Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00193
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/18/2012
Parcel: 2S103BA00140
Jurisdiction: Tigard
Site address: 12035 SW LYNN ST
Project: Foglio Subdivision: LERON HEIGHTS NO.2 Lot: 30
Project Description: Add heat pump. Placement of heat pump must maintain 5' side and rear setbacks.
Contractor: MPS HEATING & COOLING LLC Owner: FOGLIO, DAMIEN
PO BOX 5597 11500 SW GRABHORN RD
BEAVERTON, OR 97006 BEAVERTON, OR 97007
PHONE: 503 - 319 -7798 PHONE:
FAX: 503 - 746 -6117
FEES
Specifics: Description Date Amount
Heat Pump 04/18/2012 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 04 /18/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04 /18/2012 $28.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility - - ter. ose rules are set forth in OAR 952- 001 -0010 through OAR 952 -001 -0090. You may obtain a copy of the rules
or • ect questions to O ' by ailing 503.232.1987 or 1.800.332.2344.
I ued By: ) //1// / Permittee S ignature: j ar
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Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
' Mechanical Permit Application F(:)R OFFICI.; us': ()NIA
Receiv,
J of Tigard Date/By: 7 Permit No.: M610/01100/9
IN ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
T I G A It D Inspection Line: 503.639.417 Date Ready/By: Juris: • ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Addition/alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
• Value:.$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
,l- 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:
Air conditioning •
Job site address: 12 3 S 5 u- \ LY K v\ SA- (requires site plan showing placement) 46.75
I l Furnace 100,000 BTU ( ducts/vents) 46.75
Cit /ZIP: - Ga
(.3.4v !i �� 2-"Z 3 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: VV Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Ductwork 23.32
17\k`)A- k Hydronic hot water system 23.32
��( h� Residential boiler 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
� 1' Gas fireplace/insert 33.39
I CI I d P 1'[ tltr P C) y P Flue vent 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 ❑ TENANT Chimney liner /flue /vent 23.32
Other: 23.32
Name: - Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Phone: ( ) Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) .23.32
APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23:32
Other: 23.32
Business name: �A � .5 �� \ / \ piping:
g_
�` \ q f �Y1r+ l e Op1tY1 Fuel m
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Contact name: N \t c ? J bO � 1 d $14.15 for first four; $4.03 for each additional
B6
Address: 0 ( 65 q � \ Furnace, etc.
Cam ` Gas heat pump
City /State /ZIP: UC i - 1f)Nr 031D C1; Cr* Wall /suspended/unit heater
Phone: 565) ZAp _ -17 cl W Fax: j (53"S)) Qe u w_. 122 p Water heater
- 1 1 i....„ v Fireplace
E-mail: �� S 0.\V∎ c f c avv v : ∎ �' C f'SW Range
-e CT Barbecue _
Business name: Clothes dryer (gas) •
Other:
Address: MECHANICAL PERMIT FEES" r ---- -,
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: IC\ C\Ck % State surcharge (12 %ofpermit fee) , gC
d, TOTAL PERMIT �EE /0, '4
Authorized signature: d - This permit application expires if a permit is no obtained within 180
days after it has been accepted as complete.
Print' name: he i A (7 5csk- - E> I Date: '(ft•/ it * Fee methodology set by Tri County Building Industry Service Board
1:\ Building \Permits\MEC- PermitApp.doc 09/09/10 . 44046171' 11 /07JCOM/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 $20721 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 foreach 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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