Permit CITY OF TIGARD MECHANICAL PERMIT
c - COMMUNITY DEVELOPMENT Permit #: MEC2009 -00105
T t G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/16/2009
Parcel: 1 S134BD06700
Jurisdiction:
Site address: 11655 SW SPRINGWOOD DR
Subdivision: Lot: 0
Project: ANDERSON
Project Description: Replace furnaca.
Owner: FEES
SHANE ANDERSON Description Date Amount
11655 SW SPRINGWOOD DR
TIGARD, OR 97223 Furnaces < 100K BTU 03/16/2009 $14.00
12% State Surcharge - Mechanical 03/16/2009 $8.70
PHONE: 503- 329 -2903 Minimum Fee Adjustment - Mechanical 03/16/2009 $58.50
Contractor:
ANDERSON & ASSOCIATES .
11655 SW SPRINGWOOD DR
TIGARD, OR 97223
PHONE: 503 - 524 -8600
FAX: (503)746 -5819
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp: R -3
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
Total $81.20
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
iss ce, or if wo • ' suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
ility Notification Cent- Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OU , • call • 03.246.6699 or 1.800.332.2344.
Issued By: A // i / �, Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
#Mee ianical Permit Appl• . tipC FOR OFFICE USE ONLY
Da Ci of Tigard Re e Bv / 6, a gyp Permit No.: eC �( J�- �QS
q 13125 SW Hall Blvd., Tigard, (It 3 vvv - --
III C Phone: 503.639.4171 Fax: 503.59 '�� 1 2009 Date/By: Review Other Permit:
TIGARD Inspection Line: 503.639 Date Ready/By: lun ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
CITY OF TIGARD ��/
TYPE lik DIVISION COMMERCIAL FEE' SCHEDULE - USE CHECKLIST
❑ New construction d ;Add ition/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.
CATEGORY OF CONSTRUCTION Value: $
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 Heating/cooling
Air conditioning or heat pump
Job site address:
//6 _S � i 0 / / 7".,, p[ . �a/ /' ' (requires site plan showing placement) 14.00
City /State /ZIP: „r, 9 7 5 Furnace 100,000 BTU (ducts/vents) / 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: et,ehi;.„.„ Gas heat pump 14.00
Cross street/directions to job site: //__< / ,F;%77,,/ / /h Duct work 10.00
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. 14.00
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00 _
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
yy�' Gas fireplace 10.00
�j�wlG � - vi /�crr� Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
� Other: 10.00
Name: S� ,,ti , �-ce Environmental exhaust and ventilation
Range hood/other kitchen
Address:
/,4SS 2 .i/ S r / 4. d �..oc ' equipment 10.00
City /State /ZIP: / 9777> Clothes dryer exhaust 10.00
`�f G „ Single -duct exhaust (bathrooms,
Phone: („:),3' ) 3z9 - 2 U 3' Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall/suspended/unit heater /
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: � $, y..- //5 �, =° Clothes dryer (gas)
Other:
Address: 47e'5 SN S22 /i voe,.7 1�,re' MECHANICAL PERMIT FEES'
City /State /ZIP: aid l ?77 Subtotal
y �� Minimum permit fee ($72.50) -72, s?
Phone: ( 3) . 5 - 2 1{... I Fa ( ) Plan review (25% of permit fee) -65
CCB lie.: /7 0y 2 � /0 State surcharge (12% of permit fee) (.70
TOTAL PERMIT FEE �1. ?...D Authorized signature: This p ermit a expires ifs permit is not obtained within 180
days after it has been accepted as complete.
Print name: SL_,,,_, ? . Date: / /&/d 7 • Fee methodology set by Tri -County Building Industry Service Board
C\ Building \Permits\MEC- PermitApp.doc 01/19/07 440- 4617T(I1 /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.
l:\ Building \Pennits\MEC -PerrnitApp.doc 01/19/07 2