Permit V CITY OF TIG ',RD MECHANICAL PERMIT
;.:.. -
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00243
,T[GARDj DATE ISSUED: 4/30/2007
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 133RD -12100
SITE ADDRESS: 11307 SW SUMMER LAKE DR ZONING: R -7
SUBDIVISION: SUMMER LAKE LOT: 002 JURISDICTION: TIG
PROJECT: LIEBSWAGER
Project Description: Replace gas furnace.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
DUANE LIEBSWAGER Description Date Amount
11307 SW SUMMERLAKE DR
TIGARD, OR 97223 [MECH] Permit Fee 4/30/2007 $72.50
[TAX] 8% State Surcha 4/30/2007 $5.80
Total $78.30
Phone: 503 - 579 -5132
Contractor:
HARDY PLUMBING + HEATING
14689 NE COUNTRYSIDE
AURORA, OR 97002 REQUIRED ITEMS AND REPORTS
Contact #: PRI 222 -9654
Reg #: LIC 60947
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules • • rect ques •s to OUNC by calling 503.246.6699 or 1.800.332.2344.
0/ sued By: ( ! - Permittee Signature: •\
Cali 503.639.4175 by 7:00 a.m. for inspections 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.
Mech2nica Permit Application FOR OFFICE USE ONLY
City of Ti and Received
I� ✓ g Date/By: ir
Ar f D ? Permit No.: iltev4D7 �
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
= Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Ins Line: 503.639.4175 Date Ready/By: IN fa See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Addition/alIeration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
11 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ Multi - family 0 Master builder For special information use checklist.
❑ Other: Description 1 Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning or heat pump
Job site address:
j 3 S Li MM� p/Z (requires site plan showing placement) 14.00
City /State /ZIP: 7 L pr-re , D2 Furnace 100,000 BTU (ducts/vents) 1 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. _ 10.00
Subdivision: Lot no.:
Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
` Flue vent for water heater or gas
r
r : 1 / v2- i fe--f�P z fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 10.00
Other: 10.00
Name: 1✓ X ,gS / ,J A-Le . lir Environmental exhaust and ventilation
Address: 11 L'j� S L.,) / 0A l/4�,e ] /C)i )Oi' Rangehoodlotherkitchen
J equipment 10.00
City /State /ZIP: 17 ` pep Clothes dryer exhaust 10.00
�1 !! L � Single -duct exhaust (bathrooms,
Phone: ( j) ,„c s ) 3 2 Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name:
Other: 10.00
Fuel piping
Contact name: $5.40 for first four; S1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax :: ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: / 92-P ` � G }J Clothes dryer (gas)
Other:
?-4!"- (((% `�
Address: 1 1.) C` , j 1 ('avr 77t 9---) / S /0 5 JOJ MECHANICAL PERMIT FEES*
IrT
City /State /ZIP: 'V e ,/a p / 6R/ Q Subtotal
'` Minimum permit fee ($72.50) .7A SO
Phone: ( J ) `ate _ C)r L S y Fax: ( _2 ) Z g . to y g 6 Plan review (25% of permit fee)
CCB lic.: {, D 9l 1.1 State surcharge (8% of permit fee) ?j Z
C /\ TOTAL PERMIT FEE .� , ?(�
Authorized signature: . This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: ILO — /3 A 24 y Date: yJ _ 3 p _ U—) * Fee methodology set by Tri- County Building Industry Service Board
l.\ BuildinglPermits \MEC- PermitApp.doc 04/06 /06 440 -4617T (11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: ` Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1.\ Building \Permits\MEC- PermitApp.doc 12/30/05 2