Permit e •
r‘" 111 wri." � � � �� ® MECHANICAL PERMIT
.
T "' AR COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00454
DATE ISSUED: 7/24/2007
TI GARD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
A'k" ".,.. ri PARCEL: 2S104DA - 06500
SITE ADDRESS: 13136 SW RAPTOR PL ZONING: R -4.5
SUBDIVISION: QUAIL HOLLOW - WEST LOT: 051 JURISDICTION: TIG
PROJECT: DIERINGER
Project Description: Add an a/c unit.
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: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
BARBARA DIERINGER Description Date Amount
13136 SW RAPTOR PL
TIGARD, OR 97223 [MECH] Permit Fee 7/24/200r $72.50
[TAX] 8% State Surcha 7/24/200 $5.80
[MECH] Investigation F 7/24/200r $72.50
Phone: 503- 939 -5800 Total $150.80
Contractor:
HARDY PLUMBING + HEATING
14689 NE COUNTRYSIDE
AURORA, OR 97002 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 222 -9654
FAX 503- 678 -4498
Reg #: LIC 60947
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
n ._ , i , \ _ _ _ _
- - ,... _ _ .. _ _ ____ ____ _ _ _ .. ... _ .. . , , , , . ,
Issued By: i ;� t 't =x° Permittee Signature:. /
a Call 503.639.4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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Mechanical Permit A pp ., ,� ,T ` FOR OFFICE USE ONLY , P::4 1 r ,
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:C, ?r. • Received
w,,' City of Tigard F-a Permit No.
�' g �a� i .; i -y n 4" =; Date/$y: / b JU Permit ` •f 4,,,. V 13125 SW Hall Blvd., Tigard, OR 972 ;�s / n, I 1 E -. Pl n Review
«' ® Phone: 503.639.4171 Fax: 5 03.5913.19bu -�., P. u ,! A i l� , 4 --- D ' f e / y_ Other Permit:
'T I G A I D Inspection Line: 503.639.4175 Date Ready /By: if See Page 2 for
L '' Internet: www.tigard- or.gov a Notified/Method: Supplemental Information
TYPE OF IIK ( v, , q •
I� COMMERCIAL FEE* SCHEDULE USE CHECKLIST
❑ New construction Additio e'� -ot/1y� x Y , Mechanical permit fees* are based on the value of the work
-J1.. TNe I 'O N performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: .I. `� mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES* '
VI 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
Air conditioning or heat pump
Job site address:
) 3 ).L . S Li i P jv/i (requires site plan showing placement) 1 14.00
City /State /ZIP: •'77 G 1,. 0 �� Furnace 100,000 BTU (ducts /vents) 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: Duct work 10.00
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. 14.00
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
. DESCREPT ON OF. WORK Water heater 10.00
Gas fireplace 10.00
'P'n ID b- 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
PROPERTY OWNER ❑ TENANT Other: 10.00
e
Name: f ) g t (00Z Environmental exhaust and ventilation
Address: n )1 S� )e A- P TO I equipment hood /other kitchen
J v e ui ment 10.00
City /State /ZIP: ---17 4, t.1 0 r 2 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT . • ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
• CONTRACTOR : • Barbecue
Business name: )9--h-to / ) l i ?- ) 9p � f Clothes dryer (gas)
/ Other:
Address: L P
1 1 l.� 9 �r cot>.�� / s � to,� MECHANICAL PERMIT FEES* •
City /State /ZIP: p I) gp / r)e • 9) 862 Subtotal
Minimum permit fee ($72.50) -7-2.56 1( Z
Phone: ( 3 ) `�`�'a s Fax: ( 2) �, �� - 1.49 7D Plan review (25% of permit fee)
CCB lic.: Cif ® 9 4 ) State surcharge (8% of permit fee) 5.k0
TOTAL PERMIT FEE /60 . 5
Authorized signature: This permit application expires if a permit is not obtained within 180
g I " days after it has been accepted as complete.
Print name: 21) r--1 7 0-71-� pi Date`. _ ' �-5) * Fee methodology set by Tri- County Building Industry Service Board
B
I: \ uilding \Permits \ MEC- PermitApp.doc 01/19/07 / 440- 4617T(1 I /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee: •
$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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