Permit r! CITY OF TIGARD MECHANICAL PERMIT
111
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00659
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2010
Parcel: 2S104DD07600
Jurisdiction: Tigard
Site address: 13604 SW 130TH PL
Project: HILLER Subdivision: MOUNTAIN HIGHLANDS NO. 3 Lot: 34
Project Description: Gas furnace replacement.
Contractor: G L HEINTZ HEATING & COOLING Owner: HILLER, DAVID C &
20871 SW 216TH PLACE GASPEED, MINA
SHERWOOD, OR 97140 13604 SW 130TH PL
TIGARD, OR 97223
PHONE: 503 - 625 -6798 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/21/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/21/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/21/2010 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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 :!0 32.2344.
Issued By: / L - Permittee Signature:
A
CaII 50 .: .• 175 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 FOR OFFICE USE ONLY
City of Tigard Received ell
° 13125 SW Hall Blvd., Tigard, OR 97 _ DateBy: ,11114 Plan Revie
Phone: 503.639.4171 Fax: 503.598; DateByOther Permit:
I G A R D Inspection Line: 503.639 F D Ready/By: Mil 63 See Page 2 for
Internet: www.tigard- or.gov 20 Notified/Method: Supplemental Information
DEC 1 1
TYPE OF WOR COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
I(—I � 1 it t t � S Mechanical permit fees* are based on the value of the work
❑ New construction Addition /alter 1 �/ 2'e IVIA
���L .l performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
1 -and 2-family dwelling RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
y g ❑ Commercial /industria ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: (3 (30-0- 1 Air conditioning
(requires site plan showing placement) 46.75
City /State /ZIP: '1 GA, Cr/2 Fumace 100,000 BTU (ducts /vents) ' 46.7 /16.,74
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
(� e U ^'� Gas fireplace vent 33.39
e Flue vent for water heater or gas
V `e , l fireplace 23.32
(� Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
4ROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
r I � Other: 23.32
Name: D7.410 t4\ ( \ l )- Environmental exhaust and ventilation
Address:
k ) (4.. " 6 \ (� 13 O p / l � Range hood /other kitchen
equipment 33.39
City /State /ZIP: l 1 .6 I not 9,�'L2 Clothes dryer exhaust 33.39
1 Single -duct exhaust (bathrooms,
Phone: (5n) ( `tn -r „ Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT C ` ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name:
Fuel piping
Contact name: $14.15 for first four; 54.03 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: fib (� a(i �J Clothes dryer (gas)
4 CO Other:
Address: avEn S („) 7 / ( eL MECHANICAL PERMIT FEES*
City/State /ZIP: V 1Ar ) U U d CO / L( 0 Subtotal tie . 75--- �� ) '��^ ( ) Minimum permit fee ($90.00) GI(�, pQ
Phone: ` Fax: • Plan review (25% of permit fee)
CCB lic.: ( 0 Z$ J ( State surcharge (12% of permit fee) `( c
TOTAL PERMIT FEE too , t
A ' I 1 l This permit application expires if a permit is not obtained within 180
Authorized signature: .A tt days after it has been accepted as complete.
Print name: (,t
/ ^ T n- * Fee methodology set by Tri- County Building Industry Service Board
lol t . '� � Date:
1:\ Building \Permits\MEC- PermitApp.d 10/01/09 440- 4617T(1I /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, 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.
L\ Building \Permits\MEC - PermitApp.doc 10/01/09 2