Permit C TY TIGARD MECHANICAL PERMIT
• DEVELOPMENT SERVICES PERMIT #: MEC2004 -00708
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/26/2004
PARCEL: 2S 110AD -01500
SITE ADDRESS: 10540 SW CANTERBURY LN
SUBDIVISION: LANG HILL ZONING: R -12
BLOCK: LOT: 012 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:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
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 OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replacement of gas furnace.
Owner: FEES
HADLEY, MICHAEL F Description Date Amount
10540 SW CANTERBURY LN [MECH] Permit Fee 10/26/20( $72.50
TIGARD, OR 97224 [TAX] 8% State Surchari 10/26/20( $5.80
Phone: Total $78.30
Contractor:
ABODE HEATING AND A/C
6151 SE HACIENDA STREET
HILLSBORO, OR 97123 REQUIRED INSPECTIONS
Phone: Heating Unt Insp
hone: 649 2440
Final Inspection
Reg #: LIC 76115
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 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246- 6699_ I �� ��
Issued By: �/ Permittee Signature:
�� a
Cali (503) 639 -4175 by 7:00 P.M. for inspections needed the ti ess day
Mechanical Permit Application • FOR OFFICE USE ONLY '
City of Tigard _ C E I VE D ReceiDatved yid O , '
eB ` Permit No: / % t
13125 SW Hall Blvd., Tigard, OR •t� - Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / tl�, �,* 11,1. Date/By: Other Permit:
Inspection Line: 503.639.4175 (6 2Ufl4 - e m/ I1 Date Ready/By: lin El See Page 2 for www.ci.tigard,or.uS OCT I Notified/Method: Supplemental Information
CITY OF y �
F TIG , . .
?' ,. "° „ �C171007� UfV tioN�. COMMERCIAL ' FEE *_ ' USE CHECKLIST
Mechanical permit fees* are based on the value of the work
1:1 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
,---,::.-'1';,-.,: ; Valu e
dwelling Commercial/industrial RESIDENTIAL EQUIPMENT /-SYSTEMS FEES
x- and 2-family y g ❑ ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
- JOB SITE INFORMATION AND LOCATION,? Heating/cooling
Job site address: �J// 5c -e:.J €,Q� Air conditioning or heat pump
D .�7t� C + ti L` � (requires site plan showing placement) 14.00
City/State/ZIP: -" ,r.,,,I.. 1 ( 7 ( Furnace 100,000 BTU (ducts/vents) t 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name:
Gas heat pump 14.00
Cross street/directions to job site: `,
�> 5 �' 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
Subdivision: Lot no.: Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION-OF WORK. . Water heater 10.00
Gas fireplace 10.00
P - Er 9 /(2 c C t✓L■ �,,L_ 4 t cL5 ru eIkc< c-, C C_ Flue vent for water heater or gas
// fireplace 10.00
Log lighter (gas) 10.00
. Wood /pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
ROPERTY OWNER. `: T: r
❑ ;TENAN_` - , Other 10.00
NameP � // �� J/
�'L /. ce__ ( r/ ri L Y (� y Environmental exhaust and ventilation
/ C' / L Range hood /other kitchen
Address:
/0 $ 7 e / C6.e cc-7 /De-c R K equipment 10.00
City/State /ZIP: 7 ��� d C� 5 j ' ' „a- c-/ Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (.5 sa / 6 Y Fax: ( ) toilet compartments, utility rooms) 6.80
PPL1CANT : CONTACT. PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: a 6o Fuel piping
Contact name: ` . / BLS $5.40 for first four; $1.00 for each additional
/ / Furnace, etc.
Address:
t! f 5� 1 F ,tL`t4 Gas heat pump
City/State/ZIP: /t//( E� j �_ Wall/suspended /unit heater
Phone: ($ 8 5 , ' C Fax:: ) f8',_7 /,ems Water heater
Fireplace
E -mail: Range
, . ; : , CONTR ' ' Barbecue
Business name: A 1 1�[_ Clothes dryer ( gas)
Other.
Address: �h/ - ff l/ r 4C t. el,,Je w MECHANICALPERMIT .
City/State /ZIP: a ' /f 1,„,„ l5g-- 5-74.2_ Subtotal
r Minimum permit fee ($72.50) � , n
Phone: (1 2� Fax:) S� �� / Plan review (25% of permit fee)
CCB lic.: .76/45 r I -) : 1 y State surcharge (8% of permit fee) )'N
TOTAL PERMIT FEE n,1 O
Authorized signature: � F., - This permit application expires if a permit is not obtained within 180
/ / days after it has been accepted as complete.
Print name: 1d Yk,t,_ %., 5 D ate: /O �/ .iy • Fee methodology set by Tri- County Building Industry Service Board
i:\Building\Permits\MEC- PermitApp.doc 12/03 440- 46!7T(II /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
~'Total ;Valua t.'�,_ ;
$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.
•
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