Permit 1 1( Sub CSh►hvN ms '
. Mechanical Permit Application FOR OFFICE USE ONLY i
. ' City of Tigard Received
N. n 1312 ° g ICE VED Date/By: Permit No.: fl �!L J i t
5 SW Hall Blvd., Tigard, OR 4 Plan Review
Phone: 503.639.4171 Fax: 503.5' :.1 ' :•. Other Permit:
Date/By:
TIGARD Inspection Line: 503.639.4175 n r� ZOO Date Ready /By: 0 Sec Page 2 for
Internet: www.tigard - or.gov MIG $ 1 S Notified/Method: !' Supplemental Information
TYPE OF IX ® I ` COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
New construction ® Addition /a
VISION �� permit fees* are based on the value of the work
� a ement Mechanical p
performed. Indicate the value (r• • : . . - . .. . of all
❑ Demolition ❑ Other: mechanical materials, e. ent, labor, overhead, and profi\
CATEGORY OF CONSTRUCTION Value: $
❑ 1- and 2- family dwelling ® Commercial /industrial RESIDENTIAL . r SYSTEMS FE *
❑ Accessory building
For special information use checklist.
❑ Multi- family 0 Master builder
0 Other: Description I Qty. I Ea. I Total
. e;iR �Jr OB SITE INFORMATION AND�TION Heating/cooling
Job site addr ' Washington Square Rd Spa Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State/ZIP: Portland OR 97223 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Sanrio heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
./ /// ��� hydronic) 14.00
Z' 1 Unit heaters (fuel - type, not electric),
v in -wall, in -duct, suspended, etc. 14.00
Subdivision: Washington Square Lot no.:
Flue/vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK • Water heater 10.00
Gas fireplace 10.00
Tenant alteration of existing space 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 I ❑ TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name: Macerich Environmental exhaust and ventilation
Range hood /other kitchen
Address: 11411 North Tatum Blvd equipment 10.00
City/State/ZIP: Phoenix AZ 85028 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (602)953 -6220 Fax: ( ) toilet compartments, utility rooms) 6.80
i3. ' El APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name: PPS
Other: 10.00
Fuel piping
Contact name: Brenda Bender $5.40 for first four; $1.00 for each additional
Address: 75 60 Street SW Furnace, etc.
Gas heat pump
City /State/ZIP: Wyoming MI 49548 Wall /suspended/unit heater
Phone: (800) 285 -7866 x 3 Fax: : (616) 493 -9351 Water heater
Fireplace
E -mail: brendab @precisionpermits.com Range
—MD CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State/ZIP: Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB tic.: State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: R p e:,,,.0 peg_ Date: a i j(s / g • Fee methodology set by Tri- County Building Industry Service Board
1:\Buitding \Permits \MEC - PermitApp.doc 01/19/07 440-4617T (I1 /02/COM/WEB)
Community Development
Request for Permit Action
T.l'G AR D;
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor in City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
V 0 1 City/State /Zip:
e f Q 4W--. Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
'18 1 - CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: r C ( O3 g . oneNO Ckci
Site Address or Parcel #: 9 55 C.06.61-/,....r0,6 4. eb
Project Name: /} E ( n
Subdivision Name: A)/el Lot #:
EXPLANATION: ()Q) L1 e _ e tyr i 0,3 A k13rot ioe_OHPLg rr . a EQf1 C�
Co ►.r1 A eToI 10/ 1440 eH-O E,J Co Alr.(24eT2 5u8N,r A PUC »i7a
7f 51 V! n> T Signature: Date: 9 (cl O
Print Name: l U f }b,p} H S/4
Refund Policy
1 The Director or Building Official may authonze the refund of
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended
c) not more than 80% of the land use application fee for issued permits
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended
e) not more than 80% of the building permit fee for issued permits pnor to any inspection requests.
2 Refunds will be returned to the original Payer in the same method in which payment was received Please allow 1 -2 weeks for processing refunds
FOR FFILE USE ONLY' t
Rte to S s Adnun: Date Cit p ; Rte to Bld: Admin: Date B
Refund Processed: Date - B , all Invoice Processed: Date B
Permit Canceled: Date AM_ B „A„, Parcel Ta: Added: Date B
Recei it # Date Method Amount $
1: \ Building \ Forms \RegPemvtAction doe Rev 07/26/07
• 'k 5a). G&Shlh v
�
fit N � m�
Mechanical Permit Applic ion . . - . FOR OFFICE. USE ONLY
City of Tigard -- CENED y d
13125 SW Hall Blvd , Tigard, OR ' '^" -t Date /B Receive _ ..e: i I
Phone 503.639 4171 Fax 503.5'<: 1 ' Plan Review
Date / � Permit No Other Permit
T I G AR D Inspection Line 503 639.4175 �` 1 g OO8 Date Ready /By RE El See Page 2 for
Int- ' wwy ardor ov U G U Notified/Method Supplemental Information
PO ;9' o tt►. 0 1y
YPE �
b" r"Ne Olv 1. COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
acement y1� Mechanical permit fees* are based on the value of the work
0 New construction 0 Addition/afilitiWpi
performed Indicate the value (ra • : . . - • . a. • of all
❑ Demolition ❑ Other: mechanical materials, e. .. ent, labor, overhead, and profi\
CATEGORY OF CONSTRUCTION Value. $
RESIDENTIAL E ■ - • SYSTEMS FE *
❑ I- and 2- family dwelling ® Commercial /industrial ❑ Accessory building
For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty Ea. Total
B SITE INFORMATION AND�TION Heating/cooling
Air conditioning or heal pump
Job site addre Washington Square Rd Spa (requires site plan showing placement) 14.00
City /State /ZIP: Portland OR 97223 Furnace 100,000 BTU (ducts /vents) 14 00
Furnace 100,000+ BTU (ducts /vents)
i) \rt..) Suite/bldg. /apt. no.: Project name: Sanrio Gas heat pump 14 00
Cross street/directions to job site: Duct work 10 00
Hydrontc hot water system 14 00
Residential boiler (radiator or 17 90
hydronic) 14 00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc 14.00
Flue /vent for any of above 6 80
Subdivision: Washington Square Lot no.: Other 10 00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10 00
Gas fireplace 10 00
Tenant alteration of existing space 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: Macerich Environmental exhaust and ventilation
Range hood /other kitchen
Address: 11411 North Tatum Blvd
equipment 10 00
City /State /ZIP: Phoenix AZ 85028 Clothes dryer exhaust 10 00
Phone: (602 953 -6220 Fax: Single -duct exhaust (bathrooms,
( ) toilet compartments, utility rooms) 6 80
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10 00
Business name: PPS
Other 10 00
Fuel piping
Contact name: Brenda Bender $5.40 for first four; $1.00 for each additional
Address: 75 60 Street SW Furnace, etc
Gas heat pump
City /State /ZIP: Wyoming MI 49548 Wall /suspended/unit heater
Phone: (800) 285 -7866 x 3 Fax: : (616) 493 -9351 Water heater
Fireplace
E -mail: brendab @precisionpermits.com Range
) CONTRACTOR Barbecue
Business name:
Clothes dryer (gas)
142 - r e -e 7 v ozi r== #m 4 :71 11 7-' Other
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Minimum permit fee ($72 50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lie.: State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: k R yN cip t e>eo Deg_ Date: a PcQ / * Fee methodology set by Tn- County Building Industry Service Board
1 \Bu ddmg\Permits \MEC- PermnApp doc 01/19/07 440 -4617T (1 I /02 /COM/WEB)