Permit t j �• •
CITY OF TIGARD MECHANICAL PERMIT
7 ` COMMUNITY DEVELOPMENT Permit #: MEC2009 -00196
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/05/2009
Parcel: 2S111CC15300
Jurisdiction: Tigard
Site address: 10065 SW HIGHLAND DR
Subdivision: Lot: 0
Project: Gottlieb
Project Description: Install furnace.
Owner: FEES
GOTTLIEB, EDWARD F /MARIAN I Description Date Amount
C/O GOTTLIEB, MARIAN I CUMMINGS &, Furnaces < 100K BTU 05/05/2009 $14.00
GOTTLIEB, EDWARD F LIFE ESTATE, 10065 SW Duct Work 05/05/2009 $10.00
PHONE: 12% State Surcharge - Mechanical 05/05/2009 $8.70
Minimum Fee Adjustment - Mechanical 05/05/2009 $48.50
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
issua i suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
U y Notification Center. hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
I ued By: 4k Permthee Signature: �
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 Application FOR.OFF U SE ONLY
Receive
1111 4 City of Tigard RECEIVED RECEIVED 6---4) / S
Date /By: Permit No.:'� CO
- n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 M AY 0 5 2009 Date/By: Other Permit:
TI GARD Inspection Line: 503.639.4175 Date Ready /By: ]urns. ® See Page 2 for
Internet: www.tigard -ocgov CITY OF TIGARD Notified/Method: -- Supplemental Information
TYPE OF NVDING DIVISION
COMMERCIAL .FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Nr Addition /alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
y 1- and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ Accessory building
Master builder For special information use checklist.
Multi -famil
❑ Multi-family ❑ ❑ Other:
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
/ c Air conditioning or heat pump
Job site address:
/00 J so / 4 I �] II I$ N b tit (requires site plan showing placement) 14.00
City /State /ZIP: 7 0 V /722 y Furnace 100,000 BTU (ducts /vents) • 1 14.00
Suite/bldg. /apt. no.: Project name: ac-rL / g , Furnace 100,000+ BTU (ducts /vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work 1 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
•
Subdivision: Lot no.:
Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK. Water heater 10.00
�I tt Gas fireplace 10.00
1V if1 N lJ. It.) A 4 /4 11 11 i1 1M1 N A rC Q Flue vent for water heater or gas
W' J 1 « K � , f4I 4 con ` e 4' bU C I �� L fireplace 10.00
rr1 /`f J T t L Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
IX PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00
Other 10.00
Name: / t% A 14 4,3ift,Ez Environmental exhaust and ventilation
Range hood /other kitchen +
Address: / QO r_S u ? 5 1, I 1 pt Da equipment 10.00
City /State /ZIP: '1(y 144 1) pQ 7 z y Clothes dryer exhaust 10.00
1 Single -duct exhaust (bathrooms,
Phone: (5. g'( v -/./3 1 7 Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON 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
CONTRACTOR Barbecue
y�
Business name: C ' j �� 1 E/2 Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) -7;,k •S°
Plan review (25% of permit fee) .'
CCB lic.: State surcharge (12% of permit fee) % . 70
�
� ` , , 4 / TOT AL PERMIT FEE 1 I , 2-0
Authorized signature: �, �i/41lu This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: /41 4? ( g).4 6• // t l r Date: Lt..- I -0 9 * Fee methodology set by Tri- County Building Industry Service Board
I \Building\Permits\MEC- PermitApp.doc 01/19/07 440 -4617T (11 102 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: . Permit , 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