Permit 1 N '' MECHANICAL PERMIT
� b' a CITY OF TIGARD
a '- COMMUNITY DEVELOPMENT Permit #: MEC2010 -00347
T I GARI) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/16/2010
Parcel: 1S125DA11900
Jurisdiction: Tigard
Site address: 6570 SW ALFRED ST
Subdivision: COOPER MLP96 -0017 Lot: 3
Project: Black
Project Description: Heat pump and A/C installation. Unit must meet 3' rear and side yard setbacks.
Owner: FEES
BLACK, JESSE W & KAREN K Description Date Amount
6570 SW ALFRED ST
TIGARD, OR 97223 Air Conditioning 07/16/2010 $46.75
Heat Pump 07/16/2010 $61.06
PHONE: 12% State Surcharge - Mechanical 07/16/2010 $12.94
Contractor:
INTEGRITY HEATING
12564 SW MAIN ST
TIGARD, OR 97223
PHONE: 503 - 880 -8492
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $120.75
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 o <!! .2344.
Q A n r
Issued By J /� J • �.
_� — Permittee Signature: sJ �/ /`
►T
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.
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Mechanical Permit Application ti,;�r�z�i Icu�y ��,�_ �;■•
City of Tigard Date/By: / , Permit No.: V r ^ `0
1
° 13125 SW Hall Blvd., Tigard, ■ OR 97223 , -� r - "
, Plan Review
11 Phone: 503.639.4171 Fax: 503.598.196 \r y r:.- ; B
D ate Other Permit:
Inspection Line: 503.639.4175
'3,0 � " " y
I I (J A K ', t� Date R H See Page 2 for
Internet: www.tigard-or.gov �
.0- �' 2 Notifie
li Information
y.t �^
� r -
COMMERCIAL 'FEE* SCHEDULE -. USE CHECKLIST
v. .
TYPE • OF WORK #M ex r+ m .
❑ New construction ddition/alteration/Fgp( ' '�n ? Ctt l�fgl.�r® �� . M echanical 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: $
RESIDENTIAL EQUIPMENT [ SYSTEMS FEES*
*;f71- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: /, //�� pp�� Air conditioning [��
e( $' �t,3 S , ,4 F/�-C j> (requires site plan showing placement) T" 46.75
City /State /ZIP:7C 7 0 R / 7 Z �3 Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: R( �yk Heat pump / 61.06
red Cross street/directions to job site: 'l y L(,l`r e r ItrtZ¢ p Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
C roil AC F 0 /S' W11 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: Lot no.:
. Other: 23.32 _
Tax map /parcel no.: Other fuel appliances
DESCRIPTION. OF WORK • Water heater 23.32
Gas fireplace 33.39
A DD )4A /9 & 7 /,vc Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
• Chimney /liner /Flue /vent 23.32
PROPERTY OWNER ❑ TENANT' Other 23.32
Name: 'Tt?SS EC A< /C Environmental exhaust and ventilation
Range hood/other kitchen
Address: J ' V S._
AC FkeT> equipment 33.39
City /State /ZIP: pare/341p al_ 1'7ZZ3 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT at CONTACT PERSON Attic /crawlspace fans 23.32
i Other: 23.32
Business name: //v /...Vie_) :` i' AbvI S Fuel i in
PP 1;
Contact name: R:c k IJ j4 , 5 514.15 for first four; 54.03 for each additional
Address: Fumace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit [ heater
7'
Phone: (Sq3 ) l7 , 7 U) 0 Fax: : ( ) Water heater Fireplace
E -mail: Range
' CONTRACTOR • • Barbecue
Business name: tt Clothes dryer (gas)
�NyElr�rt t �/ �� -G�- / p'{ t 1Z Other:
Address: /ZYIy" •,-, /7,4,, S7- MECHANICAL PERMIT FEES*
City /State /ZIP: 4.44/10 (} it g7ZZ5 Subtotal tv'
Phone: Sftr 3 ) ye-u- ar i j Z Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: / 7 / ta! V State surcharge (12% of permit fee) 1 a , 11
/7 TOTAL PERMIT FEE _lath 75
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name _ Date: 7- /(y ..
* Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \Permits\MEC- PermitApp.doc 10/01/09 440 -4617T (11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
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
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 t� $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.
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