Permit CITY OF TIGARD MECHANICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: MEC2010 -00603
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2010
Parcel: 2S102CCO5700
Jurisdiction: Tigard
Site address: 13675 SW GARRETT CT
Project: GUSTAFSON Subdivision: Lot: 0
Project Description: Replacing gas furnace and adding A/C. A/C unit must meet minimum 3 ft. side and rear yard setbacks.
Contractor: G L HEINTZ HEATING & COOLING Owner: GUSTAFSON, GERALD R &
20871 SW 216TH PLACE LORENTZ - GUSTAFSON, CHRISTINE
SHERWOOD, OR 97140 MARIE
13675 SW GARRETT CT
TIGARD, OR 97223
PHONE: 503 - 625 -6798 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 11/19/2010 $46.75
Type of Use: SF Furnaces < 100K BTU 11/19/2010 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/19/2010 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: G `c G Permittee Signature:
Call 50�� 75 by 7:00 a.m. for the next available inspection date.
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 . USE ONLY r
t f p� �
Received
III Ci of Tigard ' � r Permit No.
¢ g Date/By: I U 0
° 13125 SW Hall Blvd., Tigard, OR 97�i 3 1'w Plan Review L
C ' ., Phone: 503.639.4171 Fax: 503. :9: I L--
Other Permit:
Date/By:
T I G A R D Inspection Line: 503.639 NOV 19 2010 Date Ready/By: � Juris: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: LyC.v Supplemental Information
OF TIGARf
TYPE OF( • �'C DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
E'er Mechanical permit fees* are based on the value of the work
❑ New constructiondition/alteration /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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
P1 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description l Qty. Ea. Total
JOB SITE .INFORMATION AND LOCATION Heating/cooling
j Air conditioning
Job site address: 1 �� S ,56..) -`Q ��'� ^Q � � (requires site plan showing placement) i 46.75
City /State /ZIP: l 1 A. 2-� l ( 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
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
(12C 1 -C e C A J 6 ,( yz .)Ace Flue vent for water heater or gas
4aA n I Co fireplace 23.32
"I" 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: C` Q f (V\ `o u_STA( y■ ry Environmental exhaust and ventilation
Address: �oaS s G .�� Range hood/other kitchen
equipment 33.39
City /State /ZIP: , \ 5A-vi cA ,1 123 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (5 6-2 — 2 @ST Fax: ( ) toilet compartments, utility rooms) 23.32
'El APPLICANT v ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name:
Fuel piping
Contact name: 514.15 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
Clothes dryer (gas)
Business name: !�1111 � -� ` i� � Other
Address: 1_ 081 ( �, ` i L (s , " ,n/ MECHANICAL'PERMIT FEES*
City /State /ZIP: - VyA U) �J IV° Subtotal 95.
Phone: // cc`` ) / vl 9 Fax: ( ) Minimum permit fee ($90.00) ,
W3 IPZ�� is } Plan review (25% of permit fee) -----
CCB lic.: ( 29 1 1/ 2.111)._ I f } State surcharge (12% of permit fee) . . p`�
/ TOTAL PERMIT FEE
This permit application expires if a permit is not obtained wit to 180 '4
Authorized signature: ) ■ x days after it has been accepted as complete.
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
h\Building\ Permits \MEC- PermitAp oc 10/01/09 440 -4617T (I 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.
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