Permit 71 CITY OF TIGARD MECHANICAL PERMIT
.;' COMMUNITY DEVELOPMENT Permit #: MEC2012 -00068
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/03/2012
TIGARD - ,. Parcel: 2S103DA06700
Jurisdiction: Tigard
Site address: 10945 SW MIRA CT
Project: Lopez Subdivision: MIRA PARK Lot: 5
Project Description: Replace gas furnace
Contractor: HEAT MASTER CORP. Owner: LOPEZ, GILBERT
14456 AMES ST 10945 SW MIRA CT
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 233 -2727 PHONE: 503 - 639 -1204
FAX: 503 - 723 -4381
FEES •
Specifics: Description Date Amount
Furnaces < 100K BTU 02/03/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 02/03/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 02/03/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
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, • • .. k is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility '•otification Ce -r. T • -e rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir• ct questions to OU cal ng .: .232.1987 or 1.800.332.2344.
Issu =. By: / / „ It Permittee Signature:
•
Call 503. 639. 4175 -by -7.:00-a.m.-for-the-next available-inspection-date.
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 �fe� r7� ICE USF ONLY
City g
CI of Tigard Received � irr Permit No.: A .. wog
ECEI G ED Date/By:
IIII " 13125 SW Hall Blvd., Tigard, OR e Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T - I G AR D Inspection Line: 503.639 p Date Ready /By: furls: RI See Page 2 for
Internet: www.tigard- or.gov FEB 3 2012 Notified/Method: Supplemental Information
CITY OF Y.IG RD COMMERCIAL FEE* SCHEDULE -. USE CHECKLIST
TYPE WjF1I V i T
�1 -' -° ; � -� I . I�-4� Mechanical permit fees* are based on the value of the work
❑ New construction N Addition/alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
gN 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
Job site address: I -,. ( � , 7 • ' r ■ ,e (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts /vents) f 46.75
City /State /ZIP: QQq5 �1(,) Mi- / Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
/�,^� LL r Gas fireplace 33.39
�� L7ii J��`�� 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
PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
tg3 Other: 23.32
Name: GI I `.� 40,,,-, Environmental exhaust and ventilation:
Address: l V 1 - 1 5 f ( ( ( r}. c.- r Range hood/other kitchen
equipment 33.39
City /State /ZIP: ' /, / b j2 / 72 3 Clothes dryer exhaust 33.39
1"...., Single -duct exhaust (bathrooms,
Phone: 6 3 ) &,3 / . y Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: 444 r-Off Other: 23.32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: f2c 0 ix Qa- i Furnace, etc.
l ,�r� � � Gas heat pump
)-
City/State /ZIP: 6 re1 £ 4 4{ ! l l. / /5- Wall /suspended/unit heater
Phone: g--2,2' Fax: (�q3) V — ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: , O 7/ Clothes dryer (gas)
Pb m A apC /// Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: 6 f j/. ) el C;/ ! P' f 7oj- Subtotal
) Minimum permit fee ($90.00)
Phone: (503 3� -��� Fax: ( - ) Plan penult fee) -
CCB lic.: J 1/4 State surcharge (12% of permit fee)
TOTAL PERMIT FEE /g0 k67
Authorized I "" signature: , This permit application expires if a permit is not obtained within 180
g days after it has been accepted as complete.
Print name: 6 f 1 04 0) Date:2_ f a0 / * Fee methodology set by Tri- County Building Industry Service Board
1. \Building\Permits\MEC- PermitApp.doc 09/09/10 440 -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 to $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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