Permit CITY OF TIGARD MECHANICAL PERMIT
1 : -. COMMUNITY DEVELOPMENT Permit #: MEC2011 00488
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Date Issued: 11/01/2011
• Parcel: 1 S135CD09900
Jurisdiction: Tigard
Site address: 9815 SW PIHAS CT
Project: Plotz Subdivision: 1999 -073 PARTITION PLAT Lot: 1
Project Description: Replace gas furnace
Contractor: GASPRO INC Owner: PLOTZ, JESSE R
7603 SE LOUNSBERRY LN MCCAULEY, JULIE A
PORTLAND, OR 972056 9815 SW PIHAS CT
TIGARD, OR 97223
PHONE: 503 - 775 -7020
PHONE: 320 - 321 -2275
FAX: 503 - 775 -7019
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/01/2011 $46 75
Type of Use: SF 12% State Surcharge - Mechanical 11/01/2011 $10 80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/01/2011 $43 25
Occupancy Grp:
Stories:
Fuel
Fuel Types
Gas Pressure
Total $100 80
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 ication - -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0 Y m obtain - -'p: of the rules
or dir t questions to OUN .y cal • 503.232.1987 or 1.800.332 2344
lss ed By: Permittee Signature'
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
Received
�/ 4 7 4 ,11 City of Tigard e �� Permit No .
I N
't 13125 SW W Hall Blvd , Tigard, OR 97223 Plan Review
2 • Phone: 503.718.2439 Fax: 503 598.1960 Other Permit
Date/By.
TIGARD Inspection Line. 503.639.4175 Date Ready/By. lures El See Page 2 for
Internet: www tigard -or gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
/ Mechanical permit fees* are based on the value of the work
❑ New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition iti Other: mechanical materials, equipment, labor, overhead, and profit.
Value. $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
/0 Multi - family ❑ Master builder ❑ Other: Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 45---- 72/ (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP:
;G An 0 4 /- 7;22 Furnace 100,000+ BTU (ducts /vents) 54 91
Suite/bldg. /apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic 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: I Lot no: Flue /vent for any of above 23 32
Other 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23 32
/ Gas fireplace I 33 39
-e.p! . (4'C L q "Q14- Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
ROPERTY OWNER I ❑ TENANT
Chimney /liner /flue /vent 23 32
Other. 23 32
T
Name: ) 2 53 ( /0L, ,Li Environmental exhaust and ventilation:
Address: CC Range hood/other kitchen
1 (; equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: jji o1 / 02 Fax: ( ) toilet compartments, utility rooms) 23 32
al APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23 32
` l Other
Business name. �� ,/ /j/
—
Fuel piping: 23 32
Contact name: O "II 1 / i / {' $14.15 for first four; $4.03 for each additional
Address: 70 ? { �' ) ow , 1 P � � y C „ / Furnace, etc
J G °(/ Gas heat pump
fj
City /State /ZIP: it. f ✓ /(f Q 0 6 Wall /suspended/unit heater
Phone: (� 1 7 vw 7 S' 70 1 Fax: 7 2
: ( ) Water heater
� Fireplace
E -mail: G4—f 'X, )JLk_® L , ( (/ - t -sue Range
CONTRACTOR Barbecue
iq S , Q� Clothes dryer (gas)
Business name: _roc__
Address: � � Other.
�6 6-L 0 V � f 4 4'7 y Lry MECHANICAL PERMIT FEES *
i 0 2I- Q I 9 7 /l / Subtotal
City/State/ZIP: / (/ (/ Ye)
Phone: (5 Minimum permit fee ($90 00)
t/J ) 7 7 2 U Fax: ( ) Plan review (25% of permit fee) ----
CCB lie.: /(O 7 Ci y State surcharge (12% of permit fee) /,e. fro
TOTAL PERMIT FEE /On. t n..)
� — This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: / � � ,p Date: /A * Fee methodology set by Tn- County Building Industry Service Board
I \Budding\Permos\MEC- PermitApp doe 09/09/10 440 -4617T (11/02 /COM/WEB)
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 \BuildingPernutskMEC- PermitApp doc 09/09/10 2