Permit CITY OF TIGARD MECHANICAL PERMIT
.
a COMMUNITY DEVELOPMENT Permit #: MEC2010 00406
T [ G A R f] 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/15/2010
Parcel: 1S136DA00700
Jurisdiction: Tigard
Site address: 11530 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Hi Hat
Project Description: Install dryer vent
Owner: FEES
HI HAT INC Description Date Amount
11530 SW PACIFIC HWY Permit Fee 08/12/2010 $69.06
PORTLAND, OR 97223 Plan Review 09/15/2010 $17.27
PHONE: 503 - 267 -3126 12% State Surcharge - Mechanical 08/12/2010 $8.29
Contractor:
OWNER
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT Type of Const: VB
Occupancy Grp: A -2 Occupancy Load:
Stories:
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressue: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 1 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $94.62
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire /Smoke Dampers:
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 or 1.: r r
Issued By: , . � ��� ittee Signature:
Call 503.639.4175 by :00 a.m. for an inspection that busines • y.
This permit card shall be kept in a conspicuous place on the job site until completion of the proje t
Approved plans are required on the job site at the time of each inspection.
Mechanical l l Permit Application OR OIFFICI. USE UONLY Cl } of Tigard �� Permit No.: 4
Date/By: 11 ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review I`
' C Phone: 503.639.4171 Fax: 503.598.1960 OC O Date/By: ►�� (0 Other Permit:
1 - C, RI) Inspection Line: 503.639.4175 t
Internet: www.ti ardor. ov Date ed/ y: tuns: See Page 2 for
g g V 3 Notified/MetMet hod: /0d Supplemental upplemental Information
I' R�
TYPE OF WORK c1 ° GN �� COMMERCIAL A
FEE* SCHEDULE - USE CHECKLIST
El New construction El Addition/alteration/re
Vnt Mecha permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other: itev 4.. 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
y f-f- Air conditioning
Job site address:
Or, es kQQ/4 l/�( (requires site plan showing placement ) 46.75
City /State /ZIP: I1 530 SL f c i441 7" 19 .,e,G6R 97-z2-3 Fumace 100,000 BTU (ducts/vents) 46.75
f' Fumace 100,000+ BTU ( ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: p (i ( C7.; Heat pump 61.06
Cross street/directions to job site:. Duct work 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
Gas fireplace 33.39
v T 1,$dr Daz1ye . \ - ,,t 1 r?- llsp 1 QU,II Flue vent for water heater or gas
Fe-ow, \ f3 ` -se rem 1 r Tb O hAd ���� L L lace 23.32
r
VT�C Log lighter (gas) 23.32
ct4S i Wood/pellet stove 33.39
Wood fireplace /insert 23.32
rig PROPERTY OWNER 1 ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32
Name: pl .e I U t/ 1 J `et , r i f Environmental exhaust and ventilation _
Address: v �'1 Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 1 33.39 33.3
Single -duct exhaust (bathrooms,
Phone: (5 'a 6 7._ 3 0,6 at! Fax: ( ) toilet compartments, utility rooms) 23.32
APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: / ply) Pi T
G� � � Other: 23.32
r (I /f V r F ue l p i p ing
Contact name: ,n f ` L I j � i / r 514.15 for first four; $4.03 for each additional
Address: / J 53 ° 0 S [) P �, )-)- F� is Furnace, etc.
fn C� r Gas heat pump
City /State /ZIP: 6 j ._ 4tQ d CS / ���� Orl Wall/suspended/unit heater
Phone: ( 6 _ (e Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
viJe� Other:
dryer (gas)
Business name: cr
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal -
Minimum permit fee ($90.00) .6 (✓•(p
Phone: ( ) Fax: ( ) Plan review (25% of permit feed ' t Z,
CCB lic.: State surcharge (12% of permit fee) � � � _
_
TOTAL PERMIT FEE 5
This permit application expires if a permit is not obtained within 180
Authorized signature: I 57/ / • / !O days after it has been accepted as complete.
Print name: 0 14 ill I Date: y (i Z (/ 2 • Fee methodology set by Tri-County Building Ind ervice Board
I:\ Building \Permits\MEC- PermitApp.doc 10 /01/09 440.461TT(11/021COM/WEB) q 'ft
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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