Permit I . - CITY OF TIGARD MECHANICAL PERMIT
I u COMMUNITY DEVELOPMENT Permit #: MEC2009 -00398
Date Issued: 08/05/2009
TIGXRD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S104DC04100
Jurisdiction: Tigard
Site address: 13534 SW CLEARVIEW PL
Subdivision: Lot: 0
Project: Beale
Project Description: Installation of (3) exterior wall mount a/c units.
Owner: FEES
BEALE, ALLEN M & Description Date Amount
SRIWALLOP, SUMUNYA J, 13534 SW Air Conditioning or Heat Pump 08/05/2009 $42.00
CLEARVIEW PL
12% State Surcharge - Mechanical 08/05/2009 $8.70
PHONE. Minimum Fee Adjustment - Mechanical 08/05/2009 $30.50
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
issu , or if wo ' suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
U ' ity Notification Cent- Those :re set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules
direct questions to OUN • • , - ng 03.246.6699 or 1.800.332.2344.
I
_
I sued By: ` t� i / Permittee Signature: t4� ` e
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 Applicati ^ C FOR OFFICE USE ONLY
City of Tigard Permit No
13125 SW Hall Blvd., Tigard, OR 97223 A l) I1 052009 Plan Review
• _ Phone: 503.639.4171 Fax: 503.598.1960 Date/By; Other Permit:
T1'GARD Inspection Line: 503 639.4175 CITY OF TIGARD Date Ready/By; I See Page 2 for
Internet: www.tigard- or.gov BUILDING' DIVISION Notified/Method; / eQ Supplemental Information
',��A„.. �:-'. '° i " p i ��:ex:.?.4�s -.. .,.: r -s.; ::.r� , _:3: va .?.:y . soFr .,a+a�:e_s�; =^=a �zxa ^�.._.wY', :, �s*:�•�x?.;...; =;s` , -s �.sr: +ck >.-: -;: -H ::.
"�•ti „_,, �'�"kM Mxs r a 8<.x".` 4;iF�� ?�..:._„ , f .i,�'� �: �.p y_ w E: � *'t^'. � �., '�.
• � .> � : _,�I. 4� �w.r . , TYPEOF' WORK °,:,�`°`�. f ���`°` � � COMMERCIAI��`T�EE CHEDUL USECII�ECKLIST
❑ 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.
::F^*- ;�*ya"� '� ar'r s.�. =: �': �,. `w. s� " -. m : =;�,'. � .,, r,zcss>�.,,�,�.�x.z�::�:;:': -.:-' -.,;` ar ir3�?i:r'�' �s �� s �.". -4? Value: $ � v
RESIDENTIAL E CF[PMEN v'/ SYSTEMSFEE
S *�;
1-and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
� ,;,sr '< _»..er:.x�::::: :•:,i+. ,;:=mn �-°a, ;,:i�. *wf�"�- aura- .:rta
�` JOB'hSTEINFORMATION AND ~LOCATO
' xn�r '�.� -... z, '.,'�,,�•:�" Heating/cooling
� � Air conditioning or heat pump
Job site address:
� �� 5 � � �2C�4"�[ f �w ( (requires site plan showing placement) 14.00
City /State /ZIP: --_+ a� Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: A C ' 'l S4 LP1 Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
�7 ] Hydronie hot water system 14.00
l � I Pra+�U iet.F l )'. le t4 c' L4 L yc& t - Residential boiler (radiator or
cr/ ^ I hydronic) 14.00
f L , kJ; �l�l Y'O1.(- (A/((t a t... "rf a Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
i7 '- 1 - Lot no.: Flue /vent for any of above 6.80
Subdivision:
�f1 vi ) �� r� � I Other: 10.00
Tax map /parcel no.: Other fuel appliances
Water heater 10.00
Gas fireplace 10.00
j 't I &ii( 3 s pl i1 t\( & v 1S Flue vent for water heater or gas
f7 fireplace 10.00
t
+A(
o� `1000 7l' / ( X �� 0O Uk Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
FROPERTY�OWNER '� �_ '�� .TENANT r.ra ":. Chimney /liner /flue /vent 10.00
��:. _$ �S '" r si Other: 10.00
Name: /� L ''A'. a�� /� Environmental exhaust and ventilation
Address: I'-� "�J l Range hood /other kitchen
5C 34 6(L) e lei_-v)eG.4_) F (, equipment 10.00
City /State /ZIP: " Q � O Clothes dryer exhaust 10.00
I / Single -duct exhaust (bathrooms,
Phone: Fax toilet compartments, utility rooms) 6.80
PIF1i1NT ' , ; ..x ry � CONtIACT�PERS011 g 4 ''. a 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
CONTRAC �1�tYD3.°AY;".A.:�:
,•,.� ° b i - -;: .< �n.:y°• . �µs. <`..!:,i.`.'"#� „. ".., :*•"",".»s«::'�ii:'s:':'''s5h'n '. `°r"M'..
srfOR�� �.t�.; �.,�: �.� f � . �; Barbecue
Business name: . Cloth dryer (gas)
/ .'
Address: i ' i1 ) tt„= "s• � ... � � � *� �a���tr�;sv�
/ `/
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) �a •
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee)
TOTAL PERMIT FEE
` This permit application expires if a permit is not obtained lk
d in ISO
Authorized signature:
�_ days after it has been accepted as complete.
Print name: ,, R A , Date: t * Fee methodology set by Tr-County Building Industry Service Board
I.\ Bsilding \Permits'MEC- PermitApp.doc 01/19/07 440- 4617T(I1/02/COM /WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total" Va1 Pe „_ ..# ..
$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