Permit CITY OF TIGARD MECHANICAL PERMIT
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,; COMMUNITY DEVELOPMENT Permit #: MEC2009 -00532
_,. 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/09/2009
� CiARD Parcel: 2S112BC01203
Jurisdiction: Tigard
Site address: 14575 SW 81ST AVE
Subdivision: DURHAM ACRES Lot: 70
Project: Fast
Project Description: Install furnace and heat pump within side and rear yard setback.
Owner: FEES
FAST, MARK J & MADAE F Description Date Amount
14575 SW 81ST AVE
TIGARD, OR 97224 Furnaces < 100K BTU 10/09/2009 $46.75
Heat Pump 10/09/2009 $61.06
PHONE: 12% State Surcharge - Mechanical 10/09/2009 $12.94
Contractor:
HOLMES HEATING & COOLING
29360 HALE RD
SCAPPOOSE, OR 97056
PHONE: 503 - 543 -2399
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $120.75
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 or 1.800.332.2344.
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.
. *- , ; .
echanical Permit A lication t• •, FOR OFFICE USE ONLY
CI of Tl and � '� Received i -
`J g " . , _: Date /By, _`, Permit No. 1 �(Ntt �r b
a 2 `u�i
13125 SW Hall Blvd. Ti ard, OR 972 3
g Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /B Other Pennrt:
OCT � � 2009 Date y
TIGARD Inspection Litte: 503.639.4175 Date Ready /By: ES El See Paget for
Internet: www.tigard - or.gov CITY OF TIGARD Notified /Method: Supplemental Information
RI 111 DIN' DI \ I I S!Q
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1. `i : ,>u. e . ?,A '' -TYKE OF r WQRK l4,, NW .ai,: ' 1:''t, ;;` r,- wz <;,, r COMMERCIAL FEE CHED:ULE a....17S CH,.L, ,,:. >,,, ,
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❑ New construction [ Addition /alteration /replacement Mechanical permit fees* are based on the value of the work
performed. indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
N� ' sr „ ',�% * 7 .. r ass : ONSTRUC`TIafeWAR `-,g q5 W �y Value $
.. c , -t" _ t ;- CALEGORY OF, C A „,, R zi x:c .. ,,, : , D .,.; , j a 4,,t a.w , •RE5IDEIVTI EQUiPMENT�/ 9Y TEMS FEES*
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building "'` "' '`��`� `
For special information use checklist.
❑ Multi - family . ❑ Master builder ❑ Other: . Description Qty. Ea: Total
r - Vibl''STi'E INFOR�:11` ifei AND OCATIt NFAVI ;t' s Heating cooling
- / N Air conditioning
Job site address: �4 5 . ?5 5 Vv ( U` (requires site plan showing placement) 46.75
City /State /ZIP: ; ci �,A Q e- 1 7 . ..7j ( Furnace 100,000 BTU (ducts /vents) 1 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 1 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
4, °aV �,� MM W � � s ' k a3 V 5 �, a, °� , , X Water heater 23.32
F,,_a „ w. i p r u, I DESCR P PIONr OFj t,VYORK- 4 4t a M, , -
. Aa..,, ^it.;- ,w..'r_H »..,L bp, s. , nrz......sda. ..,trn.4.+. a.= a. - , .... o rv;i+
`' Gas fireplace 33.39
t A/ S h / � �,//v�4C-e e /fie -&-E- ., Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
s Wood fireplace /insert 23.32
Zn,APROPER�TYrOWNER ;' tifi ' iliWATa, aNin, Ohherney /liner /flue /vent 23.32
Name: M Ar tt �R� Environmental exhaust and ventilation
Range hood /other kitchen
Address: j`f $--75 -7l� `rj l cI P' equipment 33.39
City /State /ZIP: - - E? c -7 7:2 -c--� Clothes dryer exhaust 33.39
1 O Single -duct exhaust (bathrooms,
Phone: ( . ) Fax: ( ) toilet compartments, utility rooms) 23.32
, k � x r 7 APp IC' iJ[ KI n Fii IIMI ERSON,: It Attic /crawlspace fans 23.32
Other: 23.32
Business name: \ NSA S i.-` 5 4. ( Oc� i /x/9 Fuel g
�.4-F N � pipin
Contact name: g A ✓-\ ci i vy `p S $14.15 for first four; $4.03 for each additional
! Furnace, etc.
Address: L LI3, O I - � oN j,Q Q 7 Gas heat pump
Cit /State /ZIP: Wall /suspended/unit heater
y �� ��Q� � � � - � Water heater
Phone: (e3) S t 3 - ZTf-t�• Fax:: ( ) Wa e he
E -mail: Range
qn„t a9` tief — w .T• g �e w k vp¢x� y -xu a .,:,, +r . lige r.(" 7 ' 's 5 Barbecue
0 t � m g : "kr' , < � CON LRAG ORr ;`k', mi .. . aV a= :. _ ..
Business name: / Clothes dryer (gas) _
j � (1 S -( ea (' i Other:
Address: 3 6U (' �° ( r ; ;,11IEGAANIC�A'LPERMITeEES`` t
City /State /ZIP: Subtotal
SCCc .000 0 ���� Minimum permit fee ($90.00)
Phone: ( :§(1 ) 7i3 - -,) 5c fi Fax: ( ) Plan review (25 %of permit fee)
CCB lic.: f —G 1. c Q • I1 • d State surcharge (12% of permit fee)
TOTAL PERMIT FEE 160 -#1C
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
may. N - (�t /vw� S /0 10 7 1 2 0.? S
L\ Building \Permits \MEC- PerniitApp.doc 10/01/09 440 -46I7T (1 I /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi- Family Fee Schedule:
$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.
l: \Building \Permits \MEC- PermitApp.doc 10/01/09 2
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