Permit J
CITY OF TIGARD MECHANICAL PERMIT
14
• COMMUNITY DEVELOPMENT Permit #: MEC2009-00306
T (GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/24/2009
Parcel: 2S103AD04100
Jurisdiction: Tigard
Site address: 13020 SW 107TH CT
Subdivision: PATHFINDER Lot: 31
Project: Dillon
Project Description: Install furnace.
Owner: FEES
DILLON, DAVID M /ANASTACIA M Description Date Amount
13020 SW 107TH CT Furnaces < 100K BTU 06/24/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 06/24/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 06/24/2009 $58.50
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
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: :'� c � C , f I q @ i� Permittee Signature:
\ (� �__1
' -�` l \ � 1nl JL, ''��s
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.
Mechanical Permit Application RECEI I FOR OFFICE USE ONLY
1:9 � . 11'
City of Tigard Date/By: Permit No.: 1 � _ i OA _ ,
13125 SW Hall Blvd., Tigard,OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 JUN 2 4 EiD tiBRevyiew f Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: OE ® See Page 2 for
Internet: www.tigard - or.gov CITY OF TI f ' l ed/Method: Supplemental Information
BUILDING DI I I
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Ea Addition/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
.� j r j _ Air conditioning heat pump
2 � � � �� �
Job site address: I ( - ((� �� (requires site plan showing placement) 14.00
City /State /ZIP: ' Ona r A tr '72/2--3 Furnace 100,000 BTU (ducts/vents) 1 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
1{\ "A k t c Q 4A A If It1Q QQ Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
PROPERTY OWNER ❑ TENANT Chimney/liner /flue /vent 10.00
Other: 10.00
Name: ci- • <, ! L L Qr\ Environmental exhaust and ventilation
Address: 13 020 5 (t) I 0 7104-- equipment hood other kitchen
equipment 10.00
City /State /ZIP: a U 4 -7 2�3 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (% ) -0 3 I -7 Fax: ( — ) -- toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: Fuel piping
Contact name: $5.40 for first four; $1.00 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: Clothes dryer (gas)
0 Address: W6-Qcs- Other:
MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) - 7 Z . 30
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) 0
TOTAL PERMIT FEE 2 C)
/ / �,,/ 1 / i / ` This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: it ' _ ` �� Date: �� o g • Fee methodology set by Tri- County Building Industry Service Board
I: \Building\Permits\MEC- PermitApp.doc 01/19/07 440 -4617T (11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I:\ Building \Permits\MEC- PermitApp.doc 01/19/07 2