Permit 71 Y �� CITY OF TIGARD MECHANICAL PERMIT
re COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00330
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/11/2007
PARCEL: 2 S 103 BA -00200
SITE ADDRESS: 11525 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: SCROGGINS
Project Description: Replace furnace and add a /c.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
LYNN SCROGGINS • Description Date Amount
11525 SW WALNUT AVENUE
TIGARD, OR 97223 [MECH] Permit Fee 6/11/2007 $72.50
[TAX] 8% State Surcha 6/11/2007 $5.80
Total $78.30
Phone: 503- 750 -1528
Contractor:
HARDY PLUMBING + HEATING
14689 NE COUNTRYSIDE
AURORA, OR 97002 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 222 -9654
FAX 503- 678 -4498
Reg #: LIC 60947
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.
. L_
Issue B Pe Signature: Vri--- Y _
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 project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
i Received / �/ fee 4407.-0
City of Tigard DDate/By C t / Permit No 1 / ,M W 3
• 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone. 503 639 4171 Fax 503 598 1960 Date/By Other Permit
T I G A R D Inspection Line 503 639 4175 Date Ready /By ® See Page 2 for
Internet www tigard - gov Notifiied/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.
CATEGORY OF CONSTRUCTION Value $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
Multi - family ❑ Master builder ❑ Other: For special information use checklist
Description I Qty I Ea I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
p ' �• Air conditioning or heat pump
Job sitc address:
i S a 5 - S L - � / t/ v L .-.-/ v / (requires site plan showing placement) 1 14 00
City /State /ZIP: QC_ Furnace 100,000 BTU (ducts /vents) / 14 00
Furnace 100,000+ BTU (ducts/vents) 17 90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14 00
Cross street/directions to job site: 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
Flue /vent for any of above 6 80
Subdivision: Lot no.: Other 10 00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10 00
�
r Gas fireplace 10.00
C., /V
y�jJ ,e-i Jt' gE p-e 0710 - Flue vent for water heater or gas
D /V ( 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 r /w � G ! __J f Environmental exhaust and ventilation
0
Range hood/other kitchen
Address: 17 SAS vc L- 1"/14/L--)11"7" equipment 10 00
City/State /ZIP: / 1 ) z, ra-an / o Clothes dryer exhaust 10 00
Single -duct exhaust (bathrooms,
Phone: ( 1 ) -) 50 _ / S a-F Fax: ( ) 4 toilet compartments, utility rooms) 6 80
A
❑ 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: , Clothes dryer (gas)
n y ,/] z d` 2 n ,} L Other: ry g
Address: / q I T'g ,' Iz to t) , -) J'n ,/ S / / / MECHANICAL PERMIT FEES*
City /State /ZIP: `Z /2 tJ 2f5 / 6 A . Q v Q Z Subtotal
Phone: ( 3 ) 'a'?� . 9 L S L ' Fax: ( Th t - . Li (i Minimum permit fee ($72 50)
Plan review (25% of permit fee)
CCB lic.: (_P 0 9 L State surcharge (8% of permit fee) o
. Authorized signature: TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: )2 r — f ) 7-1)- f , / Date - / ) - 0) * Fee methodology set by Tn- County Building Industry Service Board
1 \Budding\PermitsV�C- Permit App doe 01/19/07 / 440-4617T (I I /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\Permmts\MEC- PermitApp doc 01/19/07 2
> 6. 4 i
T
D
P C
(
t i
) S LJ
2 -)-1