Permit (194) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2016-00009
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/06/2016
Parcel: 1 S 136CA90531
Jurisdiction: Tigard
Site address: 10900 SW 76TH PL 53
Project: FLOYD Subdivision:GARD WOODS,A CONDO COMMUNII Lot: 53
Project Description: Furnace replacement.
Contractor: ANTON HEATING Owner: FLOYD, PAMELA G&JAMES R
7816 SE 68TH AVE 10900 SW 76TH PL#53
PORTLAND, OR 97206 TIGARD, OR 97223
PHONE: 503-380-1311 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Furnaces< 100K BTU 01/06/2016 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 01/06/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 01/06/2016 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Tota 1 $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
6
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application
Received
Pennit No.: M&C
Date/By:
n)o(
City of Tigard IV Date/By- L r
13125 SW Hall Blvd.,Tigard,OR 9722 Njge Plan Review'
Phone: 503.718.2439
2439 Fax: 503 0 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Read/B Juris: 0 See Page 2 for
Internet: www.tigard-or.gov 10% Notified/Method: Supplemental Information
0�9 1
E:
Mechanical pennit fees*are based on the value of the work
❑New construction A d d i t i on a I 00'p*41a cem e n t performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition E]Other: mechanical materials,equipment,labor,overhead,and profit.
'P CValue:$
J A, 0 A
1-and 2-family dwelling El Commercial/industrial E:1 Accessory building For special information use checklist.
F1 Multi-family El Master builder El Other: Description Qty. Ea. Total
vl` 1�',I, , IT7777
A Heating/cooling:
Air conditioning 46.75
Job site address: 0 T
761k
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: ell Furnace 100,000+BTU(ducts/vents) 54.91
F
Heat
Suite/bldg./apt.no.: Project name: um 61.06
p loya 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
Gas fireplace/insert
ON OF WORK 33.39
Flue vent for water heater or gas
P12 Lo Lo a 71 a-r—e %/Z 60-0 61 ofireplace 23.32
IQ Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
'PR
RTY
Environmental exhaust and ventilation:
Name: J Range hood/other kitchen
Address: equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.3
Phone: Fax: Attic/crawlspace fans 23.32
Other: 23.32
Business name: Fuel piping:
ZL A, $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: -Z Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: 0,d on - Water heater
Phone: 70— Fax:: Fireplace
E-mail: Range
Barbecue
Clothes dryer(gas
&,A4
g�
Business name: 1 Other:
Address:
6 Subtotal
City/State/ZIP: EA. Ot' 672'2� Minimum permit fee($90.00) qo
Phone:( Fax:( Plan review(25%of permit fee)
?A Y`5�__J State surcharge(12%of permit fee)
CCB lic.: /44 6 TOTAL PERMIT FEE do
This permit application expires if a permit is not obtaified within 180
days after it has been accepted as complete.
Authorized signature: Fee methodology set by Tri-County Building Industry Service Board
Print name: L1( O� PW�o ty Date: 6
1:,Building,Permits,MEC_PertmtApp_040113.doc 440-4617T(I 1/02�COM,WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial&�}Multi-Family Fee Schedule:
f.
$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\PennitsNEC_PennitApp_040113.doc 2