Permit CITY OF TIGARD MECHANICAL PERMIT
§� 'r COMMUNITY DEVELOPMENT Permit #: MEC2009 -00675
T [ Gj1RLj 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/22/2009
Parcel: 1S136CA04600
Jurisdiction: Tigard
Site address: 10990 SW 79TH AVE
Subdivision: FRIENDLY ACRES Lot: 2
Project: Combs
Project Description: Install furnace.
Owner: FEES
COMBS, TYLER Description Date Amount
10990 SW 79TH Furnaces < 100K BTU 12/22/2009 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 12/22/2009 $10.80
PHONE: 503 - 545 -4177 Minimum Fee Adjustment - Mechanical 12/22/2009 $43.25
Contractor:
BATTLE GROUND HVAC LLC
616 SE 11TH WAY
BATTLE GROUND, WA 98604
PHONE: 360- 980 -1915
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No • . • •ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain . opy of the rul-
or dire t questions to 0 C b z = 'n' 03.246.6699 or 1.800.332.2344.
Iss ed By:
LILL
� !� � Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechan2cal Permit Application � ' -- z ¢, ` ' '' tree "`'�
[� ' i�� _;i i 19{`,01'1 IG1§USL'ONI`Y k l t g rk
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S �" 5 -�� i� +"'1 I = �7 '�.�'t*4:5 1A tBV$': ss>a"'_�� i85
City of Tigard Date/By: /2 fly D4 ( Permit eI�7,00675—
Ili ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ! mow✓`
9 Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Date/By:
I; '" Inspection Line: 503.639.4175 Date Read /B Ju ris: ®S ee Pa e 2 for
G IGi1Rl�1 Ready /By: B
_.1 +a: " _.. , a Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* .SCHEDULE — USE CHECKLIST
❑ New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S
RESIDENTIAL. EQUIPMENT / SYSTEMS FEES*
[. 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
�Jan / Air conditioning
Job site address:
0 ! 7 `' .c Iil. 79"A • a,k (requires site plan showing placement) 46.75
City /State /ZIP: - rib- a 1 �h y ", ) - Furnace 100,000 BTU (ducts /vents) 46.75 CA i ! / Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: name: 6,e V t' 5 Heat pump 61.06
Cross street/directions to job site: 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 23.32
Subdivision: Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK. • Water heater 23.32
ii Gas fireplace 33.39
r / 0 f9742 9 a Ftfraiy. Gi° Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
,PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: i C, ( rin i Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (So3 ) 5 K__ /it 7 7 Fax: ( ) toilet compartments, utility rooms) 23.32
[J APPLICANT ,❑ CONTACT PERSON • Attic /crawlspace fans 23.32
Other: 23.32
Business name: 6 / /r_ ���r /irk 1/C. Fuel piping
Contact name: (iN / i S .- G ' ‘ $14.15 for first four; $4.03 for each additional
[[��++ / Furnace, etc.
Address: b ! ' S v -; !1 /1 W „
Gas heat pump
City /State /ZIP: 6 AG, / w .
l d Y Wall /suspended/unit heater
p
(J Water heater
Phone: ( 3b0 Q' � _ l ?� f ) / Fax / :: ( ) Fireplace
E -mail:
41/4 z„
t /1l id - N tile. r!_044 Range
CTRACTOR Barbecue
Business name: pi, ///( /' {- Vr�C i,IC
Clothes dryer (gas)
Other:
Address: / 6 SI- /> 1 MECHANICAL PERMIT FEES*
City /State /ZIP: C/ jtp o �6D G7 Subtotal 9� PO
Phone: ( � �) Fax: ��„`� """"" as: ( ) Minimum permit fee ($90.00)
di/ �� - �/ / Plan review (25% of permit fee)
CCB lic.: I g76-3 i /' State surcharge (12% of permit fee) „ go
TOTAL PERMIT FEE l (9 . ?sr)
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: A ; 5- S 10 Date: 9 a/� a/ 7 * Fee methodology set by Tri- County Building Industry Service Board
0
I:\Building\Permits 'NEC- PermitApp.doc 10/01/09 440-46I7T (1 I/02/COM/WEB)
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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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