Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00643
T f G AR L? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 12/02/2009
Parcel: 1 S 134DC09900
Jurisdiction: Tigard
Site address: 11485 SW CORNELL PL
Subdivision: Lot: 0
Project: Adamski
Project Description: Replace gas furnace.
Owner: FEES
ADAMSKI, CURTIS R Description Date Amount
4109 FIR ST Furnaces < 100K BTU 12/02/2009 $46.75
VANCOUVER, WA 98660 12% State Surcharge - Mechanical 12/02/2009 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 12/02/2009 $43.25
Contractor:
BLAIRCO INC
7609 MACARTHUR BLVD
VANCOUVER, WA 98664
PHONE: 360 - 695 -1476
FAX: 360 - 699 -9310
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 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 Not =: '• - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir- questions to OU • .y alli g 503.246.6699 or 1.800.332.2344.
Is. ued By: / / Permittee Signature!
• 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
Cl O! Tigard Received - �M�� permit No.: GA ` , I iqt
City b Date/By: c C.. • LV
a 13125 SW W Hall Blvd., Tigard, OR 97223 Plan Review
Phon 503.639.4171 Fax: 503.598.1960 Other Permit •
• D ate /B y:
T I G A R D Inspection Line: 503.639.4175 Date Ready /By: Jura: El See Page 2 for
Internet: www.tigard - or.gov Notified /Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
I=1 New construction [t] Addition /alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION
Value: $ ;6103. (,t7
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
and 2- fatnily dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- fatnily ❑ Master builder ❑ Other:
Description Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 1 L4. 5 ,..c, m
6 e 1 ( 119 1 Air conditioning
(requires site plan showing placement) 46.75
City /State /ZIP: I I C O q- S Furnace 100,000 BTU (ducts /vents) / 46.75 .75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: -- Project name: (i-' A MSKI Heat pump 61.06
Cross street /directions to job site: Duct work 23.32
Hydronic hot water system 23.32
St,) r- ( 1 J Cor. Dr ' o-i-c o-c S'L) - ed Ll/Y • e/ Residential boiler (radiator or
C) - C . -t- &)3 \ C iceevN C e_ - hydronic) 23.32
J 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
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
C Gas fireplace 33.39
e -eP/CLC e 6..c ' lAl�lC e - Flue vent for water heater or gas
`J fireplace 23.32
L 6 Log lighter (gas) 23.32
V) T (CLrr er S j'v\(Je( . .S T5< c 77 - 12- Wood/pelletstove 33.39
Wood fireplace /insert 23.32
Chimney /liner /flue /vent 23.32
PROPERTY OWNER ❑ TENANT Other: 23.32
Name: C L.A. art s A- 0 M SiA, I Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
E — APPLICANT [- CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name:
tat ( u I n ( • Fuel piping
Contact name: '.7e I •l JC ��(SU✓l $14.15 for first four; $4.03 for each additional
Furnace, etc.
Address: - 7(,„,(3q (nc,..c_p-rr , g j oci , Gas heat pump
City /State /ZIP: Vc- v. - U -e,- i - J CIk (:)(c4 Wall/suspended/unitheater
Phone: c3(c9 ) x155 -- i 76 Fax: : (3 (,V) (j4 .t('3 J V Water heater
Fireplace
E - mail: bI -Cr C bICi 1 CO I1eCt—Tme\3• C.Or Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name:
Ql tie Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Minimum permit fee ($90.00) 9 O . 00i
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
CCB lic.: "] 5 o 9V4,4;\ t ` State surcharge (12% of permit fee) /Q • kQ
TOTAL PERMIT FEE /X • gr
ature: f 1 C This permit application expires if a permit is not obtained within 180
Authorized si
V l t-•-aa G s c, J"�- -f `'• I days after it has been accepted as complete.
Print name: g I I)'A Gk I rsor) Date: /� / 2 ooI * Fee methodology set by Tri- County Building Industry Service Board
I: \Building \Permits \MEC- PermitApp.doc 10/01/09 440- 4617T(11 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard L,� ✓��
Page 2 - Supplemental Information I v `
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
C 00 $3.07 for each additional $100.00 or 4 (. 25
1 L 3 - 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 $1 0,000.00 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.
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