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Permit CITY OF TIGARD MECHANICAL PERMIT 3 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00177 • T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2012 Parcel: 2S 111 AA03500 Jurisdiction: Tigard Site address: 8615 SW GREENSWARD LN Project: WOLTERING Subdivision: GREENSWARD PARK Lot: 3 Project Description: (2) gas furnaces with gas piping and (1) NC installation. A/C unit must meet 5 ft. minimum rear and side yard setbacks. Contractor: BUDGET HEATING Owner: WOLTERING, SCOTT C & MARIANNE H 13885 SE 177TH CT 8615 SW GREENSWARD LN DAMASCUS, OR 97089 TIGARD, OR 97224 PHONE: 503 - 233 -3133 PHONE: FAX: 503 - 558 -9050 FEES Specifics: Description Date Amount Air Conditioning 04 /10/2012 $46.75 Type of Use: SF Furnaces < 100K BTU 04/10/2012 $93.50 Class of Work: ALT Type of Const: Fuel: Piping 04 /10/2012 $14.15 Occupancy Grp: 12% State Surcharge - Mechanical 04 /10/2012 $18.53 Stories: Fuel Fuel Types: Natural Gas Gas Pressure: Total $172.93 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 -009a o - ay obt a in a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: _ -s Permittee Signature: � / • Call 51 . • 175 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 I�oR OFFICE USE ONLY �p� City of Tigard B Permit No.: EG +� 7 . ° 13125 S50 Hall Blvd., Tigard, OR 97 iI � ' ���� R Plan Date eceiRevv ed iew N i1/ tI � II Phone: 503.718.2439 Fax: 503. ' •' � O ,` � Other Permit: DateBy: y: .4 T I G n It D Inspection Line: 503.639 Q t � 1 \ GQ . Cj \ Q `° Fax: Date Ready/By El See Page 2 for Internet: www.tigard Q, ' C , �� ,A Notified/Method: Supplemental Information ` \C ' I! E OF WORK �� `�Q� COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ,J Mechanical permit fees* are based on the value of the work ID New construction Addition/alteration acement 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* land 2 family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use check/Lst ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Ai r conditioning `a` ,--77,-.-- Job site address: G [ s 6 re L i (requires site plan showing placement) 46.75 _i Y 6 /- f / Furnace 100,000 BTU (ducts/vents) 46.75 ' 0 City/State /ZIP: ct/ �i © b il 772 r Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name:Q Heat pump , �r J (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: 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 � �� f tG Gas fireplace/insert 33.39 ! � Pi C , / Flue vent for water heater or gas e f c t / / (4 r - • " fireplace 23.32 A � ! !' Log lighter (gas) 23.32 / Pe Wod/pell et stove 33.39 ti, Ac Xeld 6 4 tl ` Wood fireplace /insert 23.32 23.32 ' ROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 0 Other: 23.32 Name: Sa IA/ /fj 9 Environmental exhaust and ventilation: Address: U ' s' E �cvN� !Akita /� Range hood/other kitchen [ v' equipment 33.39 City/State /ZIP: C� e a 4 Clothes dryer exhaust 33.39 / / 7�c� Fax: Single -duct exhaust (bathrooms, Phone: !� e72� ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32 Business name: Other: 23.32 Fuel piping: Contact name: $14.15 for first four; $4.03 for each additional y Address: Furnace, etc. I /1./5 /5 Gas heat pump City/State /ZIP: Wall /suspended/unit heater Phone: ( ) I Fax: : ( ) Water heater Fireplace E -mail: Range CONTRACTOR /J j Barbecue Business name: 7I' h Ye e - 9 Q Clothes dryer (gas) Other: / c 4/ Address: MECHANICAL PERMIT FEES* City/State /ZIP: G "li G( 6 i i 201 0 7 Subtotal /5 At0 PhoneA .03 2.32 2 fU Fax: ( ) Minimum permit fee ($90.00) ' 44 / Plan review (25% of permit fee) I CCB lic.: / y 77' 5 / State surcharge (12% of permit fee) /s , 14101.. TOTAL PERMIT FEE ('7a , Authorized signature: �� /117/1f This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. IA ',ffi! gi. Date: e7,EI , . Fee methodology set by Tri -County Building Industry Service Board I:\Building\Permits\MEC -Perini • ...doe 03 /Y 12 440.4617T(11 /02/COMIWEB) 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 ti. • • $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. • • • _ 1:\ BuildinePertnits \MEC- PennitApp.doc 03/07/12 2 • • TY3 sstil 9 / txf