddition/alteration /replacement
'Mechanical permitfeeS* are based on the value eif the _work`
• • . performed. Indicate'the value (rounded to the nearest dollar)"of all '
❑ ❑ Other: mechanical materials, equipment labor, overhead, and profit. ,
Value: $:
. 'CATEGORY OF 1CONSTRUCTION
,RESIDENTIAL'EQUIPMENT /iSYSTEMS FEES* • ., .y
- 6 1- and2- family dwelling EJ Commercial/industrial ❑ Accessory building -
For special use checklist.
❑.Multi- family ❑ Master builder ❑Other: _
Description Qty._ Ea. Total
JOB SITE JNFORMATION. LOCATION Heating/coolin
�+ / , - Air conditioning
Job site, address: ] - 1 0 Cil (,i l (!1L L ( t.& - Gl
(� (requires site plan 'showing placement) 46:75
X Z1.3 Fumace 100,0 ducts /ve 00 'BTU City /State /GIP: �� (0 C.- ( ) I 46 ?75 e/(P'c`j / Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: Q.yt Gat? .Heat pump / 61-.06 ' bt'.O(_ •
Cross street/directions to job site: 1 Zs . ` S,( oLLS . , Ductwork 23.32'
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 I 23.32 7-3. 32
Subdivision: Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuelappliances
t
' 4 ' 'DESCRIPTION:,OF'WORK - , . . Water heater. 23.32
y � n y , ;�• / Gas-fireplace 33 >39:
g� IJI4 ) (7/ 3 ( ll 3 f/ �` i ` Flue vent for water heater or gas
,,,A� // fireplace 23.32
// /44.„ J .,7 (✓ � ( ` AL ' Log lighter (gas) 23.32
1,%) - I' /. Uv /v7/t l Wood/pelletstove 33.39
• Wood'fireplace /insert 23.32
Chimney /liner /flue /vent 23.32:
• ❑ • PROPERTY-OWNER ❑ . TENANTe r . p' O ther: 23:32
Name: 6/6:-g y c,0_l. Environmental exhaust and ventilation •
Range; hood/other kitchen
Address: (, g (.,) C L C �k C' eq uipment 33.39
City /State /ZIP: TT Cry /Z4 6 `r gz23 Clothes dryer.exhaust 33.39 .
-1 Single- duct .; exhaust (bathrooms
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Phone: ( ¶ (' 14 Fax: ( •) toilet>compartments,.utility rooms) 23.32
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4 "' h' ".APPLICANT," ' .. -' , ❑`:CONTACT PERSON Attic /crawlspace fans. •23.32
Business ; name: EJL h� T i f . • , j,, i .-/ �e Other. 23.32
(� ✓ 1 Fuel piping
Contacfname: �/f^/ Q
L'4' 7 $14.15 for first four; $4.03 for each additional
4� '
Furnace, etc: 1 ' `y A`c 1
Address: / ?a0 SfJ e G
Gas ,heat pump
City /State /ZIP: `77tj,� 0 f ,?116/ Wall/suspended/unit heater
/ /
.Phone: (�,) b !�1 Fax: : ( ) Water heater Fireplace
E -mail: • Range
' .. • ._. CONTRACTOR ?' A d Barbecue
Business name: v Clothes dryer - .(gas)
Other:
Address: r MECHANICAI)PERMIT FEES* `t
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( . Minimum.permit fee ($90.00)
Plan'_review (25p /o of permit fee)
CCB lic.: ./ 5 .' State surcharge (12% of permit fee) • /
. TOTAL PERMIT FEE ,,
/ This permit application expires if a permit is not obtained within"180
Authorized signature: i days after it has been accepted as complete.
Print name: / /6, U Z { {{
W� .. I / / ! 1 7 * Fee methodology set byTri- County Building Industry Service Board
I:\ Building \Permits \MEC- PermitApp.doc 10/01/09 440-4617T (1'.1 /02/COMIWEB).
Mechanical Permit Application - City of Tigard • • }
Page 2 - Supplemental Information •
Commercial & Multi- Family Fee Schedule:
TotalAValuation ' "?Pe
$0.00 to $500.00 Minimum fee
$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 $10,000.0'0 and
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00. ' j N , J
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $106.00' 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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t \ Building \Permits\MEC- PennitApp. 10/01/09 2