Permit ., .
T Y 0 F 1 GA R D MECHANICAL PERMIT
4 IL 4 PERMIT #: MEC2004 -00676 DEVELOPMENT SERVICES
c - ± 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/8/2004
PARCEL: 1 S136AD -00603
SITE ADDRESS: 10435 SW 66TH AVE
SUBDIVISION: VILLA RIDGE NO. 2 ZONING: R -4.5
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: st
Remarks: Installation of gas furnace and gas piping.
Owner: FEES
ROBERT ROUNDTREE Description Date Amount
10435 SW 66TH AVE [MECH] Permit Fee 10/8/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchar€ 10/8/2002 $5.80
Phone: 503 244 - 3271 Total $78.30
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Gas Line Insp
Mechanical Insp
Reg #: Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952 C 46-6699. ou..•h OAR 952 - 001 -0100. You may obtain copies of these rules or direct questio . to OUNC by calling
(50
, 0 ' > p / /
Iss i �_ �G� � Permittee Signature: _ „ ..40,", _ ,
Call (503 639 -4175 by 7:00 P.M. for inspections needed the next business day
,. ( , • •
• I •
• •
Mecfianical Permit Application
• . FOR OFFICE USE ONLY . • ' . '.. • •
City of Tigard
13125 SW Hall Blvd., Tigard, OR 97223 i
A., Received
Date/By: i 170
Plan Review ,
iglei% Permit No.: t-PfC „ ... 4, -
Phone: 503.639.4171 Fax: 503.598.1960 --,.....4011,i. Date/By: Other Permit:
Inspection Line: 503.639.4175 AI e*i I I - Date Ready/By: 0 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: i ii , Supplemental Information
Typt OF WORK ..:1-,: ".-4 :..,, -f. , --: ' :' ' ■ ' COMMERCIAL 'F',EE'. SCHEDULE L. USE :
Mechanical permit fees* are based on the value of the work
0 New construction 0 Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION -".,1'.:.-;--':',----2:--!---/-.:;:' Value: $
= , `•:' _..,' ,.' -... . • - _ . , r- . -- . • - , - ....„ ;-.,.. ,- :: -' ..,,,,. .:.: - : i.-:•• __......- • • - • • • , • _,,
:x.ESIDENTIAL'EQUIPMENT / SYSTEMS FEES*
0 1 and 2 dwelling 0 Commercial/industrial 0 Accessory building
For special informati use checklist.
0 Multi 0 Master builder 0 Other:
Description Qty. Ea. Total
30B SITE INFORMATION AND LOCATION,:y .:: .,:` -, -- ,: : Heating/cooling
Air conditioning or heat pump
Job site address://3r" .. 56,
(requires site plan showing placement) 14.00
ad
City/State/ZIP: -7-76,,D Furnace 100,000 BTU (ducts/vents) / 14.00 /
i Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: kaAre -
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) 14.00
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
'' - .` ... .;,..' :-.:' ,...,-',.;,., .: "-. ' . DESCRIPTI OF W °RK.>" -- - - :.--.': '.. -. ... - C: r ' .°:'Ll ' ;' .:.-' ' .1..': ' :.' Water heater 10.00
Gas fireplace 10.00
61.1 /r/.1,-6 /747 ,4 4 PL. -. 7 - _ Flue vent for water heater or gas
fireplace 10.00
7 - /7/ - - e- -- -- Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
: .-.. _. ' • i- - ' - . Chimney/liner/flue/vent 10.00
PROPERTY .10, .,PERTY' ' `.1: :
OWNER';',...-. ' - - -- ., 0 :TENANT ". - '.
- 10.00
Name: s - F 2 5 . - Z2w Environmental exhaust and ventilation
Range
Address: hood/other kitchen
/ _-"k 6 ---_
equipment 10.00
City/State/ZEP: 7/ ‘2Z_ 977.,..2:3 Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone:,(03 if7 Z44/- 7 3 .,9 7 . _ - Fax: ( ) toilet compartments, utility rooms) 6.80
•--a ''APPLICANT .-...,"; ' .'" ' ' ' '' .• ':' -a. CONTACT PERSON '' Attic/crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; 51.00 for each additional
Address: Furnace, etc. /
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E-mail: Range
' • ' : -' , - - ' " ''- - -5.t -- CONTRACTOR . ' ,, '- - . -- - . . - t :t - '- -- - - Barbecue
Business name: l0106g- Clothes dryer (gas)
Other:
.. ,
Address: '"4'':.:. :: ,,.' .:MECHANICAL5PERMIT FEES* '
City/State/ZIP: Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee) 6. r C)
. _ kirr TOTAL PERMIT FEE 7? . 36
T his permit application expires it a permit is not obtained within 180
Authorized signature: ....."" ., ,.,e. days after it has been accepted as complete.
Print name: ..p,/,& Date: , 7 2 1..... - e:::2 • Fee methodology set by Tri-County Building Industry Service Board
i: \ Building \Permits \M:EC-PermitApp.doc 12/03 440-4617T (11/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total'Valuation Permit Fee ' 4 s .
$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.
is\ Building \Pemvts\MEC- PernvtApp.doc 12/03 2