Permit 11111 CITY OF TIGARD MECHANICAL PERMIT
'' COMMUNITY DEVELOPMENT Pe
COMMUNITY MEC2016-00561
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/04/2016
Parcel: 15136DD00800
Jurisdiction: Tigard
Site address: 11585 SW 67TH AVE
Project: Family Baptist Church Subdivision: WEST PORTLAND HEIGHTS Lot: 7-19
Project Description: Replace(4)gas furnaces
Contractor: WILLAMETTE HEATING&AIR CONDITIONING INC Owner: FAMILY BAPTIST CHURCH
4760 SW HAMILTON 11585 SW 67TH
PORTLAND, OR 97221 TIGARD, OR 97223
PHONE: 503-284-3740 PHONE:
FAX: 503-284-2821
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 08/04/2016 $207.21
Class of Work: ALT Type of Const: Plan Review 08/04/2016 $51.80
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 08/04/2016 $24.87
Stories: Info Process/Archiving-Sm$0.50(up to 08/04/2016 $5.00
11x17)
Project Valuation: $5,000.00
Fuel Air Handlers
Fuel Types: Units<10000 cfm:
Gas Pressure: Units> 10000 cfm:
Furnaces Boilers&Compressors
Furnaces<100K BTU: 4 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 $288.88
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct quos to OLINIC cal g 503.232.1987 or 1.800.332.2344.
Issue By: ---(-( (/( 4 Permittee Signature: IN
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
CEI E D y. Permit No.: /
13125 SW Hall Blvd.,Tigard,OR 97~ lam \1/( Date/By. y 1� £C��� oo5't0
'll i Phone: 503.639.4171 Fax: 503.598.1'.1 Plan Review
Date/By: Ocher Permit:
Inspection Line: 503.639.4175
kris.Date Ready/By: Seepage 2 forInternet www.tigard-or.gov y • 'f 2016 Notified/Method: Supplemental
Information
Ca Or TIGARD
TYPE Ott� ireplacement NG DIVISION COMMERCIAL FEE*,SCHEDULE - USE CHECKLIST
0 New construction ddition/alteerrationn/ Mechanical permit fees*are based on the value of the work
!ll��� ��, performed.Indicate the value(rounded to the nearest dollar)of all
o Demolition 0 Other: mechanical materials,equipment,labor overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$ j1 `S
❑ 1-and 2-familydwellingCommercial/industrialRESIDENTIAL EQUIPMENT/SYSTEMS FEES*
0 Accessory building
❑Multi-familyFor special information use checklist.
0 Master builder 0 Other: Description
Qty. Ea. Total
JOB SITE INFORMATION ANDL ATIO Heating/cooling
Job site address: // f913 _ Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: J Cir�,'�, �� Furnace 100,000 BTU(ducts/vents)Fur14.00
Suite/bldg./apt.no.: F Project name:i lly 1lj,9Or�r ///L�d�� Gas ee 100,000+BTU(ducts/vents) Al17.90
j ✓l, (..-/1' '�-C Gas heat pump ` 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler(radiator or
hydronic) 1400
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 10.00
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
12 c i e j e I Gas fireplace 10.00
- €_. 4/ 7z3(/z_ _,( Flue vent for water heater or gas
fireplace 10.00
Log lighter(gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
0 PROPERTY OWNER 0 TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name:
Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single-duct exhaust(bathrooms,
Phone:( ) Fax:( ) toilet compartments,utility rooms) 6.80
0 APPLICANT 0 CONTACT PERSON Attic/crawlspace fans 10.00
Business name: Other: 10.00
Fuel piping
Contact name: $5.40 for first four;$1.00 for each additional
Address: Furnace,etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone:( ) Fax::( ) 1 Water heater
E-mail:
Fireplace
Range
CO CTOR Barbecue
Business name: Clothes dryer(gas)
Other
Address: eelel,?:- t }�j� MECHANICAL PERMIT FEES*
City/State/ZIP: .( (�/ Subtotal
Phone:( ) ��� � Fax.( ) Minimum permit fee($72.50)
CCB lic.: f47 -79,- Plan review(28%of permit fee)
State surcharge(8%of permit fee)
/ TOTAL PERMIT FEE 38-3g
Authorized signature: j� �( This permit application expires if a permit is not obtained within 180
`'( ///�" days after it has been accepted as complete.
Print name: 4Date:
7`e0 i/ /77j� • Fee methodology set by Tri-County Building Industry Service Board
I:\Building\Permits\MEC-PermitApp.doc 04/06/06 440-461/7T(11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to$2,000.00 Minimum fee$72.50
$2,001.00 to$5,000.00 $72.50 for the first$2,000.00 and$2.30
for each additional$100.00 or fraction
thereof,to and including$5,000.00.
$5,001.00 to$10,000.00 $141.50 for the first$5,000.00 and
$1.80 for each additional$100.00 or
fraction thereof,to and including
$10,000.00.
$10,001.00 to$50,000.00 $231.50 for the first$10,000.00 and
$1.35 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,001.00 to$100,000.00 $771.50 for the first$50,000.00 and
$1.25 for each additional$100.00 or
fraction thereof,to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first$100,000.00 and
$1.10 for each additional$100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
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