Permit r
CITY TIGARD MECHANICAL PERMIT
wig DEVELOPMENT SERVICES PERMIT #: MEC2005 -00591
c J I � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/20/2005
PARCEL: 2S 114BD -03400
SITE ADDRESS: 09500 SW RIVERWOOD LN ZONING: R -7
SUBDIVISION: COPPER CREEK STAGE 3 LOT: 074 JURISDICTION: TIG
Project Description: AC install.
CLASS OF WORK: FLOOR FURN: EVAP COOLERS:
TYPE OF USE: UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
ELE 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
LOUIS BAILEY Description Date Amount
9500 SW RIVERWOOD LANE [MECH] Permit Fee 9/20/200f. • $72.50
TIGARD, OR 97224 • [TAX] 8% State Surchar€ 9/20/200: $5.80
Phone: 503 443 - 2284 Total $78.30
Contractor:
GL HEINTZ HEATING & COOLING, INC.
20871 SW 216TH PL. REQUIRED ITEMS AND REPORTS
SHERWOOD, OR 97140
Phone: 503 625 - 6798
Reg #: LIC 102831
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and
all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344.
Issued By: Permittee Signature: A , Ale
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the p
Approved plans are required on the job site at the time of each inspection.
i,,, . . a (`
Mechanical Permit Ap�llgt' g IVED
FOR oI liCI USE ONLY
City of Tigard SEP 20 20 5 Date/By. , f 0 ! 6 i Permit No.: 6 ,G , i / :,64
13125 SWV Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 ci. . - Date/By. Other Permit:
Inspection Line: 503.639.4175 CITY OF TIGAR' ' 'I Li
� � _ _ , Date Ready/By: ® See Page 2 for
Internet: www.ci.tigard.or.us BUILDING DIVIS •-.■ Notified/Method Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction [ddition/alteration/replacement Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
l / CATEGORY OF CONSTRUCTION Value: $
�f - and 2 dwellin RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial/industrial ❑ Accessory building
• ❑ Multi - family ❑ Master builder For special information use checklist.
❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
0 Air conditioning or heat pump 1
Job site address: _ (requires site plan showing placement) ` 14.00
7, City /State/ZIP: -722 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: I Project name: Gas heat pump 14.00
• Cross street /directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
•
• Flue /vent for any of above 10.00
Subdivision: I Lot no.: Other: 10.00
Tax map /parcel no.: Other fuel appliances
•
DESCRIPTION OF WORK Water heater 10.00
c T Gas fireplace 10.00
\� Flue vent t for water heater or gas
. fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace/insert 10.00
Chimney /liner /flue/vent 10.00
ROPERTY OWNER I ❑TENANT Other: 10.00
Name: I I S &1.� ` Environmental exhaust and ventilation -
Address: v` , c ��� n Range hood/other kitchen
v ` equipment 10.00
City /State/ZIP: r Q Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: 53) -A-84 , Fax: ( ) / toilet compartments, utility rooms) 6.80
❑ APPLICANT _ I 4 ONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name:
'w Fuel pip
Contact name: �_�.�,.� C,� 4►J? ( K -19...._ K -19...._ $5.40 for first four; $1.00 for each additional
Address:
'r 1 �' Furnace, etc.
Gas heat pump
City /State/ZIP: WalUsuspended/unit heater
• Phone: )313 `S )9 / I Fax:: ( ) Water heater
Fireplace
E -mail:
Range
CONT' • CTOR Barbecue
Business name:
or 1111 Clothes dryer (gas)
_mil ■ `■ Aka 1 Other: -
0
Address: ■—! MECHANICAL PERMIT FEES*
•
City /State/ZIP: ) eiti,jar, G' 46 Subtotal
Minimum permit fee ($72.50)
Phones) ( 2.5 % `' • Fax: ( )
Plan review (25% of permit fee)
CCB lic.: 1 4 , State surcharge (8% of permit fee)
TOTAL PERMIT FEE 7 ; ' 5 c)
Authorized signature: 41, - This p ermit a expires if a permit is not obtaine within 180
days after it has been accepted as complete.
Print name: +‘A I Date: — �� • Fee methodology set by Tri-County Building Industry Service Board
i:\Building\PemiitsVMEC- PamitApp.doc 12/03 41046I7T (I 1 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
•
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
•
Note: All new commercial buildings require 2 sets of plans.
•
• i:\Building\Permits\MEC- PermitApp.doc 12/03 2
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