Permit CITY OF TIGARD MECHANICAL PERMIT
I g n Permit #: MEC2009 -00496
COMMUNITY DEVELOPMENT
ip
13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/18/2009
T>f . , Parcel: 2S102DB07200
Jurisdiction: Tigard
Site address: 9199 SW HILL ST
Subdivision: Lot: 0
Project: Walkiewicz
Project Description: Replace existing furnace and vent.
Owner: FEES
WALKIEWICZ, MICHAEL R Description Date Amount
9199 SW HILL ST
TIGARD, OR 97223 Furnaces < 100K BTU 09/18/2009 $14.00
12% State Surcharge - Mechanical 09/18/2009 $8.70
PHONE: 503-639-9844 Minimum Fee Adjustment - Mechanical 09/18/2009 $58.50
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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 " . • , is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N "cation Cen - . Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules
or dir:ct questions to OU C by calling . 43.246 ••99 or 1.800.332.2344. / i
Issu: d By: i \ / i 1 , i i t, Permittee 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 OF FICE USE ONL Q `
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/ b Q all �LL �Q / JrI ,, .
W',, Ci of Tigard E DE iew Permit No.' 125 SW Hall Bd, Tigard, OR 97223 EC y
- ' Phone: 503.639.4171 Fax: 503.598.196 Other Permit:
D ate / B y:
TI GARD Inspection Line: 503.639.4175 SEP 1 2 009 Date Ready By. MI El see Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
CITY QF TIGARD
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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 ❑ Other: - mechanical materials, equipment, labor, overhead, and profit.
= s I : ' , : °g C AT EGORY _ :OF : CONSTRUCTi '� : 4 :q
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❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
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For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other: -
Description Qty. Ea. Total
"```,,= .a+'v3€'Rr p a.,,,,, .:^m r -..» a. y a �c=ev *,..y,, .•,;,:;red;.,. n
;�'„ . sc $ s SITE3?INEO xis, k :._y. R:;% '. ..'' a z Heating/cooling
' R TION:, AND . • OCATION'� " r g
..._, .«d,,...a'au`�',..i«"va�.. c _�ttr`��'rr�" wr_..xcw�..m.3a- �.:.a.. - ,.- ..,. - -- � ��uc,r> , .. _ rs ?�:- a.�'.;��,` �.NC� cc.,a °, �J�°t3�s'nr',€ �,:�
�,.. "����� w " / Air conditioning or heat pump
Job site address:
/99 . - //(/' • (requires site plan showing placement) 14.00
City /State /ZIP: 6, x -7/2,7 Furnace 100,000 BTU (ducts /vents) 1 14.00
°w Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: v Project name: ` l /��L� Gas heat pump 14.00
Cross street/directions to job site: Duct work 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 d 6.80
Subdivision: Lot no.: Other: 10.00
Tax map /parcel no.: Other fuel appliances
7 `
, , ... . � �DES'CRH'`fri0 W O]iK t * , ,xz ,',31 ,fi Water heater 10.00
�xa.:latKa lF-44 _ ., .1 tR -, x- , a sa- rte,,,- ,.4. . , t .a... . ,, , ina
/� G-
as fireplace 10.00
; .. L �!i /hd• P 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
, ,: ,.,.,:F -sa, , ,.. . >:: ;,:
Chimney/liner/flue/vent 10.00
° '8 . ®: PROPERTY {OWNrR �' '. , ," TE NAs s1`1 , n ;. Y �,, ,, , x.7 >
.,., ,,.. ..,,, .r;,r ; a ), '7k . :i.. > . -,. `,•,:� z auna�. ; - r' 4 Other: 10.00
Name: / Aid./ /Z ZJa 1 /121✓/C Environmental exhaust and ventilation
• Address: 9 /9f' J L ,4,0/ � Range hood /other kitchen
equipment 10.00
City /State /ZIP: , � dill e 2 722' Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (j7J ) •J 9 rf1 -* 4/ Fax: ( ) toilet compartments, utility rooms) 6.80
u > i - , y. �• nr.::-ygr,.<,,> ',s`.3= r";o^ra r, '''S�t`s�.;a • a try =a ��.,a:m efi lmz i ',S r xw m;�;, . X' �f
' PLI ANT ,> ,ii t t s> GON2AC ,PERSO ,,,,,•- 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
" � ' rY4 �; � G ' e a , Ni r e '" ,. tt Barbecue
.._, AA ->ak k 6:. "S:. , ,_+sr>.a,ra4s �,. �� , . ,K .rsa ,=.:f
Business name: Clothes dryer (gas)
Q Other:
Address: ` ice i7 " = :qr ... -, ivgrea .,. �,
, : „, 'M`ECITANICAL PL+-RMIT FEES* z,z,;6_, ::
City /State /ZIP: Subtotal //��
Minimum permit fee ($72.50) `7oc - 6.--67
Phone: ( ) Fax: ( ) Plan review (25% of permit fee) ....6--
CCB lie.: / State surcharge (12% of permit fee) 70
TOTAL PERMIT FEE j. P•C)
This permit application expires if a permit is not obtained within 180
Authorized signature: )/ / � days after it has been accepted as complete.
Print name: CfiGe / ,E_ ls/4' J , /eL..,„ 2' Date: Ir. ' /ZQ ' Fee methodology set by Tri- County Building Industry Service Board
1 \Building\Permits \MEC- PermiApp doc 01/19/07 440 -4617T (I 1 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard V
Page 2 - Supplemental Information
Commercial Fee Schedule:
Tot 1 Valuation P1ernaa£ Fee =R ..
$ 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.
1 \ Building \Permits \MEC- PermitApp.doc 01/19/07 2