Permit CITY OF TIGARD MECHANICAL PERMIT
>s . COMMUNITY DEVELOPMENT Permit #: MEC2012 -00125
Date Issued: 03/08/2012
T I G A.R p 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S104ACO2600
Jurisdiction: Tigard
Site address: 12587 SW 133RD AVE
Project: DEZFULLI Subdivision: MORNING HILL NO.8 Lot: 170
Project Description: Gas furnace replacement.
Contractor: SYSTEM AIRE INC Owner: DEZFULLI, EBRAHIM K AND SHAHIN D
14444 SW FERN ST 12587 SW 133RD AVE
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 524 -5927 PHONE:
FAX: 503 - 590 -8357
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/08/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/08/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/08/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
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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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a • of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
/ ,/
Issued B Permittee Signature: o/ •
Call 50 . •�' 5 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 ® RD IUR orrice: usi.: mi.\
City of Tigard �� Date e /B y ved : � Permit No.: Ai • 0 42- _ CO I
Ilq u 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598. it i !
A 15�� Date/By: Other Permit:
T I G A IZ D Inspection Line: 503.639.4175 Date Ready/By: ID See Page 2 for
Internet: www.tigard \\1\(\ � R o, Notified/Method: 1$9.1 Supplemental Information
TYPE OF WORK 0 Q ! G,03 COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
� ,� Mechanical permit fees* are based on the value of the work
❑ New construction Addition /alteration/rtl ent performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
( 211 - - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
A j/ Air conditioning
Job site address: / • 5 2 7 s (3g (requires site plan showing placement) 46.75
City/State /ZIP: ( " 34 +,4 '' 7 2 2-3 Furnace 100,000 BTU (ducts/vents) 46.75 Lt6 '
Furnace 100,000+ BTU (ducts/vents) 54.91 1
Suite/bldg. /apt. no.: Project name: no 1/ 1~ Heat pump
'��/ (requires site plan showing placement) 61.06
Cross street/directions to job site: 7 1)1- 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: 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
A R - _ � , vN _ Gas fireplace/insert 33.39
(S� Flue vent ent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32
Name: —6., /1 , ' (2rJ 4 �M v- �a t1,l'V' Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State /ZIP: Clothes dryer exhaust 33.39
Fax: Single -duct exhaust (bathrooms,
Phone:
( ) ( ) toilet compartments, utility rooms) 23.32
APPLICANT ,a PERSON Attic /crawlspace fans 23.32
Business name: S / 97th ,'�� ! / � Fuel piping:
( y
Contact name: f Z �, a- /?' ) 41-- $14.15 for first four; $4.03 for each additional
Address: / `
K / /9' ___<(,),. A..0 .e A..0 Furnace, • Fuace, etc.
Gas heat pump
City/State /ZIP: ' 7 c r -- '
el' ( 1 Z 'a_ 3 Wall/suspended/unit heater
Phone: ($''i ) 7 _ 19 j ' Fax: : ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
�,( Clothes dryer (gas)
Business name: �V S (� , o -e.._ / Other:
Address: MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal if ( ,
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) qv, Of-)
Plan review (25% of permit fee)
CCB lic.: ` Z . 3 Q 6 Z State surcharge (12% of permit fee) (0 610
TOTAL PERMIT FEE (CO ,.fl)
I i r
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: ] ! -C- g' ' J �" 5 r- I Date: s 3 — 2) -- / '"Z__ • Fee methodology set by Tri -County Building Industry Service Board
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I: Building \ Perm \ its EC- PermitApp.doc 09/09/10 440- 4617T(I1 /01/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.
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Note: All new commercial buildings require 2 sets of plans.
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