Permit CITY OF TIGARD MECHANICAL PERMIT
s §
2 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00455
T1GA:RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/28/2009
Parcel: 2S103AA01704
Jurisdiction: Tigard
Site address: 10775 SW ERROL ST
Subdivision: Lot: 0
Project: Rosche
Project Description: Replace a/c maintaining 3' setback from property line.
Owner: FEES
ROSCH, MERIDETH Description Date Amount
10775 SW ERROL Air Conditioning or Heat Pump 08/28/2009 $14.00
972
TIGARD, OR 97223
12% State Surcharge - Mechanical 08/28/2009 $8.70
PHONE. Minimum Fee Adjustment - Mechanical 08/28/2009 $58.50
Contractor:
JACOBS HEATING & AIR CONDITIONING
4474 SE MILWAUKIE
PORTLAND, OR 97202
PHONE: 503 - 234 -7331
FAX: 503- 808 -9108
. Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
•
Issued By: n ' n� ^ Permittee Signature: O00 � ��
V ` �� l Call 503.639.4175 b 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application RECEIVE EEiew '� ♦ Permit No FOR OFFICE USE ONLY
/ 13125 SW Hall Blvd. Ti ard, OR 97223 t> ., ° Phone: 503.639.4171 Fax: 503.598.1960 ' I1 �' 10Pl
Date /By' Other Permit:
Inspection Line: 503.639.4175 Date Read /B ® See Pa
TI GA g g CITY CIFTIGARD Rea /By: e 2 for
Page
Internet: wtvw.ti ard -Or. ov otified/Method: Supplemental Information
BUILDING DIVISIO _
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'* �:% `°..';�� _,_,. TY,PE:, ,• . �• ��:,,,,`��.`:. °. .�,� - .COMI�RCIAL � aE� SCHEbiJLEu' [JSEJCFIECKLIST.-
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❑ New construction z7I Addition /alteration /replacement Mechanical permit fees* are based on the value of the work .
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
1 -and 2-family .,• `9 RESIDENT I1L*FQIIIPMEtNT / S} STEMSFEES *$' "" ' j'
y ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
� �,'�:,s _,.,,,
JOB SII %INF®RMATION, AND OCA ON � ,. a w Heating /cooling
p r Air conditioning or heat pump I
Job site address:
l 7 7 5 5 (.L) E2- i-r. -t_ .& 7 (requires site plan showing placement) 1 14.00
City /State /ZIP: 7 0 ,� c77ZZ3 Fumace 100,000 BTU (ducts /vents) 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: Ductwork 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
>xx's; <°,r`' +:A :":;.'£i��`.?,. _,. „,.... a:•' ?. vnz�s :•sW;y= ;�.:ax:..,..;t:.x -:syrw 4* *;c-,r,r= �:t;',.x-'x.;:;,ax; ,x ,,,e..._tr >,..;a•;,;; Water heater 10.00
Gas fireplace 10.00
A / C - 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
�. Via^+ =,.� ;�4,,, �±�vsx.x, -•same a.- aa-�.M .` b.�s".�-�:.. � i� ^ u ._ .�..�,.n��,, .�...�,� _> ..:tee_ °.; »z'.xy� -... � _ ..�ss:,�xiY.3; -m��s� OthCC I �.�0
Name: /i e'r ; 71 ¢ ---J--n Environmental exhaust and ventilation
A Range hood/other kitchen
Address:
j 07 S iJ AIL IL-e -Q equipment 10.00
City /State /ZIP: '77 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (50 ) 7 o .i ' — 9 / S3 Fax: ( ) toilet compartments, utility rooms) 6.80
.���,.. , ,•x, � -�..� t �. . .,� -��� � �;, .
;.` Attic /crawlspace fans 1000
° �- �. tAYi,P�ti�� NtT' , � � � COTACT..,PERS,ON
. 3” �C r �... �" ."'.,',�""�'�".,�swa�A v.•��^ -ns, N«'.,x _.'�.s... .. ..�r. = , s� "���z�a:'s^ti��*
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
,�s � ;�..
CON112 Cr, )ir W! .., " _ : Barbecue
1 •Business name: Clothes dryer (gas)
Other:
1
Address: 14 L 4 Cyj fr tj It
City /State /ZIP: d t 12 Q / Subtotal
Phone: Phone: 3 f a k Fax: � � Minimum permit fee ($72.50)
� ' ' �`.' _l 9 -
CCB lie.: ' L9' State surcharge (12% of permit fee) p
TOTAL PERMIT FEE V ( r Z Q
a uthorized signature: L`� This permit application expires if a permit is not obtained within 180
�� c�j days after it has been accepted as complete.
Print name:- /'1 t r l f Giy Date:
/ * Fee methodology set by Tri- County Building Industry Service Board
7 D �
l" Building \Permits \MEC- PermitApp.doc 01/19/07 440- 4617T(I I /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
� °S"`.',-"�°'`:a���'�`�w >�.� -;v �.>?$�zi: -.t� ': a, o. Y^ • �;::'si:?:;;':;- ;'- i� =."'`ra� .
I gtalVal A MPerinit 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.
l:\ Building \Permits\MEC - PermitApp.doc 01/19/07 2