Permit CITY OF TIGARD MECHANICAL PERMIT
II COMMUNITY DEVELOPMENT Permit #: MEC2012 -00496
T l GAR.D 13125 SW Hall Blvd.. Tigard OR 97223 503.718.2439 Date Issued: 09/27/2012
Parcel: 2S103AB02300
Jurisdiction: Tigard
Site address: 11320 SW WALNUT ST
Project: Subdivision: ECHO HEIGHTS Lot: 9
Project Description: (1) furnace oil to gas conversion and (1) fuel piping
Contractor: LAKESIDE HEATING & COOLING Owner: WELLS FARGO BANK
PO BOX 327 4101 WISEMAN BLVD
LAKE OSWEGO, OR 97034 SAN ANTONIO, TX 78251
PHONE: 503 - 635 -5253 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 09/27/2012 $46.75
Type of Use: SF Fuel Piping 09/27/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 09/27/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 09/27/2012 $29.10
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 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: 4 1A a 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 ONLY
RECEIVED ED Da B / '!
IIIIq City of Tigard ll E g Received �( t���[� -�'1 Permit No. ..10 'A . _ 00gpfi
q 13125 SW Hall Blvd., Tigard,OR 97223
Plan Review •
C
Phone: 503.718.2439 Fax: 503.598.1960 D � % Date/By: Other Permit:
I I G A It D Inspection Line: 503.639 SE 1 L a 2 0 q 1 2 Date Ready/By: Sufis: La See Page 2 for
Internet: www.tigard or.gov Notified/Method: 11 0 Supplemental Information
CITY OFTIGARD
TYPE OF
OU"I `ACV D itmUIN1 COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction fat 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*
as 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
Job site address: // 31(3 w a t :.- , -#-/ S 7 (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) / 46.75 4 /6, 7T
City/State/ZIP: Ti GA t /) On_ 97 Z Z V Furnace 100,000+ BTU ( ducts/vents) 54.91
Suite/bldg. /apt. no.: I Project name: 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
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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
Gas fireplace/insert 33.39
0 r( ''a qAS CakAr'/eds! . 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 I ❑ 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
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) , 23.32
'P' APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: IAk.cf,O. /h41,7 [ C OULD --.9 Fuel 1 m
P P� g:
Contact name: j As $14.15 for first four; $4.03 for each additional_
Address: y ,(r Furnace, etc. I mix /y, /I
(,V 1 IsVy 3 Z7
Gas heat pump
City/State /ZIP: LAIC 0 ..,„ J U R. 9 3y Wall/suspended/unit heater
Phone: (J(r} ) 63J Se j-3 Fax: : ( ) Water heater
Fireplace
E -mail: 3 , y , e LA[CeS:De f/(r C4,1 Range
CONTRACTOR Barbecue
/�, Clothes dryer (gas)
Business name:
2A /cc f >OC z61 -i Other:
Address: ,Ps u 1 0, 3Z 7 MECHANICAL PERMIT FEES*
City/State/ZIP: 0..61. Subtotal
y L9 /�t u 2 9 7aT}/
.su3) C3 1 = SL sj Fax: ( ) Minimum permit fee ($90.00)
Phone: (
Plan review (25% of permit fee)
CCB lic.: / q1- Lc Si6-51 t 3 State surcharge (12% of permit fee)
TOTAL PERMIT FEE (a
Authorized si ature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: SAS-- C,AXL Z.--- I Date: 7-L 7 -/ L • Fee methodology set by Tri -County Building Industry Service Board
I:\Building\PermitAMEC- PermitApp.doc 03/07/12 440-46I7T(I1 /02/COM/WFB)
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.
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