Permit (202) CITY OF TIGARD MECHANICAL PERMIT
1 ■ COMMUNITY DEVELOPMENT Permit#: MEC2016-00813
T r t;A it D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/05/2016
Parcel: 2S111AD12200
Jurisdiction: Tigard
Site address: 15120 SW 89TH PL
Project: Wong Subdivision: SCHECKLA PARK ESTATES Lot: 37
Project Description: Install new gas furnace,gas line for furnace&water heater,flue vent for water heater
Contractor: FIVE STAR HEATING Owner: WONG, LISA
10542 SE MARKET ST 98-05 63RD RD APT 15H
PORTLAND, OR 97216 REGO PARK, NY 11374
PHONE: 503-544-9567 PHONE:
FAX: 503-251-4781
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 12/05/2016 $46.75
Type of Use: SF Flue Vent for Water Heater or Gas 12/05/2016 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel Piping 12/05/2016 $14.15
Stories: 12%State Surcharge-Mechanical 12/05/2016 $10.80
Minimum Fee Adjustment-Mechanical 12/05/2016 $5.78
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you t• follow the rules adopted by the Oregon
Utility : 'cation -..ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-00140'4. You may obtain a copy of the rules
or di -ct questions to OU by . g 503.232.1987 or 1.800.332.2344.
Isi ued By: /
�, vPermittee Signature: /, 4ii..-__
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit App eir,- FOR oFr1cL ASF oNLl
�ry
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 9 3" Date/By: l� s 4, �� Permit No.:,� i/(p2'1D gl 3
I Phone: 503.718.2439 Fax: 503.59 t9YO ) C j Plan Review
Inspection Line: 503.639.4175 Date/By: Other Permit:
T 1 C ARD p Date Ready/By: funs.
Internet: www.tigard-or.gov #1" ld See Page 2 for
1 Notified/Method: Supplemental Information
TYPE of WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction g(Addition/alteration/replacement
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF "CONSTRUCTION Value:$
UX l and 2-famil RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
Y dwellin g ❑Commercial/industrial ❑Accessory building
For special information use checklist.
❑Multi-family 0 Master builder
0 Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: \ I a. �,� ^} -� Air conditioning 46.75
�� v Furnace 100,000 BTU(ducts/vents) / 46.75
City/State/ZIP: i`w�cx_`'3 c �'-..) a O1 Li Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: ( ` Heat pump 61.06
Cross street/directions to job site: 0-..—es. Duct work 23.32
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: I Lot no.: Other: 23.32
Tax map/parcel no.: Other fuel appliances:
Water heater 23.32
DESCRIPTION QFhWOI2K Gas frreplace/insert 33.39
Flue vent for water heater or gas
I. 1"'F",-) Wf n Ott tT 4 fireplace
� A f 23.32
�A A Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
"r" C,1 lE!t9PFRTY OWNER " E. Other:
23.32
Environmental exhaust and ventilation:
Name:
Range hood/other kitchen
Address: equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
Phone:( ) toilet compartments,utility rooms) 23.32
Fax:( ) Attic/crawlspace fans 23.32
'` 'Cl APPLICANT 0 CONTACT PiRSON i. ' ' Other: 23.32
Business name: Fuel piping:
Contact name: $14.15 for first four;$4.03 for each additional
Furnace,etc. f
Address: Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
Phone:( ) I Fax::( ) Fireplace
E-mail: Range
Barbecue
CONTRACTOR` Clothes dryer(gas)
Business name: i Q ci A k i i ‘'�
Other:
Address: 10 d 1� NfA. 11
MECHANICAL PERMIT FEES*
Subtotal
t)))-0 L`‘N ell0 L '11
a 1 c Minimum permit fee($90.00) GD
�D
Phone:(5-0)) 9I Fax:( ) Plan review(25%of permit fee) �--.
State surcharge(12%of permit fee) /n.to
CCB lie.: 21a /A?51/8 TOTAL PERMIT FEE /ze,, 0
This permit application expires if a permit is not obtained within 180
Authorized signature: ~L_ days after it has been accepted as complete.
�, ��
� � * Fee methodology set by Tri-County Building Industry Service Board
Print name: , A IsE 1--rtm- - I Date:(SEL- -/6
I:\Building\Permits\MEC_PermitApp_040113.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_040113.doc 2