Permit - . - CITY OF TIGARD MECHANICAL PERMIT
1: COMMUNITY DEVELOPMENT Permit #: MEC2013 -00013
• T.IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/08/2013
Parcel: 1 S 135CA04300
Jurisdiction: Tigard
Site address: 9715 SW NORTH DAKOTA ST •
Project: Hoffman Subdivision: 1991 -012 PARTITION PLAT Lot: 1
Project Description: Remodel, install (1) dryer vent and (1) vent fan. Install gas piping for future appliances, furnace, dryer, range &
water heater.
Contractor: TOM HOFFMAN CONSTRUCTION Owner: HOFFMAN, TOM
3825 SW 90TH AVE 3825 SW 90TH AVE
PORTLAND, OR 97225 PORTLAND, OR 97225
PHONE: 503 - 292 -3357 PHONE: 503 - 292 -3357
FAX:
FEES
Specifics: Description Date Amount -
Clothes Dryer Exhaust 01/08/2013 $33.39
Type of Use: SF Single Duct Exhaust (Bathrooms, Toilet, 01/08/2013 $23.32
Class of Work: ALT Type of Const: Utility Rooms)
Occupancy Grp: Fuel Piping 01/08/2013 $14.15
•
Stories: 12% State Surcharge - Mechanical 01/08/2013 $10.80
Minimum Fee Adjustment - Mechanical 01/08/2013 $19.14
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is ' . ued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicab : aw. All • will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issua. e, or if work is s •end- • •r more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili Notification Center. • .se rule - et forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You btain a copy 7f e rules
or irect questions to OUNC : Iling 5r c • : 7 or 1.800.332.2344. /
Iss ed By: % /` Permittee Signature: k j'/
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 Applica OFFICE USE ONLY
C E I V E D Receive.Q�
City of Tigard Date/By: . — I Permit No.: r MM
II " �i/�0�
1 3125 SW Hall Blvd., Tigard,OR 9 2
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Q Date/By:
Other Permit
l I G A R D Inspection Line: 503.639 AN 0 8 2013 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard -or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPE OF I4DING DIVISION COMMERCIAL FEE" SCHEDULE — USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction It 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"
❑ 1 - and 2-family dwelling 0 Commercial/industrial 0 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: 9'- ( s S W as... 44, D..144-._ (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City/State /ZIP: T 6 Or /01?-3 Fumace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: [ Project name: Heat pump
^ I (requires site plan showing placement) 61.06
Cross street/directions to job site: 5‘....) G o.e� h i t . , 9 / 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
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 ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: Tct r„` Environmental exhaust and ventilation:
Address: 3230 S` W 547.) Range hood/other kitchen
equipment 33.39
City /State /ZIP: P./ 44'--?0 g' ? r Clothes dryer exhaust / 33.39
Single -duct exhaust (bathrooms, /
Phone: ( (D3) e ll; r3 3 S 1 Fax: ( ) toilet compartments, utility rooms) / 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawispace fans 23.32
Other: 23.32
Business name: 3, Fuel t m
P�P� I;:
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc. 11/
Gas heat pump �/
City /State /ZIP: Wall /suspended/unit heater 0
Phone: ( ) Fax: : ( ) •- Water heater
1 Fireplace
E -mail: 'r'.) w+ H r�4 f..-r.ea , i o . u.r"- ►.. Range (4 il
CONTRACTOR A Barbecue J..
Business name: JQ ,,�i i 1 1--/e114774 y✓ `OA)OT7!..arp 0 - Clothes dryer (gas)
C Other:
Address: g �• 5 ,) W 9 � � MECHANICAL PERMIT FEES"
City /State /ZIP: POr•'t.-(o c0 o r 91 ;aSr. Subtotal
Phone: (b3) a i p ..-13s---) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: 5' ( y I / /I g / State surcharge (12% of permit fee)
TOTAL PERMIT FEE /gyp. ff0
Authorized siepatur�tf �J /,— ' (� � � This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: JD //, Date: • Fee methodology set by Tri -County Building Industry Service Board
I:\Building\PermitsVMEC- PermitApp.doc 03/07/12 440-4617T (II /02/CO.M/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:\Building\Permits\MEC- PermitApp.doc 03/07/12 2