Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00095
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02!21/2012
Parcel: 2S102AB00905
Jurisdiction: Tigard
Site address: 12060 SW LINCOLN AVE
Project: NGO Subdivision: KIMBERLY ADDITION Lot: 5
Project Description: Replace gas furnace and add gas piping for new range.
Contractor: FIVE STAR HEATING Owner: NGO, KEVIN
10542 SE MARKET ST 12060 SW LINCOLN AVE
PORTLAND, OR 97216 SHERWOOD, OR 97140
PHONE: 503 - 544 -9567 PHONE: 503 - 719 -8898
FAX: 503 -251 -4781
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 02/21/2012 $46.75
Type of Use: SF Fuel Piping 02/21/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 02/21/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 02/21/2012 $29.10
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
issuan if wo - suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili otification Center. Thos- 'ales are set forth in OAR 952 - 001 - 0010 through OAR 952 - 001 - 01 :0. You may obtain a copy of the rules
or irect questions to OUNC b =fling 503.232.1987 or 1.800.332.2344.
ssued By: /j!/ 1 Permittee Signature: Am Al
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.
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- Mechanical Permit- Application_ VOlz Orrlci.: usl: oNt.vv =
Received . ff® --i /
City of Tigard Receive Permit No.:
13125 SW Hall Blvd., Tigard, OR 9 T, cRED
Plan Review
C Phone: 503.718.2439 Fax: 503.59:i 1' 4 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639 Date Ready/By: Juris: IB See Page 2 for
Internet: www.tigard - or.gov FEB 21 2012 Notified/Method: Supplemental Information
TYP OF i),+HI&OF TIGAt aD COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
(.gAI( ' � N Mechanical permit fees* are based on the value of the work
❑New construction �Q Addition /altCr s+ j� it i`eP 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*
L`7 l- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
1 � Air conditioning
Job site address: 1 `�C)�C) S w r I\ c c �
1 •J /t v-� (requires site plan showing placement) 46.75
v ` Furnace 100,000 BTU (ducts/vents) ' 46.75
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City/State /ZIP: ia OR-- � ,', el a Y Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: 1 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
A • Gas fireplace 33.39
f'Q-� ka IA s r..rc-C �y Y J Q Flue vent for water heater or gas
Pr�iSw -e_ 1 ' - -e_ � a t--(1\ (A F fireplace ( 23.32
1 p Log lighter gas) 23.32
N q S l; A r" it.„,�/e ..�, Wood/pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation:
Address: ,Range hood/other kitchen
equipment 33.39
- City /State /ZIP: Clothes dryer exhaust 33.39
Phone: ( . ' ) Fax: ( ) toilet compartments, s (u tility o o )
prtmn utili rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name:
Other: 23.32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( • ) Fax: : ( ) Water heater
Fireplace
E -mail: Range l
CONTRACTOR Barbecue l
Business name: �` V.12... S i Cam -j � Nei-- Clothes dryer (gas)
Other:
Address: ( 1 f N j (/ MECHANICAL PERMIT FEES*
City/State/ZIP: of___,- Gr oZ if 6. Subtotal X70
It Minimum permit fee ($90.00) 96-
Phone: (5 03) Sli4 4 3 — ( --) Fax: ( ) _ -- - .Plan- review- (25 % of- permit -fee)-
CCB lic.: / / - , ■ k Vat(/' I/ State surcharge (12% of permit fee) /Q. Sd
Y / / TOTAL PERMIT'FEE , //wD„$
Authorized si ture: '/ - This permit application expires if a permit Is not obtained within Igo
days after it has been accepted as complete.
Print name: !Ea . TA. j /i, I Date: D pt o1 / J o2 , • Fee methodology set by Tri -County Building Industry Service Board
1:\ Building \Permits\MEC- PernutApp.doc 09/09/10 440-4617T(I1 /02ICOM/WEB) '
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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 forr 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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