Permit CITY OF TIGARD MECHANICAL PERMIT
. . : <„ COMMUNITY DEVELOPMENT
Permit A. MEC2011 -00475
Date Issued 10/26/2011
TIGARD. 13125 SW Hail Blvd , Tigard OR 97223 503 718 2439 parcel 2S102CA00215
Jurisdiction Tigard
Site address 13185 SW ASH DR
Project LOUW Subdivision VIEWCREST TERRACE Lot 13
Project Description Furnace replacement
Contractor RIVER CITY HEATING & COOLING Owner LOUW, JAN PETER A
9220 SW BARBUR BLVD STE 119 -201 PO BOX 230624
PORTLAND, OR 97219 TIGARD, OR 97281
PHONE 503 - 591 -9950 PHONE
FAX
FEES
Specifics' Description Date Amount
Furnaces < 100K BTU 10/26/2011 $46 75
Type of Use SF 12% State Surcharge - Mechanical 10/26/2011 $10 80
Class of Work ALT Type of Const Minimum Fee Adjustment - Mechanical 10/26/2011 $43 25
Occupancy Grp
Stories
Fuel
Fuel Types
Gas Pressure
Total $10080
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_Q nter Those rules are set forth in OAR 952- 001 -0010 through OAR 952 -001 -0090 You may obtain a copy of the rules
or direct qu stions to ObNC by ca14 5 223322 1 987 or 1 8 00 332 2344
Issued B( J / \1 /l / ' � ✓ 0 -- Iti L. Permittee Signature .. -A' _/
Call 503 639 4175 by 7 00 a m for the next available inspection date
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 FOR OFFICE USE ONLY
11 q City of Tigard (NcS ` \i . BE • Permit No ;VI
13125 SW Hall Blvd , Tigard, 0[L p7223 $ 1 -� . �'ss�
B ' 9 ') f+" Plan Review
�; Phone 503 718 2439 Fax 503 98''1960' Date/By Other Permit
TIGAgU Inspection Line 503 639 4175 C•` 2 11-° D ate Ready /By ® See Paget for
Internet www tigard gov O G PO Notified/Method Supplemental Information
atri TY OF WORKAG V(v ry COMMERCIAL FEE' SCHEDULE - USECHECKLIST
x3;V! Mechanical permit fees* are based on the value of the work
❑ New construction Addition /alto ation /replacement performed Indicate the value (rourded to the nearest dollar) of all
❑ Demolition ❑ Other mechanical materials, equipment, labor, overhead, and profit
Value $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other Description Qty La Total
JOB SITE INFORMATION AND LOCATION Heating/coohng•
-1 w ` tx Air conditioning
J
Job site address ' t Y j 5 S. S `^ Q ( (requires site plan showing placement) 46 75
1 Furnace 100,000 BTU (ducts /vents) { 46 75 F /( a ,15
— 7 1‘...a
City /State /LIP o o\ t 0 , on /Cs Furnace 100,000+ B I U (ducts /vents) 54 91
Sulte/bldg /apt no Project name L Ci ��,o I teat pump
V (requires site plan showing placement) 61 06
Cross street/directions to Job site k S i c . A c `x Q Duct work 23 32
Ilydronic 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
fax map /parcel no Other fuel appliances:
DESCRIPTION OF WORK Water heater 2332
5 Mk-Lek Gas fireplace 33 39
4 � ire pl,flreM Flue vent tor water heater or gas
fireplace 23 32
Log lighter (gas) 23 32
Wood/pellet stove 33 39
Wood fireplace /msert 23 32 _
1:1 PROPERTY OWNER ❑ TENANT
Chimney/liner/flue/vent vent 23 32
Other 23 32
Name J 'T 0,, ,.-, old ■n i Environmental exhaust and vennlation:
Address ) 1 k Q 5 CA t N ;y S s ., cJ f
Range hood/other kitchen 33 39
City /State /ZIP \ s . . O ar A Ur t- 1 - t) Clothes dryer exhaust 33 39
/ i Single -duct exhaust (bathrooms,
Phone (SO1) 4 1.... 3) Q Fax ( ) toilet compartments, utility rooms) 23 32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23 32
Business name Other 23 32
Fuel piping•
Contact name $14.15 for first four, $4.03 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
n Clothes dryer (gas)
Business name
Tl1 ts. C k i QANcnc k c n,\s s Other
Address O 2 7, o S u p,„„ 6 „ ps .,_, s4„._ \\(:)-16 1 MECHANICAL PERMIT PEES'
City /State /ZIP ? 0c'\ \q , d L Subtotal
Minimum permit fee ($90 00)
Phone (50-5) 6 Fax ( ) Plan review (25% of permit fee)
CCH he i 6 2q t-} V ,(K /i3 Stale surcharge (12% of permit fee) �y.�
TOTAL PERMIT FEE MO' d /
Authorized si nature I his permit application expires if a permit is not obtained within 180
6 l✓ /
f�� days after it has been accepted as complete
Print name 7
9-0 1 60 . Dale I 0 /t 6/3 l • Fee methodology set by Tn- County Bu lding Industry Service Board
mgNe
I\Buildm,isWIFC- PermnApp doe 0 440 -4617T (11 /02/ OWWEB)
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
Note: All new commercial buildings require 2 sets of plans.
I \ Building \Permits \MEC- PermrtApp doc 09/09/10 2