Permit CITY OF TIGARD MECHANICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit#: MEC201300037
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/22/2013
Parcel: 1 S 135DB02900
Jurisdiction: Tigard
Site address: 11515 SW 91ST AVE
Project: Hampton Subdivision: CHARBEN Lot: 12
Project Description: Replace existing gas furnace
Contractor: PNW MECHANICAL LLC Owner: HAMPTON, KENNETH B&
3611 SE 190TH AVE KNOLL, LAURA D
VANCOUVER,WA 98683 11515 SW 91ST AVE
TIGARD,OR 97223
PHONE: 360-772-9742 PHONE:
FAX:
FEES .
Specifics: Description Date Amount
Furnaces<100K BTU 01/22/2013 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 01/22/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 01/22/2013 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance r1 is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili otification Cent- Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or erect questions to OUN • .l'•• 503.232.1987 or 1.800.332.2344.
I sued By: ■ & /7 Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR Oil l( I: 1 SF ON 1.1
City of Tigard Date/By:
Permit No.: ��/'O�yt
III
u 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review wv
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TI G A R u Inspection Line: 503.639.4175 Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
O 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 1`5`Cj t.Jo 6k(Sic 0.iJt.S2- (requires site plan showing placement) 46.75 /
- Furnace 100,000 BTU(ducts/vents) 11 46.75 f4.7
City/State/ZIP: -(:( 8.Jd, O V Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: tto ktk, \I .uA o .. 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
?..•2 i14C 2 G'g.:Skiv�d &tSLA-Y vxC 2y 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
a PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: 14\k C1/41/t tsj�"`�!_ „ oUt Environmental exhaust and ventilation:
Range hood/other kitchen
Address: k l n VC 5 i.0 ck e.,'c Ti equipment 33.39
City/State/ZIP: '•• 5 c",_qd 6 V Clothes dryer exhaust 33.39
Single-duct exhaust(bathrooms,
Phone:(' ) Fax:( ) toilet compartments,utility rooms) 23.32
APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name: ? \ W t,A.€GkCcvd cA U-c___ Fuel piping:
Contact name: V A0 $14.15 for first four;$4.03 for each additional
Address: 3 6l_ e 1.4(�a� at�� Furnace,etc.
Gas heat pump
City/State/ZIP: 1/4..)&\ . Q V V W a q,8(oP,5 Wall/suspended/unit heater
Phone:(3(. •) '77.2_47q'7. Fax::( ) Water heater _
Fireplace
E-mail:
Range
CONTRACTOR Barbecue
Clothes dryer(gas)
Business name: 9 ht Lo C> Cal u_e_
Other:
Address: 3 Cc 'S-e (Ctl eua- MECHANICAL PERMIT FEES*
City/State/ZIP: ct 2,6 Subtotal
�PJ.t�`C.O U�4 C.vct
Phone:( 369(1 -2 7Z- L(Z Fax:( ) Minimum permit fee($90.00) �Q
/1tfPlan review(25%of permit fee) .-\ ? ,•7q FA State surcharge(12%of permit fee) 0- O
TOTAL PERMIT FEE /X.
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: ` Fee methodology set by Tri-County Building Industry Service Board
I:\Building\Permits\MEC-PermitApp.doe 03/07/12 440-4617T(11/02/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.
I:\Building\Permits\MEC-PermitApp.doc 03/07/12 2