Permit CITY OF TIGARD MECHANICAL PERMIT
rs COMMUNITY DEVELOPMENT Permit #: MEC2012 00219
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/03/2012
Parcel: 2S110AD02200
Jurisdiction: Tigard
Site address: 14684 SW 106TH AVE
Project: Uhler Subdivision: LANG HILL Lot: 19
Project Description: Replace furnace and A/C
Contractor: HEAT MASTER CORP. Owner: UHLER, ANN S &
14456 AMES ST COATES, LAURA C
OREGON CITY, OR 97045 14684 SW 106TH AVE
TIGARD, OR 97224
PHONE: 503 - 233 -2727 PHONE:
FAX: 503 - 723 -4381
FEES
Specifics: Description Date Amount
Air Conditioning 05/03/2012 $46.75
Type of Use: SFA Furnaces < 100K BTU 05/03/2012 $46.75
Class of Work: ALT Type of Const: VB Fuel Piping 05/03/2012 $14.15
Occupancy Grp: R -3 12% State Surcharge - Mechanical 05/03/2012 $12.92
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure: Low
Total $120.57
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: „/t k 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 FOR OFFICE USE ONI,1'
City of Tigard Received
iv City g Date/By: 5 3 - I� /vl • ,1 IZIEMNIMII
III 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
17 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T i el A It a Inspection Line: 503.639 Date Ready/By: Sufis: ® 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"
❑ 1- 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 Heatinp,/cooliog:
Air conditioning I
Job site address: / 6'8w 'moo -to �j�" e *ie (requires site plan showing placement) 46.75
City /State /ZIP: Furnace 100,000 BTU (ducts/vents) 46.75 i
J
/� c n Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: to I E /v 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
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
g Q � Q F )� / ` e e_4-0-01 Gas fireplace/insert 33.39
+�'(. c C [ �� C Flue vent for water heater or gas
a C n f �,P / C P /� V fireplace 23.32
I`['/tJ►✓ r`��' [yli._ /T Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Xi' PROPERTY OWNER ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32
Name: .A t )I _ �,,�J\ Environmental exhaust and ventilation:
Address: 1•g( 6 'is r y t_ Range hood/other kitchen
/ equipment 33.39
City/State /ZIP: / i p 1 D� 9? Clothes dryer exhaust 33.39
z Single -duct exhaust (bathrooms,
r �
Phone: ) !9,574( Fax: ( ) 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
Address: Furnace, etc. iT
Gas heat pump ,
City/State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue ,
is
Business name: �1■ Clothes dryer (gas)
� Other:
Address: / - 7 ceo MECHANICAL PERMIT FEES*
City/State /ZIP: 6 �_.1 OR 970/ Subtotal -
Phone: (0 ) a Fax: ( ) Minimum permit fee ($90.00)
_ -
� 10� — ( J�I P lan review (25% of permit fee)
CCB lic.: I 667y State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: � ^ i � 1 \6 6 -,„\ D a t e: • Fee methodology set by Tri -County Building Industry Service Board
i
I :\ Building \Permils\MEC- PermitApp.doc 09/09 /10 440 -4617T (I I /0?JCOM/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.
Note: All new commercial buildings require 2 sets of plans:
5 L ib(r)
1:\Building\Permits\MEC-PermitApp.doc 09/09/10 2
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