Permit . .
� a CITY OF TIGARD MECHANICAL PERMIT
` -`' IS = COMMUNITY DEVELOPMENT Permit #: MEC2009-00645
T (GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/02/2009
Parcel: 2S112BCO2800
Jurisdiction: Tigard
Site address: 8355 SW MURDOCK ST
Subdivision: HAMBACH PARK Lot: 12
Project: Cornwell
Project Description: Replace gas furnace.
Owner: FEES
CORNWELL, PAUL Description Date Amount
8355 SW MURDOCK ST Furnaces < 100K BTU 12/02/2009 $46.75
TIGARD, OR 97224 12% State Surcharge - Mechanical 12/02/2009 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 12/02/2009 $43.25
Contractor:
THOMAS SHEETMETAL & HVAC LLC
22960 NE TRANQUIL LN
NEWBERG, OR 97132
PHONE: 503 - 537 -7363
FAX: 503- 554 -9231
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal ode, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This per it 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 - - • - • • • ow the ru s adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You ma obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: IIIP
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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
CI Of TI and RECEI E eceived permit C
`J g Date /By A CL-C) �� ' (:),-.4 1
. 13125 SW Hall Blvd., Tigard, OR 97223 pEC 0 2 2009 Plan Review
Date/By C Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
TIGARD Inspection Line: 503.639.4175 Dat Ready /By tuns El See Page 2 for
Internet: www.tigard CITY OF TIGA Notified /Method: Supplemental Information
BUILDING DIVISIO
TYPE OF WORK 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.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE ` INFORMATION AND LOCATION Heating/cooling
/ q /� Air conditioning
Job site address: i> 3 SS '5 ) / Y t^n / tL ,c1 /.2 l.� `- (requires site plan showing placement) 46.75
City /State /ZIP: 6 ;1�2 0 (777e_____ 7 ZZ4 Furnace 100,000 BTU (ducts /vents) ( 46.75
J Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: / de,—,,em t 't 7C Heat pump 61.06
Cross street/directions to job site: 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: t Lot no.: Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
&_- 0/4 -e_. i i Flue vent for water heater or gas
` � ! 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
❑P OWNER ❑ TENANT Other: 23.32
//
Name: , , ( to akZ/ Environmental exhaust and ventilation
!! T Range hood /other kitchen
Address: `� 5 6Z0 in �2 � equipment 33.39
City /State /ZIP: 77 c '.) Ore-- q72.--2-4 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (Q 3) to y -& c,/ /Gf Fax: ( ) toilet compartments, utility rooms) 23.32 • ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Furnace, etc.
Address: Gas heat pump .
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax::( )
Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
• —T,�/ 5/.,/ I , r Ili} i Clothes dryer (gas)
Business name:
/ (7'!'1/7 t / C,� ( (7t /7 41� ‘...e.
Other:
Address: 2 ici L? /IA A 14 at44 L, L 16 MECHANICAL PERM IT FEES*
City /State /ZIP:
1 b - ' L' q 7 / 3 - - _ Subtotal ^ 00
�' / Minimum permit fee ($90.00) ( yo.
Phone: (S( 554/ - 1 Z 3 Fax: ( ) Plan review (25% of permit fee) ®--
CCBlic.: / (D State surcharge (12% of permit fee) 0 -g0
TOTAL PERMIT FEE /OQ, 00
This permit application expires if a permit is not obtained within 180
Authorized signature: ` / / days after it has been accepted as complete.
Print name: 794 / T 2 1 EL2 i3, - /1/ Date: '2`z � * Fee methodology set by Tri- County Building Industry Service Board
t\ Building \ Permits \MEC- Permit App doc 10/01/09 I' 440 -4617 (11 /02 /COMM'EB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi - Family Fee Schedule:
$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 \Permits \MEC- PermitApp.doc 10/01/09 2