Permit 1111 CITY OF TIGARD MECHANICAL PERMIT
n., COMMUNITY DEVELOPMENT Permit #: MEC2009 -00120
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/24/2009
Parcel: 2S 101 AD02400
Jurisdiction: Tigard
Site address 12753 SW 68TH AVE
Subdivision: WEST PORTLAND HEIGHTS Lot: 32
Project: George Fox University
Project Description: Install gas line for new generator on roof.
Owner: FEES
GEORGE FOX UNIVERSITY Description Date Amount
ATTN: FINANCIAL AFFAIRS, 414 N MERIDIAN Permit Fee 03/24/2009 $72.50
NEWBERG, OR 97132 12% State Surcharge 03/24/2009 $8.70
PHONE:
Contractor:
OWNER
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT Type of Const: •
Occupancy Grp: Occupancy Load:
Stories:
Fuel Air Handlers
Fuel Types: Natural Gas Units < 10000 cfm:
Gas Pressue Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $81.20
Hoods: Comm Incinerators: Required Items and Reports (Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire /Smoke Dampers:
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
Utili bfification : I ter. T• :se rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
i
I ued By: u •: Signature:
Cali 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
City of Tigard Date/By: . .91174° Permit No.: r, g a p 414 114 ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Date/By: Inspection Line: 503.639 I G A R D Date Ready/By: _____ ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction g 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 Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling 'Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: l '2.75 3 5 W 9 / 1 ' < Air conditioning or heat pump
6 (requires site plan showing placement) 14.00
City /State /ZIP: D 1 /e._,// 0 2 q 7 2 2-S Furnace 100,000 BTU (ducts/vents) 14.00
1 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
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: 2,5 - / - //4 1/7 Z goo Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
/ Gas fireplace 10.00
/ „ 5 1 a / / .5 4 t, h // 2 LP • e-1\eA Yo f 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
al PROPERTY OWNER I ❑ TENET Chimney/liner/flue/vent 10.00
Other: 10.00
Name: 0 & -PO ,- /)' (,,9 ; 0,7si ll (/ Environmental exhaust and 'ventilation
Range hood /other kitchen
Address: cm/ fit/. / / i ' A,.r S) /
t equipment 10.00
City /State /ZIP: GUPu4. e4 9 7/.? Z Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (503 )..0-V 2c /V Fax: (163) SSz / toilet compartments, utility rooms) 6.80
Kg1 APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: _ 10.00
Business name:
Fuel piping
Contact name: DA h Sr 4.-.)9,e/-
✓ ), $5.40 for first four; $1.00 for each additional
Furnace, etc.
. Address: CM /L" A /. t 64 Pr sl- Gas heat pump
City /State /ZIP: ii)pj, I p `` n._ 7/ t 7/ 3 2 Wall/suspended/unit heater
Phone: (�3) G� Zo/ Fax: : ( J is- C./ 7GIOef Water heater
/ �J /� Fireplace
E -mail: L' /SGG d2 olC r ,4 y, eN' -' Range
CONTRACTOR Barbecue
Business name: `tir Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Minimum permit fee ($72.50) 7 'E J
Phone: ( ) Fax: ( ) Plan review (25% of permit fee) —
CCB lic.: State surcharge (12% of permit fee) ff 70
TOTAL PERMIT FEE Q t . 9 - 0
Authorized signature: This permit application expires if a permit is not obtained within 180
1'� days after it has been accepted as complete.
Print name: /3Q h S 1, v I Date: 3/c / 4 • Fee methodology set by Tri-County Building Industry Service Board
1:\Building\Permits\MEC- PermitApp.doc 01/19/07 440-4617T(11 /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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