Permit CITY OF TIGARD MECHANICAL PERMIT
� 4
11111
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00659
Date Issued: 12/13/2012
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Parcel: 2S111 CD08800
Jurisdiction: Tigard
Site address: 15920 SW SERENA CT
Project: Manzano Subdivision: KERWOOD ESTATES Lot: 38
Project Description: (1) gas furnace replacement
Contractor: BUDGET HEATING Owner: CONNELL, JOHN
13885 SE 177TH CT 2750 DIAMOND LOOP #A
DAMASCUS, OR 97089 MILTON, WA 98358
PHONE 503 - 233 -3133 PHONE 503 - 593 -8163
FAX 503 - 558 -9050
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/13/2012 $46 75
Type of Use: SF 12% State Surcharge - Mechanical 12/13/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/13/2012 $43 25
Occupancy Grp:
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 1_- 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 You/
Issued By: Permittee Signature: , ' 1 41111
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 1
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 ONE)
City of Tigard Received / 1 3 _ Permit No ' 6...7C go / a — 4x76 t
° 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DateBy. Other Permit
T I G A R D Inspection Line: 503 639 Date Ready/By Juris El See Page 2 for
Internet: www.tigard or.gov Notified/Method. 17 c Supplemental Information
TPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction A ddition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition El Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use check list.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
(� �
Air conditioning
Job site address: , 5720 � (requires site plan showing placement) #... 46.75
City /State /ZIP: ? ` G,/'a c/�'�p•l C7 ef Furnace 100,000 BTU (ducts/vents) 46.75
/ f Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: 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
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) Flue vent for water heater or gas
6 &,,3. pm ti. pJlJ fieplace 23.32
Ft) Log lighter (gas) 23.32
P �-- Wood/pellet stove 33.39
Wood fireplace /insert 23.32
[!kf'ROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23 32
,0�" ( /
Name: D A V (� Environmental exhaust and ventilation:
Address: ZO S W G ret/N °L Range hood/other kitchen
! equipment 33 39
City/State /ZIP: arc/ ®r� 6 7U�� Clothes dryer exhaust 33 39
6 Single -duct exhaust (bathrooms,
Phone: (SOS ---51‘ 3 Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPL CANT ❑ CONTACT PERSON Attic /crawlspace fans 23 32
Business name: Other: 23.32
Fuel piping:
Contact name: $14.15 for first four; $4.03 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
P� Clothes dryer (gas)
Business name: Of // tl
c � �/ �
Address:
4
Other. CJ // �J �,g MECHANICAL PERMIT FEES"
City/State /ZIP: p �
Ct fi/ SC(, : O 01 77c9 9 Subtotal
Phone: (�
� , c1 / Fax: ( ) / Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: J't795s / State surcharge (12% of permit fee)
/ TOTAL PERMIT FEE ((j0. 20
���v� This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: (!r ' � Date: /?j r / • Fee methodology set by Tn-County Building Industry Service Board
I \ Building\Permits\MEC- PermitAppdoe 03/07/12 440-4617T (I 1/02/COM/WEB)
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.
1 \Bmlding\Permits\MEC- PermitApp doc 03/07/12 2