Permit INCITY OF TIGARD MECHANICAL PERMIT
;j . COMMUNITY DEVELOPMENT Permit#: MEC2020-00138
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/11/2020
TIf'aA[ L Parcel: 1S134BD05500
Jurisdiction: Tigard
Site address: 11550 SW GLENWOOD CT
Project: POTTRATZ Subdivision: ENGLEWOOD NO.2 Lot: 143
Project Description: Heat pump installation.
Contractor: OWNER Owner: POTTRATZ, LOUIS A&JULIA E
LOUIS & JULIA POTTRATZ 11550 SW GLENWOOD CT
11550 SW GLENWOOD CT TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-590-2766 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Heat Pump 03/11/2020 $61.06
Type of Use: SF 12%State Surcharge-Mechanical 03/11/2020 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 03/11/2020 $28.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
• 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By` 7!% EOM,11
■ `IPlan Review Other Permit:G/ -
Phone: 503.718.2439 Fax: 503.59RE C E( V E D Date/By:Re �
n r n Inspection Line: 503.639.4175 tJ v i — _�
Internet: www.tigard-or.gov Date Ready/By: MI 55 See Page 2 for
MAR 112020 Notified/Method: Supplemental Information
TYPE OF van(OF TIGARD COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
El New construction � 'DIVIr,:?r-P" Mechanical permit fees*are based on the value of the work
❑Addition/alteration,replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,
equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
❑ i-and 2-famil d RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
Ywellin g ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heatinglcooltng:
Air conditioning 46.75
Job site address: ti,.j!-) LJ ' G L a,0,2.,..1 (/l c t' Furnace 100,000 BTU(ducts/vents) 46.75
C;fj te/E1P: f'1 e-0 iy 7Z2 3 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: name, d-01.4h rL Heat pump ] 6 L06 p r olco
-
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
DESCRIPTION OF WORK Gas fireplace/insert 33.39
�C
Flue vent for water heater or gas
`7L/P /hS r 1-A d.,l fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ElPROPERTY OWNER ❑ TENANTOth
S' 23.32
Environmental exhaust and ventilation:
Name: l-f4.45 j1-'02T 2412., Range hood/other kitchen
Address: 1/S�eW q „_ ,,,,u ez equipment 33.39
r�tl� Clothes dryer exhaust 33.39
City/State/ZIP: Tic Kr) o�, 73 Single-duct exhaust(bathrooms,
Phone: /
toilet compartments,utility rooms) 23.32
(��) 7(✓G' Fes'( ) Attic/cmwlspacefans 23.32❑ ICANr 0 CONTACT PERSON Other:
23.32
Business name: Fuel piping:
5
R $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
E-mail: Range
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: 4 Other:
Address: /�
MECHANICAL PERMIT FEES*
Subtotal (L/0(,
City/State/ZIP: Minimum permit fee($90.00) 4 U,or()
Phone: Plan review(25%of permit fee)
( ) Fax:( ) State surcharge(12%of permit fee) 10- 51)
CCB lie.: TOTAL PERMIT FEE ( W.
��y/�
This permit application expires if a permit is not obtained within lib
days after it has been accepted as complete.
Authorizld SignatlU Fee methodology set by Tri-County Building Industry Service Board
Print name: G A f e,trg 4_t2,,, Data:l —fi—.1„,e,
I:\Building\Permits\MEC_PermitApp_0401 1 3.doc 440-4617T(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.
I:\Building\Pemuts\MEC_PerniltApp_040113.doe 2