Permit ' ; MECHANICAL PERMIT
;i :� ` CITY OF TIGARD
= �' COMMUNITY DEVELOPMENT Permit #: MEC2010 -00348
Date Issued: 07/16/2010
T I G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
• ,; Parcel: 2S102BA02900
Jurisdiction: Tigard
Site address: 9789 SW JOHNSON ST
Subdivision: JOHNSON & GRANT Lot: 5
Project: Thibeau
Project Description: Water heater replacement.
Owner: FEES
ALCAZAR R, MARIA Description Date Amount
9789 SW JOHNSON ST Water Heater 07/16/2010 $23.32
TIGARD, OR 97223 12% State Surcharge - Mechanical 07/16/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 07/16/2010 $66.68
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 • .800
Issued By: / - 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.
Mechanical Permit Application 4' . „ - ': :; Tr Z ( ) I Z - -1 i rr) r , � . y f i _ 1 ;, . •
City of Tigard ���� Received
�� Date/By: 7 (Q ip Permit No u F 4 — 4 I , r 13125 SW Hall Blvd., Tigard, OR 972 Ai "L
Plan Review
II Phone: 503.639.4171 Fax: 503.598.1 : I\ Date/By: Other Permit: .
Inspection Line: 503.639.4175 6 1 . ,,,f •I' tC. A IL I) Internet: , 1 D ate ed /Met y: S See Page 2 Internet: www.tigazd www.tigard-or.gov �� a � R n Notified/Method: Supplemental Information
�� ®F �1 j� 15
• TYPE OF Wi amck. , �G D COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
ItatkA Mechanical permit fees* are based on the value of the work
❑ New construction S,Addition/alteratildiureplacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL_EQUIPMENT / SYSTEMS FEES*
jg 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION • Heating/cooling
Air conditioning
Job site address:
7 ,5 Ge) Z O ///V ,SDv.) (requires site plan showing placement) 46.75
City /State /ZIP: 77 f A-R , p 972 z. ,3 Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
/61A) /() T 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
•
DESCR OF WORK Water heater j 23.32 r f 3.3)
• Gas fireplace 33.39
'5 Pi A- C__ /5:— 17 U)11 7i1 K Flue vent for water heater or gas
fireplace 23.32
4 /¢ 5 Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
r;K OPERTY OWNER • ❑ TENANT Chimney /liner /flue /vent 23.32
• Other: 23.32
Name: 1/4 _ER / 4- / B/`4 -Gt Environmental exhaust and ventilation
o �p ' - Cr Range hood/other kitchen
Address:
�3 s3 / c5 6 ,3 0 equipment 33.39
City /State /ZIP: P 0 4 77_4_70 b 0 /e- 9 7 2_ / 9 Clothes dryer exhaust 33.39
0 //' Single -duct exhaust (bathrooms,
Phone: (5-U3) 51(0 44/4 ‘ 5"7 : P F. (6,03) - e0 - x'515 toilet compartments, utility rooms) 23.32
a APPLICANT • ❑ CONTACT PERSON , Attic /crawlspace fans 23.32
Other: 23.32
Business name: ,.r ,�' (i Fuel piping
Contact name: W $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
"CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
Other
Address: MECHANICAL PERMIT.FE .
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00). q) .
Plan review (25% of permit fee)
CCB lic.: State surcharge (12 %ofpermit' fee) to lob
TOTAL PERMIT FEE j()(), 6?
r -, �1
iir4 " L This permit application expires if a permit is not obtained within 180
Authorized sign • re. /� J
• �/+ days after it has been accepted as complete.
Print name 47/5411M1/ -, Date: 7A a • Fee methodology set by Tri- County Building Industry Service Board
1:\Building \Permits \MEC- PermitApp.doc 10/01709 - -.., • 0 -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:\ Building \Permits\MEC- PermitApp.doc 10/01/09 2