Permit CITY OF TIGARD MECHANICAL PERMIT
IN a COMMUNITY DEVELOPMENT Permit #: MEC2013 00223
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/13/2013
Parcel: 1S133AD02200
Jurisdiction: Tigard
Site address: 10820 SW 130TH AVE
Project: Westgate Baptist Subdivision: CHAPARRAL Lot: 1
Project Description: Relocate ducts and grilles for TI
Contractor: B DUTTON CONSTRUCTION INC Owner: WESTGATE BAPTIST CHURCH
16775 SW LAKE FOREST BLVD 12930 SW SCHOLLS FERRY RD
LAKE OSWEGO, OR 9703 TIGARD, OR 97223
PHONE: 503 - 572 -7392 PHONE: 503 - 524 -3500
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 06/13/2013 $69.06
Class of Work: ALT Type of Const: VB Plan Review 06/13/2013 $17.27
Occupancy Grp: B Occupancy Load: 12% State Surcharge - Mechanical 06/13/2013 $8.29
Stories: 1
Project Valuation: $500.00
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $94.62
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: duct work
Duct Work: 1
Fire /Smoke Dampers:
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 co• of the ules
or direct qu - . • • • OUNC • calling 503.232.1987 or 1.800.332.2344.
Issued B Permittee Signature: V ,
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 1012 OFFICE USE ONLY _
City of Tigard Date/By: � _ Permit No.: r C eao /5 . a�3
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review R /
C Date/
By: Phone: 503.718.2439 Fax: 503.598.1960 Other Permit: /O� C/5 OUO i
T I G A R D Inspection Line: 503.639.417 Date Ready/By: runs: ® 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: $ 5dD _00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling Commercial/industrial ❑ 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 46.75
Job site address: /Q'� i20 1- k. Furnace 100,000 BTU (ducts/vents) 46.75
City/State /ZIP: ! 7 -- 16/02. , 0 Q tL F 4 7 1 ,3 Furnace 100,000+ BTU (ducts/vents) 54.91
6 Heat pump 61.06
Suite/bldg. /apt. no.: Project name: 4J FS TGkGr6 Duct work 23.32
Cross street/directions to job site: 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
Flue /vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map /parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
020(.6 R kw ' - k r;Aj i L ` fireplace 23.32
� '� �� Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney/liner /flue /vent 23.32
gl OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: i / C5, G � 2 p . r 5 r 14 Range hood/other kitchen
!/l/ V equipment 33.39
Address: /2_9 30 3 ZL' F At Clothes dryer exhaust 33.39
City/State/ZIP: -rt .0 6 4.6 g7ZZ3 Single -duct exhaust (bathrooms,
6 toilet compartments, utility rooms) 23.32
Phone: ( ) Fax: ( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four; $4.03 for each additional
Contact name: Furnace, etc.
Address: Gas heat pump
Wall /suspended/unit heater
City/State /ZIP: Water heater
Phone: ( ) Fax: : ( ) Fireplace
Range
E -mail: Barbecue
CONTRACTOR Clothes dryer (gas)
Business name: Other:
8 cp Ir/7bAl ( r A(S i K t r(OA) L MECHANICAL PERMIT FEES*
Address: 671 S 54,3 L( tr pt( /L Vh Subtotal
City/State /ZIP: .n,‘. kit 022 7)0g1 Minimum 25% permit fee permit fee)
Plan review (25 % of permit fee)
Phone: (5o&) 5? Z 7 3SZ Fax: ( ) State surcharge (12% of permit fee)
CCB.lic.: ic s ` g6 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: d,,,,, m a • Fee methodology set by Tri- County Building Industry Service Board
I Print name: RR lAJV ) V fib ,. I Date:
r:\ BuildinglPermits \MEC_PermitApp_040113.doc 4404617r (I 1 /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.
1:\Building\Permits MEC_PermitApp_040113.doc 2