Permit CITY OF TIGARD MECHANICAL PERMIT
° • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00459
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/06/2012
Parcel: 1 S134BD07500
Jurisdiction: Tigard
Site address: 11627 SW PENN CT
Project: Vondrak Subdivision: PENN LAWN ESTATES Lot: 3
Project Description: (1) furnace installation
Contractor: A ABSOLUTE COMFORT HEATING & COOLING INC Owner: VONDRAK, SCOTT
15886 PARK PLACE CT 11627 SW PENN COURT
OREGON CITY, OR 97045 PORTLAND, OR 97223
PHONE: 503 - 513 4795 PHONE: 503 - 593 -8668
FAX: 503 - 513 -0797
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 09/06/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 09/06/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 09/06/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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, 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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4 , 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 Applic.�; G •• F OR OFFICE USE ONLY
� Vie'- Rec
City of Tigard A ( ((1 Permit N / �� ,y.� ��
O 2U12 DDate/By: o A -vv1j 0
• 13125 SW HaII Blvd., Tigard, OR 9722 EP Plan Review
' a C ' Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Inspection Line: 503.639.4175 DateBy:
T I G A R D CITY OF Tom® Date Ready/By: Juris: HI See Page 2 for
Internet: www.tigard- or.gov
BUILDING VISION Notified/Method: (i c Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition/alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $ $2,500.00
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® I- 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:
Air conditioning
Job site address: 11627 SW Penn Court (requires site plan showing placement) 46.75
City /State /ZIP: Tigard, OR 97223 Furnace 100,000 BTU (ducts/vents) 46.75
Fumace 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
Replace old furnace with new 75,000 btu furnace - no other modifications Gas fireplace/insert 33.39
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
Other: 23.32
Name: Scott Vondrak Environmental exhaust and ventilation:
Address: 11627 SW Penn Court Range hood/other kitchen •
equipment 33.39
City /State /ZIP: Tigard, OR 97223 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)593 -8668 Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ® CONTACT PERSON Attic /crawlspace fans 23.32
Business name: A- Absolute Comfort Heating and Cooling, Inc.
Other: 23.32
Fuel piping: •
Contact name: Eric Kruse $14.15 for first four; $4.03 for each additional
Address: 15886 Park Place Court Furnace, etc.
Gas heat pump
City /State /ZIP: Oregon City, OR 97045 Wall/suspended/unit heater
Phone: (503) 535 -9068 Fax: : (503) 513 -0797 Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue '
Business name: A- Absolute Comfort Heating and Cooling, Inc. Clothes dryer (gas)
Other:
Address: Andy Hart MECHANICAL PERMIT FEES*
City /State /ZIP: Oregon City, OR 97045 Subtotal
Minimum permit fee ($90.00)
Phone: (503) 513 -4795 Fax: (503) 513 -0797 Plan review (25% of permit fee)
CCB lie.: 132407 l•..- t0I11/ State surcharge (12% of permit fee)
TOTAL PERMIT FEE /� -& >!i
Authorized signature: ( j j j Thi p ermit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: A (i iJict Date: 9 - • Fee methodology set by Tri- County Building Industry Service Board
I:\Building\Permits\NEC- PermitApp.doc 03/07/12 440-4617T(II /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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