Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2013 00221
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/23/2013
Parcel: 2S104DCO3000
Jurisdiction: Tigard
Site address: 13265 SW CLEARVIEW WAY
Project: Adams Subdivision: BENCHVIEW ESTATES Lot: 30
Project Description: (1) furnace installation
Contractor: NW SUNDANCE SERVICES INC Owner: ADAMS, KEONI
10117 SE SUNNYSIDE RD STE F1201 13265 SW CLEARVIEW WAY
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503 - 750 -7442 PHONE: 503 - 313 -5659
FAX: 503 - 655 -3347
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/23/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04/23/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/23/2013 $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 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.
Issued By: ' J J //n that /' t- Permittee Signature: Qact 4 3O — OA
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.
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Mechanical'erinit Application RECEIVE
Ilig Tigard R Pexn itNo.:
� ! City of Tigard
SW Hall Blvd.,'figard, OR 97223 APR 2 3 2013 �at�y; (9_3 1 3 � /A �Ca)1�f3 - nv�l
Plan Review poet Perrin:
Phone: 503.718 2439 Fax: 503.598.1960 Bate/Ii
t t 1, i , Inspection Line: 503.639 4175 to .ReedrJ CITY OF TIG r 7uri r; See Page 2 far
� �
Internet www.tigard- or.gov BUILDING DIVIS10 : , lens', snppteeieritaI bibrutatioa
COMMERCIAL rwf,E' 6G1•I DtTI.B - USE. 'IL S}
TIOS . OF: WORK Mechanical permit fees' are based on the value of the work
❑ New constnretion /alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
m ec'haincal.materials, equipment, labor, overhead, and prulit.
Q Demolition ❑ Other: Value: $
CA * ESIDENTIAL EQUIPMENT I SYSTEMS IEEE'
CATEGORY OF CONSTRUCTION '
M 1- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building For specialinjbnnradon ow eke ddist
❑ Multi - family ❑ Master builder ❑ Other: Description f Qty. Ea l Total
JOB 3t INFORMATION AND LOCATION Heating/cooling: •
Job site address: I ( r . lT ..1 _ Air conditioning 46.75
City/State /ZIP: ' p . 1\ ' V • "1111 Furnace 100,000 BTU(ducts/veot4) I 46.75 ,
Suite/bldg./apt. no.: Project name: Purc1ace 100,000+ BTU (ducts/vents) 54.91
Cross stroet/directions to job site: Heat pump 6L06
Duct work 23.32
H'.dronot w system 2332
Residenti a boiler ater (radiator or
hydronie) 2332
Unit heaters (foci -type, not electric),
Subdivision: EE in -wall, induct, suspended, etc. 46.75
Tax tnap'ptttt el nn.: Flue/vent for any of above 23,32
DESCRIPTION OF WORK Other. 23.32 -
Other fuel appliances:
I► . ►a M. \��u .
Water heater 23.32 _
Gas fireplace/insert
eplace/insett 3339
Flue vent for water heater or gas
fuaplace 23.32
Log lighter (gas) 23.32
❑ PROPERTY OWNER IIIIIIIIIEIMEEIIIIIIIIIIIII Wood/pellet stove 33,39
Name: r !� A i�... LL
Wood fireplace/insert 23.32 f
Address: !� +- } . �� _ . Chimney/linet /flue/vent 23,32
City/State/ZIP: .4" t e at N {z - • Other: 23.32
Phone:. ry ) ,_ Environmental exhaust and ventilation;
❑ APPLICANT 0 CONTACT PERSON Range /1°°d/other kitchen
equipment 33.39
Business name: 1. Ii, !t,YN. ' - i ,
Clothes dryer exhaust 33.39
Contact name: kik A, , ,A .. P.. «A , Single -duct exhaust (bathrooms,
toilet cornyartments, utility rooms) 23.32
Address:. 1 , . 1 . Iglall
Attic/crawlspace fans 23.32
City/State/ZIP: ,n._,l , ,,. 0 I r - 0
Other: 2332
Phone: (ggi) Zw — ►. ,,...4 Sri. _ Fuel piping:
E -mail:
,, At , • .. 4 - . ' ,L ' 4 4• 4 S' l'l't $14.15 for tllrst four: $4.63 for each aA4ftUOta)
CONTRA - s
R furnace, etc_
Business name: t ; , to, t, l r, Q Gas heat pump
Address: . 1-- -- , 1 , v Wall/susperadedJunit heater
• • u
Water heater 1221:MIMIEMIIIIII w Fax' ( ? — Fireplace
CCB lic.: • q Range
Barbecue
Authorized signature: Clothes diver (gas)
Print name: /5 Ai k, • • A £ .•A,._;. f Date: 4 •� Other
MECHANICAL PERMIT FEES. •
I:\Building\Pamitc'5.00 PermdtApp O40113.doc 440-4617T (J1/07X074/M003)
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Subtotal
Minimum permit fee ($90.00)
Plan review (25% of permit fee)
State surcharge (1 of permit fee)
TOTAL PERMIT FEE
Tbis permit application expires if a permit is not obtained within 180
days after it has been accepted is complete.
* Fee methodology set by 7ti-Coucty'Building Industry Service Board
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Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi - Family Fee Schedule:
Total Permit Pee:
$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.
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