Permit CITY OF TIGARD MECHANICAL PERMIT
0 COMMUNITY DEVELOPMENT Permit#: MEC2013-00050
T t G A.R D 13125 SW Hall Blvd,Tigard OR 97223 503.718.2439 Date Issued: 01/23/2013
Parcel: 25111 DD09200
Jurisdiction: Tigard
Site address: 15915 SW 87TH AVE
Project: Ford Subdivision: CHESSMAN DOWNS Lot: 18
Project Description: (1)furnace replacement
Contractor: NW SUNDANCE SERVICES INC Owner: FORD, NANNETTE MARIE
10117 SE SUNNYSIDE RD STE F1201 15915 SW 87TH AVE
CLACKAMAS,OR 97015 TIGARD,OR 97224
PHONE: 503-750-7442 PHONE: 503-419-8451
FAX 503-655-3347
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 01/23/2013 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 01/23/2013 $10 80
Class of Work: ALT ' Type of Const: Minimum Fee Adjustment-Mechanical 01/23/2013 $43.25
Occupancy Grp:
Stories:
"d
Fuel
Fuel Types
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232 1987 or 1 800.332.2344. �f
JAILtithy Issued By: 1/1 0 Permittee Signature: 4PP .fe4.TD�.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
01/22/2013 17:06 5036553347 NWSUN PAGE 02/04
Mechanical Permit Application ��T���T F Olt(11 1 If 11. 1 �F (,\i.1
City of Tigard RECEIVE rDate/By: I a-'3 (3 S1 PermitNo1.{6'Z /3 -Dla
• 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Review
- JAN 2 2 2 0I;ra►tesy: Other Permit:
T!(,A u.:, Inspection Line: 503.639.4175 pate Ready/By: JWie: El See Page 2 for
Internet: www.t era or, oy CITY OF TIGA',it°ined,Method: j I Sup ts'Information
E~OF W�BUii.HI�G DNt ` COMMERCIAL Ppm*.C EDVLE-USE CHECK UST
Mechanical permit fees*are has on the value of the work
New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other. ,mechanical Material?,equipment labor,overhead,and profit.
\hike:$
CATEGORY OF':CONSTRUCTION . • . R4IEm munef err/ XEMS Fuse•
E1 t'and 2-family dwelling 0 Commercial/industrial d Accessory building For opal*,tnjonnanon eat deadtlisa
0 Multi-family ❑Master builder ❑Other Description LQtyJ Ea. J Total
JOB SITE INFORMATION AND.LOCATION - - -
Air conditioning
Job she address; l `6" c W 411-41A N w L(rehuires site plan showiaa placement) 46.75
Furnace l00z000 BTU(duets/wets) _ 46.75 46,.
City/state/ZIP: cerrkAckyjs 1 6ct.. c1,'1- .2.q Furnace 100,000*BTU(ducWveuts) 54.91
Suite/bldg./apt.no.: Project name: Heat Pump
(requires site Plan showing piacaweat) 61.06
Cross street/directions to job site: Duct work , 23.32
" Hyronic hot weer system 23.32
Residemial boiler(radiator or
hydronic) 23.32
'1 Unit heaters(fed type,not elect ric),
in-Wall,in-duct,suspended,etc. 46.75
Subdivision: 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 3339
14 Q. cyyt(J.A Flue vent for water heater or gas
„fireplace 23.32
Log llbter(gas) 23.32
Wood/pellet stove 33.39 _
Wood fireplace/insert 23.32
- II?ROPERTY OWNER I : 0.TENANT. . Chimney/finer/flue/vent 23.32
Other: 23.32
Name: v10...4 vi G Environmental exhaust and ventIlation:-
t5 � Range hood/other kitchen
Address: _. ,_• equipment 33,39
City/State/ZIP:TPA k-Acitkok OZ.. ( ?1..i Clothes dryer exhaust 33.39
t ✓Single-duct exhaust(bathrooms,
Phone:($03)411 - 9461 Fax:( ) toilet compartments,utility rooms) 2132
}APPLICANT ❑`CONTACT PERSON : Aiti/c space fans 2332
Other. 2332 Mlle:WW Y Y> L ,5i1 - W
FAping
Contact name: $1415 for 8tst four;$4.03 for each additional
Address: ttll s�S std. • -F 1701 L Furnace,etc.
T
Gas heat pump
City/State/ZIP: C Xvt t O . , "11-0k
Wall/suspended/unit heater
Phone: 3 )111.•_,Lev 1 Fax::( )(.4*- --8744-1' Water heater , .
� C01S1 it/t R
Fireplace
E-mail; V fiaS§ q th • Cotil Range
.
Barbecue
Business name: QJV.� s.0,Ac.u\ee c e,1u%4 e. Clothes drys (gas)
t-�- Other:
Address: #Q M, SIC,(_7 Q . .1`l�i?\ MEC191AN1CAd.REIItMFI>N EES" . _ -
City/State/ZIP: ,o -C S O--. Chi lS _ Subtotal
f Minimum permit fee($90.00)
Phone:(�',�) -_ a 1 Fax;(bi)-S) - 331.{3.- Plan review(25%of permit fee)
CCB lie.: l Cj 3 , g- State surcharge(12%ofpermit foe,
TOTAL PERMIT FEE /(;') .O
Authorized Signature: Ws peek ays aftere 1 has been accepted as complete. 1*
Print name: k f* Ile A a• , Date: •.L VS • Fee methodology set by Tri-County Building Industry Service Board
I:1Buitding\Pmnits1.MEC-Perm tApp.t1o4 03/07/U 440.4617T(I 1 02/COM/WEB)
01/22/2013 17:06 5036553347 NWSUN PAGE 03/04
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial&Multi-Family Fee Schedule:
Total Valuation: . Permit Fee:
$0.00 to$5.00.00 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 fust$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:\BuildinggPermib\MCC-PetmitApp.doc 03/07/12 2
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