Permit o CITY OF TIGARD MECHANICAL PERMIT
—
a COMMUNITY DEVELOPMENT Permit #: MEC2012 00128
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/09/2012
Parcel: 1 S 125DA04400
Jurisdiction: Tigard
Site address: 6775 SW ALFRED ST
Project: Johnson Subdivision: KINGS VIEW Lot: 29
Project Description: Replace furnace, add gas piping for furnace, water heater & range.
Contractor: RUMBOLD HEATING & AIR COND INC Owner: JOHNSON, RICHARD W /ELIZABETH A
PO BOX 397 6775 SW ALFRED ST
BEAVERCREEK, OR 97004 TIGARD, OR 97223
PHONE: 503 - 656 -0475 PHONE: 503 - 803 -8310
FAX: 503 - 656 -4572
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/09/2012 $46.75
Type of Use: SF Fuel Piping 03/09/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 03/09/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 03/09/2012 $29.10
Stories:
Fuel
Fuel Types: Natural Gas
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct • • -s ion - OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue. By: I 4 1 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 RECEIVED I Ol+ Of us, t )N 1
City of Tigard MAR 9 Datee/ 5? / . , We 042_4,5)64) ,
2012 Permit No.:
a 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
N. Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juris: El See Page 2 for
I I L. A It D Internet: www.tigard- or.gov BUILDING DIVISION 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 ❑ Other: mechanical materials, equipment, labor, overhead, and profit
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
al- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special Information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
/ J Air conditioning
Job site address: /O 7-7, 54/ A-I Fyn' e_ (requires site plan showing placement) 46.75
2- Z. 3 Furnace 100,000 BTU (ducts/vents) 1 46.75
City /State /ZIP:
�y , 0 -/ Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: 1 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
(O 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
y ai Q / Gas fireplace/insert
vent water 33.39
/2 ,T c-� �G� Fent for 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: �irGlk. �D 5 t9-✓l Environmental exhaust and ventilation:
7 7 5-- Address: c A/ Ranee hood/other kitchen
equipment .7 ment 33.39
City/State /ZIP: 1)' aka t g� 9 -7 2 Z "� Clothes dryer wdlaust 33.39
t Single-duct exhaust (bathrooms,
Phone: (50, 5-03 -6.3 0 Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawispace fans 23.32
Business name: Other: 23.32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater /
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: g i_ A i cr i � Clothes dryer (gas)
Other:
Address: p, O r B p yt, 30, '-7 L MECHANICAL PERMIT FEES*
City/State /ZIP: Le 67e- q--700lrG Subtotal 9e,
Phone: (5)3) Co 5 --0 et-7 s Fax: (563) (0 3 Z 2' 5 Minimum (25% fee permit fee)
Plan review (25% of permit fee) ---- _
CCB lic.: / 7 -7 s'4. /4 3 State surcharge (12% of permit fee) /v• IV
(1c7 TOTAL PERMIT FEE ( SO
Authorized signature:
This p ermit a expires if a permit is not obtaine in 180
days after it has been accepted as complete.
Print name: Jo V> ) e (,e Date: 3 5'— / Z • Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Permils\.MEC- PermitApp,doc 09/09 /10 440- 4617T(I1 /O2/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 firsti$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.
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