Permit r CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit it: MEC2014-00196
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/30/2014
Parcel: 2S104AD05100
Jurisdiction: Tigard
Site address: 12860 SW 129TH PL
Project: Block Subdivision: 2004-003 PARTITION PLAT Lot: 2
Project Description: Installation of a/c. Placement of unit must comply with manufacturers clearance requirements.
Contractor: COMFORT ZONE HEATING&AIR COND Owner: BLOCK, KRISTIN S&JAMES W
1032 NW CORPORATE DR 12860 SW 129TH PL
TROUTDALE, OR 97060 TIGARD,OR 97223
PHONE: 503-667-5595 PHONE: 503-753-8266
FAX: 503-491-8252
FEES
Specifics: Description Date Amount
Air Conditioning 04/30/2014 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 04/30/2014 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 04/30/2014 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N. • . -. enter. Tho e rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dirt ' questions to • NC b . ing 503.232.1987 or 1.800.332.2344.
Issu d By: Permittee Signature: � 144
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit APPli OIZ t)rrlt is l SE ON 1.1
EIVE r Received
City of Tigard Date/By: -_� Permit No.: ,/ .. /
illig
13125 SW Hall Blvd.,Tigazd,OR 97223 � ��/�
Phone: 503.718.2439 Fax: 503.59 801 ')014 Plan Review Other Permit:
Inspection Line: 503.639.4175 �1 " 3 L
Date/By:Re
I I G A P.D p Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPIBIJIM 4G DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
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 1 46.75
Job site address: l ,-1 g O 5 .1.P. P I Furnace 100,000 BTU(ducts/vents) 46.75 VZ �
City/State/ZIP: 6 f,'09, 3 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: � f*ject name: r �, Heat pump 61.06
Duct work 23.32
l
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
D CRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
44,d-an 4 c,- fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove _33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
_
Name: (\� 3 t ,>� Range hood/other kitchen
equipment 33.39
Address: le , 0 S, t as lot
Clothes dryer exhaust 33.39
City/State/ZIP: T` -a c () `e (-7 aa3 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:Sci5 , S3 2`(Qcj 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:( ) I Fax: :( ) Fireplace
Range
E-mail:
Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: tork c.}. 7 o n H.era,tn� c C' t(_ MECHANICAL PERMIT FEES*
Address: /0,6 ?J&) C(j,Q-iet,4- & , l `":1/� Subtotal 5j)�a
City/State/ZIP—"7 , A L G� 9-.7e&-) Minimum permit fee($90.00) 1r
Phone:(�1) �4-7— 6-57e Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee) 16 ,'(O
CCB lie.: (( 00O( r ��JT/�0 TOTAL PERMIT FEE 1(j�i_ g�
1 This permit application expires if a permit is not obtained within 180
'/1/( Cgd _ ��
days after it has been y Building as complete.
Authorized signature: V -` ` r�(0 rJ'a` /1./{/L, * Fee methodology set by Tri-County Building Industry Service Board
Print name: ' , 0 t cI f 1111 elk)*etc Date: -T r-�(j.,f L.1
I\Building\Permits\MEC_PermitApp_0401 I3.doc 440-4617T(11/02/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.
I:\Building\Permits\MEC_PermitApp_0401 I3.doc 2