Permit CIT F TIGARD MECHANICAL PERMIT
I � I A O SERVICES PERMIT #: MEC2006 - 00380
`e - DEVELOPMENT ', 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/7/2006
PARCEL: 1 S134AD -05700
SITE ADDRESS: 10710 SW PONDEROSA PL ZONING: R - 4.5
SUBDIVISION: BLACK BULL PARK LOT: 022 JURISDICTION: TIG
Project Description: Replace AC
CLASS OF WORK: OTR 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: 1 DOMES. INCIN:
ELE 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
MCCORMICK, ROBERT C /JEAN L Description Date Amount
10710 SW PONDEROSA PLACE
TIGARD, OR 97223 [MECH] Permit Fee 8/7/2006 $72.50
[TAX] 8% State Surcha 8/7/2006 $5.80
Total $78.30
Phone: 503- 684 -4846
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 656 -1184
Reg #: LIC 447
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 or direct questions to OUNC by calling 503 - 246 -6699 or 1 -800- 332 -2344.
Issued By: /� Permittee Signature: (-01/141.
Call 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.
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Mechanical Permit A _ .. FOR OFFICE USE ONLY • 2Y/' (.� 1/Z PermtNoM . .00 O
STigard, OR 97223 S1q Phone: 503.6394171 Fax: 503.598.1960 x,1.1 t.7 ( 200 hG m fi r ' A D u Other Permit:
Inspection Line: 503.639.4175 n s • II Date Read /B J ® See Pa e 2 for
Inter www.ci.tigard.or.us l,i � f �
Y UIIO� ":r ' -�' Y o --
Notified/Method: g
g ( SupplementalInformation
BUILDING a{VI Ok't •
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❑ New construction [a 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.
w r s „ , k ,. a . r Value $
- 3 CATEGORY O CONSTRIJC 'ION` P s k .{ x s r , s , >',
, ??ESIDF IiL4L IyQO.LPMENT / S Y S TEMS -FEES
51 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
'i;.,4 c4', -• SOB - SITE NROiiiii lON i `LOCATIOgI.E" f. K. "r` - "l;` "1 Heath': t,
ti c! -.xv.> " {...ice? _S.a+:K ..,.... v.. . , rx.. .,..n-. ,.-u .. k -....w a .i ...�i
Po • r conditioning or eat pump
Job site address: )LJ
d -7 1 0 u....) �o ,A.c\GY'C st. P l • •:: • .o , owing placement) \ 14.00 / /, 60
City/State/ZIP: T� G �,(- . 0 9. -2.72_-3 urnace 100,000 BTU ( ducts/vents) 14.00
J 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 o r . - - - hydronic) ' - • • 14.00
' Unit heaters (fuel -type, not electric),
in -wall, in- duct, etc. 10.00
Subdivision: Lot no.: Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
Z ,�►. ¢ err u �� r t t : ,a " t* +Nza . .
4K + . r ak e - /#0. ,t's,.z t �°. D. ,SxCRIP. IO1V4k4p 1 - �iztti rA . Water heater 10.00
Gas fireplace 10.00
V e..- pr.4.ce I A/ C , Flue vent for water heater or gas
fireplace l 10.00 /0,00
Log lighter (gas) ' 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
aa; tliiii O EERti � qEr. t $ ,, ,a ' : s"4 atI EN T-N a *u T'4 ; Other: mney /liner /flue /vent 10.00
Name: iz,nb C ,,v.� vAGC-CScv\Acv. Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/ State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (603) &15y _ L y (o Fax: ( ) toilet compartments, utility rooms) 6.80
Y `' ' l APP,IvTCANTr s z° s ; ,' _ - CONTACT P , - iv., '. Attic/crawls fans 10.00
Business name:
Other: y 10.00
.l \ {\ r Fuel piping
Contact name: e --6��S $5.40 for first four; $1.00 for each additional
Address: r Furnace, etc. 1 : 7 t C ID
/SSSC� I- �t 2 V
Gas heat pump
City/State/ZIP: 0.c•L+ =, , ..Z. 6 � a/ Wall/suspended/unit heater
Phone: (SU3) 2‘j ( Co Fax: : ( )
Water heater
Fireplace
E -mail:
Range
,�. , I �.. t ' ,. " - r w n s ,� »i .. a.�a r �� r sa �. ..F a e
"F' �„�,Ic ` ,J �rtxCON CT ' s . ; , -- s .` § ' r.. � ,. ' . , _. Barbecue
..�: ,k - :' • . .. i . .t - 5 1 - fi . .M1rva � YA',di Y ,.t - wkc5 .
Business name: 1,2.,__\\ t-S)t<;\A_ Clothes dryer (gas)
Other:
Address: F PIC( 1_ U ` ',I14EC 1:0' *ERiVITtxFEES*
City/State/ZIP: C .,..,--0. Subtot a9.4./ 0
Phone: (S p ) 2 _6 ( ) Minimum permit fee ($72.50) -74,50
6n 6,,q 6o / Plan review (25% of permit fee)
CCB lic.: 4 41 1 q State surcharge (8% of permit fee) 5,
TOTAL PERMIT FEE
Authorized signature:. ' This permit application expires if a permit is not obtained within 180
A i
days after ithas been accepted as complete.
`
Print name: , , 1 [ Date: I ' Fee methodology set by.Tri- County Building Industry Service Board
iABuiiding \ PennitslptEC- 'cmi,Aop.doc t2 /03 4 (11/02 /C0N-1/WEB) - - . _. .
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Tot 1 Yatua ion Pel'rimtt.F`ee._.,. d
$ 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
$1.3.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.
i :\ Building \Pemvts\MEC- PermitApp.doc 12/03 2
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SITE PLAN
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( Ot.AeK.AIVIAS, OREGON 97015 • • •
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