Permit , F7
CITY TIGARD MECHANICAL PERMIT
°` :41 DEVELOPMENT SERVICES PERMIT #: MEC2003 -00733
c i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/29/03
PARCEL: 2S 110AB -04600
SITE ADDRESS: 11430 SW GAARDE ST
SUBDIVISION: PP1996 -069 ZONING: R -4.5
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm:
GAS OUTLETS: 1
Remarks: Replace furnace
Owner: FEES
MARK HEINS Description Date Amount
11430 SW GAARDE ST
PORTLAND, OR 97224 [MECH] Permit Fee 12/29/03 $72.50
[TAX] 8% State Surchart 12/29/03 $5.80
Phone: 503 639 - 2773 Total $78.30
Contractor:
RONALD E. WHITAKER
13400 SW 17TH STREET
BEAVERTON, OR 97008 REQUIRED INSPECTIONS
Phone: Gas Line lnsp
Duct Inspection
Reg #: LIC 131187 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
Issued By j..-P//9 Permittee Signature: a „�C i- 4� Z"4
Call (03) 639 -4175 by 7:00 P.M. for inspections needed the next business day
t
Mechanical Permit Application FOR OFFICE USE ONLY
CI of Tigard Received Permit No.
` g Date/By G. a 0 ii - _a 0 - !)v 73
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 //�mraNlt�P (,t Date /By: Other Permit:
Inspection Line: 503.639.4175 ■ a!' Ii Date Ready /By: Juris 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
,; -:�•' .: t . a�iz�a: •;, -*:.a,� r:_ ;'9 r; z"�: ',:!;�..,,} - + °fix t v ,, ...,�a�;��.e.a ,,�:, .,. -s� - � '
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'�, ,.��., . � 1 - -' .. +�:�;��' ° iTI'4PE ?iOF WORK =,: � »_ �wr _ . ���;t�, g � - COMMERCIAL FEE SGHEDULE.�;,=
t , �Ci � �, �t�n�`�,��ds`Ks..a.'.� ".r.�,��xi n< r.•, =�.��,:�.�x,�., � =:y� �`a�' ,. ' zt ;.,. • r '^ , �� >k:�• „�Ea,*��.� .t %�,<�;.�.,<,.,,a ..,_,,.,. ..,. �., :, ... � :.. ..x:.. r,: :,,
Mechanical permit fees* are based on the value of the work
❑ New construction ,z, Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
... .tx` <'s , a1 Value: $
ut „ . 11 1 V e r..4:r�? CATEGORY ..PF uCONSTRUG /rip,M ,,,,* . s ,,O .._...ems '- - . < ,.. • s, #.. .. .. T
_
RESIDENTIAL EQUIPMEN /SYSTEMS;FEES*
1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building _.
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea, Total
«?;'"���:� ��n �"n: -- xF - ..:a�.� `��:��rvussr*;�.��.:, <» :^ w � .w�
ktI YRII `1 JOBEjSITEs'INFORMATION AND LOCATION Heatin
.; ? 'wit Ili._.F - ....„. at ,v,..ar...,.< w:- a.�.... ,. n, - r ....n- °...;_ .. ,,,,4
Air conditioning or heat pump
Job site address: j 1 450 5/ 6 ' 6 (e (requires site plan showing placement) 14.00
City/State /ZIP: ( „-,r"' , f\--,k) 0 6P Fumace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90 )e,_
' Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work i 14.00 / y 17
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. 10.00
Flue /vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
;. , .._ ,..,rP4 - 1 ..,; ru s ,g ,_ �r „rs a ,, _ ,: t• "° ". r: S"etit :i; ° "'"'F� Water heater 10.00
.'.w�p x'i g atE i P >'` Niti SGR OF WORK ' WO. r eNi I IN0 ..M
Gas fireplace 10.00
� j' t' F- 12 /✓ /Z-�rr 16� h/ i.,., Flue vent for water heater or gas
fireplace 10.00
/A Lys-fa J rC (6..5-P-,9 . Log lighter (gas) 10.00
. Wood /pellet stove 10.00
Wood fireplace /insert 10.00
t , a�i € . ._ `;§ TENANT' . "� . _ f Chimney /liner /flue /vent 10.00
M' ? j . , : PROPERT .4 NER � k.: 2'F. i i, :444'n 6,1 . ,. l .,. . . ,Age 4i , :: Other: 10.00 _
Name: /14 vt % t /Ns Environmental exhaust and ventilation
I I Range hood /other kitchen
Address: )0.50 S a�� - l . O $1 equipment 10.00
City/State/ZIP: .--1 !1 Clothes dryer exhaust 10.00
1 Y' Single -duct exhaust (bathrooms,
Phone: (s ) 2» 3 -2 773 Fax: ( ) toilet compartments, utility rooms) 6.80
r, : . :, �.,, „ mk:ikra = ;ice`; >. r TACT P T, ,,,, ,r,,V -,' ., '�V. rr: i lace fans 10.00
Attic/crawlspace ` n "1 � ® APPL VORY:i� ' w GQNTACTl PERSONI � P
4 Other: 10.00
Business name: I R O 4 ',J 1 E. L
. � /r 1- (74 -f�G_ Fue piping
YY P
Contact name: fe.,A) $5.40 for first four; $1.00 for each additional
Address: tyro Furnace, etc.
j� S� I b l ✓ I Gas heat pump
City/ ate /ZIP: ,,. •(' a D Wall /suspended /unit heater
P .ne: ( ) 7 C9 g( Fax: : ( ) Water heater -
Fireplace
I -mail: Range
s ir•W ,; R) � 'CONTRACT i alta g t ' a°'`, „€, 71r 1 r' ; Barbecue
z a.., :. . e_ t A = , s _ , x..,x,H._. .Lti ass _ ,'1- ...a: -k get -.s .
Bu Mess name: ��' / ✓�U `E LJ q r72 �1 f ir- Clothes dryer (gas)
yyyy t 1 Other:
Addr: s: t ;^ `s w MECHANICAli, PE,,, ft F ;
City/State ZIP: Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lie.: /3 / ( 0 p "2 State surcharge (8% of permit fee)
TOTAL PERMIT FEE
signature. This permit application expires if a permit is not obtained within 180
Authorized si
days after it has been accepted as complete.
7
IS * Fee methodology set by Tri- County Building Industry Service Board
Print nam • - v / Date:
i:\ Building \Permits \MEC- PermitApp.doc 12/03 440 -4617T (1 I /02 /COM /WEB)
•
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
- .. <��� °,... �.� � ° ':�`;: : a�,�' rt?:s
< T.ota'l %valuation y. # t t'ew�rxutr.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.
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