Permit II CITY OF TIGARD MECHANICAL PERMIT
t: COMMUNITY DEVELOPMENT Permit #: MEC2010 -00597
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/18/2010
Parcel: 2S111CC15300
Jurisdiction: Tigard
Site address: 10065 SW HIGHLAND DR
Project: Gottlieb Subdivision: SUMMERFIELD NO. 4 Lot: 204
Project Description: Add on heat pump to existing air handler with coil. Unit must meet 3' minimum rear and side yard setbacks.
Contractor: PORT AIR MECHANICAL Owner: GOTTLIEB, DOUG
PO BOX 469 10065 SW HIGHLAND DR
CORBETT, OR 97019 TIGARD, OR 97224
PHONE: 503 - 200 -9871
PHONE: 588 - 747 -8321
FAX: 503 - 695 -2808
FEES
Specifics: Description Date Amount
Heat Pump 11/18/2010 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 11/18/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/18/2010 $28.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
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 -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: f / A . Permittee Signature: /,' `
Call 503.639.4175 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 App i � � FOR OFFICE USE ONLY
I City of Tigard Received
`J Tigard he / 1 i r Permit No �/��`a .-0 & i 7
° 13125 SW Hall Blvd., Tigard, OR RN 200
Plan Revie • Other Permit:
°� Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
.1 I G A R D Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: BS
10 See Page 2 for
Notified/Metho
Internet: www.tigard- or.gov BUILDING DIVISION Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New constructionAddition / 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*
1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description
Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: I Air conditioning
1 o O I / ,5 5 �1 Q n t' a showing (requires site plan showing placement) 46.75
City /State /ZIP: Ti 5 la Q oil q7111/ Furnace 100,000 BTU (ducts /vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name:
Heat pump ' d 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
N bl) D N HP LKC 1 S I- 1 K 5 A v il Flue vent for water heater or gas
e n L9 1 � 1 to 1 L l ice 23.32
1 vvt.
IL I�, Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney /liner /flue /vent 23.32
IA PROPERTY OWNER ❑ TENANT Other: 23.32
Name: 'odvs r'7' a•�•L I E 6 Environmental exhaust and ventilation
I' Range hood/other kitchen
Address: I 0 O 6S �lI 1-I-1 `, k 1 srN1„. ' n equipment 33.39
City /State /ZIP: " 1G (A A D be q 7 Z VI Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (Sn) - 241_ _ T3 , I Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name:
Fuel piping =
Contact name: $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: A� b it A a . /(/f � L r ` �� Ji - A-' Clothes dryer (gas)
1 / Other:
Address: P l 0 % b y 44,q MECHANICAL PERMIT FEES* .
City /State /ZIP: C O Ry C b (L q 1 0 I 1 Subtotal
� J ! Minimum permit fee ($90.00) 95, 0-1)
Phone: ($b3 ) [.r7(,- Cj-.3"1 1 ez Fax: ($ ) k`{S Z4'O 8 • Plan review (25% of permit fee)
CCB lic.: ! ' l 503 • S — N3f q � _47aad /� State surcharge (12% of permit fee) /D ,,
1 TOTAL PERMIT FEE / ,,()
� This permit application expires if a permit is not obtained within 180
Authorized signature: -- I //� / - If
= �.. days after it has been accepted as complete.
Print name: TA Piles L ( or � t c (( Date: 1 1 _ ( co 1 * Fee methodology set by Tri- County Building Industry Service Board
1: \Building\PermitsU9fEC- PermitApp.doc 10/01/09 440-4617T (t 1 /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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