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Permit y p CITY OF TIGARD MASTER PERMIT 114 2 • COMMUNITY DEVELOPMENT Permit #: MST2011 -00038 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/09/2011 Parcel: 2S104CA06600 Jurisdiction: Tigard Site address: 13350 SW HILLSHIRE DR Subdivision: HILLSHIRE Lot: 66 Project: MURPHY Project Description: Cantilevering kitchen wall 2 ft. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Total: 0 sf Value: $78,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 0 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 0 Garbage Disp: 1 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 1 Natural Gas Heat Pump: N Hoods: 1 Other Units: 0 Fum <100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 2 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea addi 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 4 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF 0 Owner: Contractor: MURPHY, PAUL B & JEANINE KHI CONSTRUCTION Required Items and Reports (Conditions) 13350 SW HILLSHIRE DR 3201 NE WYNOOSKI RD Al TIGARD, OR 97223 NEWBERG, OR 97132 PHONE: PHONE: 503 - 554 -8601 FAX: 503- 554 -8659 Total Fees: $611.19 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 thro c : . 952- 001 -0090. You may ob -' . - - - - 4. - questions to OUNC by calling 503.23 1987 or 1.800.332.2 44. . Issued = _�/ _ — , - I - - --..r . 7: _ - ermittee Signature: Cal 13 0. y 7:00 a.m. for the next available inspe on date. This permit card s • in a conspicuous place on the job site un completion of the project. Approved plans are required on the job site at the time o each inspection. Building Permit Application E � Residential 061\1 FOR (1FF1('1 I. O \l.l City of Tigard 3 , po, Da; ,$ed ' Permit No.: WA 2 13125 SW Hall Blvd., Tigard, OR 97223 0 Plan Review g Phone: 503.718.2439 Fax: 503.598.1960 GARS Date /B : Other Permit: T [ G A R D Inspection Line: 503.639.4175 OF � t ' ► to Ready /By: furls: ® See Page 2 for Internet: www.tigard - or.gov C iISG l 1 Notified/Method: 3/ / 1 Supplemental Information O IL U CD e - M(A , J y P% TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ® Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ® I- and 2- family dwelling ❑ Commercial /industrial Valuation: $ —2 UW It\ 12 Accessory building ❑ Multi- family Number of bedrooms: 0 ❑ Master builder 0 Other: Number of bathrooms: 0 JOB SITE INFORMATION AND LOCATION Total number of floors: 0 Job site address: 13350 SW Hillshire Drive New dwelling area: 22 square feet City/State /ZIP: Tigard, Oregon 97223 -5601 Garage /carport area: 0 square feet Suite/bldg. /apt. no.: Project name: Murphy Residence Addition Covered porch area: 0 square feet Cross street/directions to job site: Won Walnut, Son 135 Son Hillshire Deck area: 0 square feet Other structure area: 0 square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Hillshire Lot no.: 66 Permit fees* are based on the value of the work performed. Tax map /parcel no.: 2S104CA06600 Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Add 22 square feet by cantilevering kitchen wall 2' Valuation: $ - t Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT Number of stories: Name: Paul and Jeanine Murphy Type of construction: Address: 13350 SW Hillshire Drive Occupancy groups: City/State /ZIP: Tigard, Oregon 97223 -5601 Existing: Phone: (503)579 -3262 Fax: ( ) New: e APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES* Business name: KHI Construction (Please refer to fee schedule) Structural plan review fee (or deposit): A6 iL ] qj Contact name: Peter Warnke 1 FLS plan review fee (if applicable): - Address: 3201 NE Wynooski Road 1/ Total fees due upon application: City/State /ZIP: Newberg, Oregon 9713 Amount received: • Phone: (503) 554-8601 Fax: : (503) 554-8659 �yj , t - / E -mail: peter @khiconstruction.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System. Business name: KHI Construction Submit two (2) sets of roof plan with connection details and fire department access, along with the 2010 Oregon Address: 3201 NE Wynooski Road Solar Installation Specialty Code checklist. City/State /ZIP: Newberg, Oregon 97132 Permit Fee (includes plan revie $180.00 and administrative fees): Phone: (503) 554 -8601 Fax: (503) 554 -8659 State surcharge (12% of permit fee): $21.60 CCB lic.: 145950 fee due upon application: $201.60 Authorized signature: �� This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Peter V1 Date: 03/04/11 * Fee methodology set by Tri -County Building Industry i' Service Board. l:\ Building \Pennits \BUP- RESPennitApp.doc 02/24/2011 440 -4613T(I 1 /02 /COM /WEB) 03/03/2011 15:50 50359B196e _ organ ' � � CITY OF TIGARD PAGE 01/01 . r Electrical ,Per pplicattion 1 1 irk , , II, I. I .r r,, l ,. City of Tigard ,!-�,v "��� 503.639.4115 Raeevroa 13125 SW Hall Blvd., Tigard, ORk9,Ti Dor=m y � ; � Fannie Nn,: l ` j _�(} Phone: 503 718.2{39 flax: 503.5411.1960 :t a P on a t r i Review ■ taupeetion Lino, ;: �,' Ure : fiber vOm+it • Internet a^+�o.titwrdvr, oar _...,M1 r �)0 i 1 y c y 7 6 t Notl la pre,. 2 for - C J.rl.F Sappremrnmllnrorma6on . TYPE or. u. ' U • tSWW . ❑ New construction ❑ Addition/al * t2a'ement Place clock afl dm. DI Demolition Z1 Other: ❑SOrviecaradar ma (rubmu ten of plans Wilms eAeeked(e1:w): or 1111(5f8 0 P■ndiat; over time Orrice. CA7EGQFtY OF CONSTRUCTION who thew snarls halt current ❑ Mary a� and hyryarda. ereerde 10,000 amp; or ISO erelq et ❑ Fleeting SuildieAa, ❑ 1 and 2•family dwelling ❑ Commercial/industrial ❑ Accessory building I01 IC Pound, or emceed, 14,000 Cl Commercial use sprieuttunt ❑ Mu lti- (amity ❑ Master builder *mpg u for all o her;nrrapnebne Setts bedding'. ❑ Other: ❑Fire pump, ❑ 1ae a0atron rrf74 KvA or JO WF'ORMATION' AND LOCATION ❑Emerpaney syrren. laegar t■rron* derived 'rum. 1:1 Ad:trirm of new motet lend of Cl p - "A• "- 1..2"."1.3'. Job p0.• Job site address: 1 335v 0: : ,t,� t0oltper more. • occupancy. Ci tyfStah /ZIP �� 0 Six or roots reaN Me. a. ❑ Recreetionr I whiele parka. 01 1 ,m itiea O[ ive O Si>pply wing: fly core It,. Sultefbldg,lbpl , no.: Project none M p 42.terdone o.O. r.;cariay 000 soil' nominal. 17 Harar e.. or feeder 100 unre3 or more. Cross slrCCt/dircctione to job site F8� ICr�bt1B^ _ arrc 1 - Qtr. f rri. I reset New residcnlial'single. or Multi- famlty dwelling unit I Subdivision: triclinic' attached garage. Lot no.: ODD vq, ft, or ksa 168 - 54 4 Tex map/pareol no,; E. add'I500 ft, or portion 33 92 l DESCRIPTION OF WORT( Limited b veeaq. A adeatinl 2 �p y, 7100 ►^• � q +.1r,`�� Q 1. - Limited energy,multl•Ihmily, 1 7 rtOksenti0l (with above RI ik 5 .00 ) 2 Services or ferias inalallation and/or relocation 1 D Paort>Klr'Y R 200 mops or km ')0.70 2 • ❑ TENANT , amps in 400 amps _ 133,56 Name: 2 401 amt so 600 amps 200.3a 2 601 amps to 1.000 amps 301,04 2 Ova 1.000 amts Or volts 552.26 2 Temporary remit-ea tar faders installation, alteration, indfo Plwno: ( ) slocitloa Fax: ( ) 200 amp(or Ica; SD.36 Owner In1t jtation: This installation is being made on pmnetty that l Own which is not 201 amps to 400 amps II intended for Sale, lea rent, or exchange, according to ORS 447. 449. and 701. 12a Ot d 401 temp to S99 amps 16t_S Owner xignatlore. Branch eirettita- ntw, iltrratioa, or e:teasion, r Panel Date: -�� � � Plc f or ❑ ,t1RLIC)uI A branch circuits sober • 0 ' orrrACtf PERSON above service Of feedar ice, name: Business n oath branch circuit 7,42 2 Cosines name: COPS , AoEx .a'•1 a, Fee for branch circuits , /,hors, 1 b. . i . c i t feeder fee, fine `.- blanch inW I Address: � j} C Each add'( bench circuit i(. r 7 �© City/State/ZIP tltiaceMneoua service or feeder not included) pp,. R k 2 Each manufactured or modular Phone: dwell ' • acrvice and/or feider 67 2 �) %A - at 3 Fox ::( ) 67 . 14 El E-mail: t , r . I1 CaWTkAG`><AE si oroutline ti• tins � 67. 84 © Business Dame: C: &gearcirc n or orii rtrite y Mi© C: .anti alteratioextamma, %j hr min Address; d !1 Q�♦ k-7 kacM addit u lea •eetf . over allowable in ■ Cry /5tatc/ZIP: •V Y } �C the above �- OK, �• (�p // ��� �� 13 c � � 66.291 hr • � shone ) 6FCIr:� Fax; ( r� r� ! sndu'tti plant l hr min) I :: Q i, ) �/ tnfpari on' sm wit ich no It i a• CCIt Lie,: ctir,call li ;ce � s Suprv. Lie.: Z.. S Suprv. Electrician Signature, required; I RL16LL1RtCll� r 5 ubfoluC Pont name: s a Plan re.cw (157 of • cal fee J c_ Dec: i ;archaize rchaize (12% of permit fee): Authorized signature! TOTAL PERMIT FEB; Print name: f. T )eu peones da pllcatlant heexpires Date: r dare a her it ben p e ;kd i � � obniaed south, tap been s e s , l , 1\an,M w■ e Dr..eh.W , GPamitAry.00C Omli /7e Number of iny,.eripre al owed per pc Milt. 440441 ST(I 1/OS1 Ce:�NJAyss T ' d xdd l dH WdzE B T T OZ 60 --.114 Plumbing Permit Application Building Fixtures VS) FOR OFFICE USE ONLY ved 1114 • City of Tigard Cj\ O Date/By: Receiive Iy� Permit No.: r /1 u IL � 13125 SW Hall Blvd., Tigard, OR 97 Phone: 503.718.2439 Fax: 503.598. 960 - ?i Plan Review e`v O Permit No.: Inspection Line: 503.639.4175 See Page 2 for TI 00( Date Read Y B y: . .rip Internet: www.tigard- or.gov r . ,. Notifed/Method: LY Ik" ® ee g Supplemental Information TYPE OF WORK i . °( C Y- 15 FEE* SCHEDULE ❑ New construction ❑ DexgolIfion For special information use checklist Description I Qty. I Ea. I A-Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 744.- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 building SFR (3) bath 500.32 ❑ Accessory g ❑ Multi- family Each additional bath/kitchen 25.02 . ❑ Master builder ❑ Other: Fire sprinkler (_ sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: `3 3.90 51, - \ -- ) c ' \,,, ` t -� - ems. Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City/State /ZIP: T 02.-.._ Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: J r Project name: Manufactured home utilities 50.03 Cross street/diredions to job site: J Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 --k:C p e -AN -. .%-.9:=1-e\ l `e- ' Dishwasher I 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 `` ROPERTY OWNER I ❑ TENANT Expansion tank 12.51 (1 C 3e1 . ; �,� n Name: tZt.�� GY+nUt `I`� Fixture /sewer cap 25.02 - Floor drain/floor sink/hub 25.02 Address: Garbage disposal t 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: ��� r ,,c b1/4-1,--C..-k... WTh Medical gas (value: $ ) Page 2 C �, r Primer 12.51 Contact name: �iA.z-_' ( Y l Roof drain (commercial) 12.51 Address: 31,1 Ne 1,- l�' iNA - Sink/basin/lavatory ' 25.02 1` City/State /ZIP: r 9 7 (3 Z Solar units (potable water) 62.54 Phone: (co")) "7$"(i - 9 3' ) U I Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: (�,��� l Ct � � t�nC �r�r � Urinal 25.02 ��'"""�� CONTRACTOR Water closet 25.02 , Water heater 37.52 Business name: R;�A (W Water piping/DWV 56.29 /M/j Address: i&h 5 ,�J Lci. f 4 Q r - Other: 25.02 City /State /ZIP: lr--}-/ "� t _ " _,� a I ),A-1 _ Subtotal �� ' L Minimum permit fee: $72.50 Phone: (�-I ) ( 9tp q Fax: ( ) g/ , Plan review (25% of permit fee) CCB Lic.: 1 7 5 1, V 1 Plumbing Lic. no.: 37 V /Ii 13 State surcharge (12% of permit fee) Authorized signature: y , ------s TOTAL PERMIT FEE Print name: C' :0, �,,G -L-`� �� Date: / //j This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. 1:\Building\Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1' 100' 50.03 0 to 2,000 $121.90 Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer - 1st 100' 62.54 7,201 and greater $327.54 Sewer - each additional 100' 37.52 Water Service - 1st 100' 62.54 Medical Gas Systems: Water Service - each additional 100' 37.52 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 62.54 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for Other Ins ections or Fees Qty Fee (ea) Total each additional $100.00 or fraction thereof, to p and including $10,000.00. Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to (minimum charge - 1/2 hour) and including $25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to Reinspection Fees 90.00/hr and including $50,000.00. Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for (minimum charge - 1/2 hour) each additional $100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping, adding or replacing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Quantiy by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Work Performed: Capped Added Relocate Plan review is required for any of the following. Baptistry/Font Please check all that apply. Bath Tub /Shower ❑ Any new commercial building with water service 2" and Jacuzzi/Whirlpool greater, except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918- 780 -0040. Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care facilities. - Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure as defined in OAR918- 780 -0040. Eye Wash Floor Drain/sink - 2" Submit 2 sets of plans with any of the above. -3" Isometric or Riser Diagram Car Wash Drain Garbage Domestic ❑ Isometric or riser diagram is required for new buildings Disposal - Domestic related that meet the qualifications above. - Commercial -food related - Industrial -food related Ice Mach./Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall • Sink/Lav - Non -food related - Bradley - Commercial -food related - Service Swimming Pool Filter *Note: If the fixture work under this ermit results in an Washer - Clothes p Water Extractor increase of sewer EDUs, a sewer permit will be issued and Water Closet - Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: I:\ Building \Permits\PLMF - PermitApp.doc 2 Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard � D a e/B Permit No • 13125 SW Hall Blvd., Tigard, OR 97223 �'` [� 1 `l jam✓ Plan Review Other Permit Phone: 503.718.2439 Fax: 503.598.1960 Date/By: T I G A R D Inspection Line: 503.639 — `'S ( Date Ready/By: Juris El See Page 2 for Internet: www.tigard or.gov k \ 10 Notified/Method: Supplemental Information TYPE OF WORK C l u ,q-.1170. 5 �, COMMERCIAL FEE* SCHEDULE – USE CHECKLIST 6 A \ Ar Mechanical permit fees* are based on the value of the work ID New construction lddition /alteration Cement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* X 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: 7 ^� Air conditioning Job site address: \ 3/ f� /7 ( 51,,_.; j C' � C 1, - (requires site plan showing placement) 46.75 Furnace 100,000 BTU (ducts/vents) I 46.75 City/State/ZIP: T i ©° Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump (requires site plan showing placement) 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 Subdivision: Lot no.: Flue/vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 23.32 V ; tom\ ; �' 01.1 / a i Gas fireplace 33.39 V� Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 ❑ PROPERTY O'YNER I ❑ TENANT Chimney/liner/flue/vent ` Other: 23.32 Name: Q l l 0-e_. �c.,.. � Environmental exhaust and ventilation: Address: Range hood/other kitchen equipment 1 33.39 City /State /ZIP: Clothes dryer exhaust ( 33.39 Phone: ( ) Fax: Single -duct exhaust (bathrooms, ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32 /_�� � Business name: k<1.\ (11, l , Other: 23.32 Fuel t m P P g: Contact name: (,,0 $14.15 for first four; $4.03 for each additional Address: 57,C2 1 i\[_ v.)J ,S/ . Y \ ok_ Furnace, etc. / a Gas heat pump City/State/ZIP: .� C [ 7 f Wall/suspended/unit heater Phone: (9t) 75 �p3 7 Fax: : ( ) Water heater E -mail: i�� Kit t C%,r_st-('� ..6-_ -F.) �\ Fireplace Range CONTRACTOR Barbecue Business name: 5 Clothes dryer (gas) �{�'�" 61 i.��J Other: Address: /2 U (1, X l MECHANICAL PERMIT FEES* Cit T !a) d/- q 70 Subtotal Phone: (�3 ) ( 5' 5 re / Fax: 6 6 9' / 6,375 Plan review (25% of permit fee) CCB lic.: f / State surcharge (12% of permit fee) TOTAL PERMIT FEE Authorized signature: 9,---e.--- This permit application after it been expires if a permit is not within 180 days after it has heel accepted as coo mpleplete. Print name: r Ke____ I Date: 37/(i • Fee methodology set by Tri County Building Industry Service Board I:\Building\Permits\MEC- PermitApp.doc 09 /09/10 440-4 l 7T (11 /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. 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