Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2013 00615
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/15/2013
Parcel: 2S110BB01200
Jurisdiction: Tigard
Site address: 12370 SW DUCHILLY CT
Project: Klune Subdivision: AMES ORCHARD Lot: 13
Project Description: Replace furnace
Contractor: RUMBOLD HEATING&AIR COND INC Owner: KLUNE,JOHN G& LOIS A TRUSTEES
PO BOX 397 12370 SW DUCHILLY CT
BEAVERCREEK,OR 97004 TIGARD,OR 97224
PHONE: 503-656-0475 PHONE:
FAX: 503-632-8669
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 10/15/2013 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 10/15/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 10/15/2013 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure: •
Total $100.80
Required Items and Reports(Conditions)
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or rk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ification Ce -r. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or d'ect questions to OU by = ' • 503.232.1987 or 1.800.332.2344. ( /
Is ued By: 1 / /) 4# 4 / Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Mechanical Permit Application FOR oFFlcl USE ONLY
r_, n Received
Cl of Tigard � ,� Date/By: /0 /7/ Permit No.:
13125 SW Hall Blvd.,Tigard,OR 972'L'U �i„ 0 1:1 o Plan Review
C' Phone: 503.718.2439 Fax: 503.598.1960 '' Other Permit:
503.718 Date/By:
f l G n R D Inspection Line: 503.639.4175 OCT 15 2013 Date Ready/By: loos El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARn
TYPE OF ,�bItK INIC1 n1li r]n m COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction }r Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
Rill and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: /,3 70 5-a- bik.c-[k•a it.y 6--- Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 1 � t �y ( Furnace 100,000+BTU(ducts/vents) 1 54.91
Heat pump 61.06
Suite/bldg./apt.no.: ( Project name: Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
- 3,,Q,2_044,17 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.
nel2/&C'e, 1:le.„-- fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
❑ -PROPERTY OWNER I - ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: .4 Khz4 ,,.e Range hood/other kitchen
equipment 33.39
Address: 54'1i'VL Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
•
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
$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: /LLt,wi,t el AlG In t_ Other.
MECHANICAL PERMIT FEES* •
Address: p o, 6, J� Subtotal 9� a°
City/State/ZIP: B.r4t� -- .,, ,t?jt--. ?y< Minimum permit fee($90.00)
Phone:5-63) 65-6-bc/-z Fax:( O, Plan review(25%of permit fee)
7 5 S 32��(o State surcharge(12%of permit fee) /v. 8"U
CCB lic.: ),7 LSO L- '> •. TOTAL PERMIT FEE /00• g'O
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature:
• Fee methodology set by Tri-County Building Industry Service Board
Print name:-ciestpv\ V k1/c,ca._ Date: i '-3 (3
1:\Building\Permits\MEC_PermitApp_040113.doc 440-46171'(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.
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