Permit Mec,banital Permit A' licat W 7 - V r , FOR OFFICE USE ONLY
h t� - r » Rec e ived
City of Tigard Permit No
131 Hall Blvd., Tigard, OR 97223 JUL Date/By �� /�� 6.7(67160 �� 170
Phone 503 639 4171 Fax 503 598 1960 JUL 4; _, 7, , , Plan Re e Other Permit
Inspection Line. 503.639 4175 ■ F I i Juns 0 See Page 2 for
Internet. www.ci. n ardor us Date Ready/By g
g CiTY OF TIGARD Notified/Method -- Supplemental Information
RU LDIAIf ll\/Icinni • ' TYPE OF WORK ' - _ COMMERCIAL FEE* . .SCHEDULE - USE CHECKLIST
❑ New construction ,Addition/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 matenals, equipment, labor, overhead, and profit
• CATEGORY OF- CONSTRUCTION Value° $ 3j(J
- RESIDENTIAL,EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ›Commercial /industrial ❑ Accessory b uilding
For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other:
Descnption I Qty Ea Total
• • ' 3OB SITE INFORMATION AND LOCATION .. , ' - Heating/cooling
Air conditioning or heat pump
Job site address:
,// s / .r_ , c �rw ✓ Gt e.`"•. (requires site plan showing placement) 14 00
City/State/ZIP: Furnace 100,000 BTU (ducts/vents) 14 00
�� � Furnace 100,000+ BTU (ducts /vents) 17 90
Suite/bldg./apt. no.: �a Project name: Cu V V ? Gas heat pump 14 00
Cross street/directions to job site: Duct work 14 00
Hydrontc hot water system 14 00
Residential boiler (radiator or
hydronic) 14 00
Unit heaters (fuel -type, not electnc),
in -wall, in -duct, suspended, etc 10 00
Subdivision: Lot no : Flue /vent for any of above 10 00
Other: 10 00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK - - - Water heater 10 00
Gas fireplace 10 00
0.0 // ' �)j G ✓ �le & 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: Environmental exhaust and ventilation
Address: Range hood /other kitchen
equipment 10.00
City/State /ZIP: Clothes dryer exhaust i.. 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6 80
❑ APPLICANT ❑ `CONTACT PERSON , - Attic /crawlspace fans 10 00
Business name: ��d 1��,,,,v _7- v� Other: 1000
/ � Fuel piping
Contact name: , /.tr ` �G $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) C( ,-5 3 3 y S Fax: : ( ) Water heater
Fireplace
E -mail:
Range
' CONTRACTOR . - ' ` Barbecue
•
Business name: �L.,..', �`� G ll G 1 / , c Clothes dryer (gas)
Other
Address �JC_) ! 'ox 3 3 3 / , . MECHANICAL P FEES*
City/State/Z . v 4 Za 8 f Subtotal
Minimum permit fee ($72 50) ?--
Phone: ( ) 4 S- 64 ( ( Fax: ( ),:f9 Y S -a -•' / Plan review (25% of permit fee)
CCB lic.: sic c? 5 --/ State surcharge (8% of permit fee) 5 W
ii TOTAL PERMIT FEE 7 , 77
Authorized signature: / ,_�. This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name- -1_ ` 1. � --1 Date: 7 E( -- • Fee methodology set by Tn- County Building Industry Service Board
I \Budding\Pevnns \IvIEC- PemutApp doc 12/03 440 -4617T (I I /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Nxr
Totalraluation ; 1 , „ - -
$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\Pemvts\MEC- PermitApp doc 12/03 2