Permit CITY OF TIGARD
MECHANICAL PERMIT
Ip
' . 2 , :- COMMUNITY DEVELOPMENT Permit #: MEC2012 00559
TI GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/25/2012
Parcel: 2S104BC01900
Jurisdiction: Tigard
Site address: 14120 SW FERN ST
Project: Cooper Subdivision: HANDY ACRES Lot: 21
Project Description: Replace furnace
Contractor: HEAT MASTER CORP. Owner: COOPER, RONALD W
14456 AMES ST ELAINE E
OREGON CITY, OR 97045 14120 SW FERN ST
TIGARD, OR 97223
PHONE: 503 - 233 -2727 PHONE:
FAX: 503 - 723 -4381
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/25/2012 $46.75 ,
Type of Use: SF 12% State Surcharge - Mechanical 10/25/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/25/2012 $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, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility 1 • ' 'cation . -nter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir questions to O , C • • •alling 503.232.1987 or 1.800.332.2344.
Issu By: / 41/14. Permittee Signature: A . ��
Ca ll 503.639.4175 by 7:00 a.m. for the next available ins ..
- Y inspection date. P
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 ApplicationpEIVED FOR OFFICE USE ONLY
City of Tigard Date/By: Q Permit No.: / ,/ LA
1 111 4
13125 SW Hall Blvd., Tigard, OR 97223 n I T
C . Phone: 503.718.2439 Fax: 503.598.1960 I - 2 5 L i — Plan Review
Date/By: Other Permit:
TI G A R D Inspection Line: 503.639 CITY OF TIGARD Date Ready/13y: ruris: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
BUILDING DIVISION
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: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
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:
�� /,,,ttt / Air conditioning
//
Job site address: ( / /� D I / / 4/1../ (requires site plan showing placement) 46.75
— /
.-----
` p llliiittt /// Furnace 100,000 BTU (ducts/vents) / 46.75
City /State /ZIP:
/ 9/7 " 1l. 2 • 9 9 2 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: / ."R \ 5 � �/� Duct work 23.32
v / ` 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
p ,, / � r_ Gas fireplace/insert 33.39
7 /4 C e/ iIy7141 • 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 I ❑ TENANT Chimney/liner /flue /vent 23.32
D ^ ' /7 0 n
Other: 23.32
Name: I'V t/ / �_ Environmental exhaust and ventilation:
Address: / ( 9 • ` � , A � equipment 33.39
Range hood/other kitchen
�/
City /State /ZIP: / 9� s 9 �� 23 Clothes dryer exhaust 33.39
Lc r � C � toilet
Single-duct exhaust (bathrooms,
Phone: � t < 1 / Fax: ( ) t comp compartmennts, utility rooms) 23.32
APPL ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: //.:—/t42,4-7— CO �`n Other: 23.32
/ ( L CO /�/ Fuel piping:
Contact name: l � $14.15 for first four; $4.03 for each additional
Address: / 7 ,, ,�, Furna etc.
Gas heat pump
City /State /ZI?DA, C ' ' /l_ % 9'7(2 Wall/suspended/unit heater
Phone:
4. ��3) e ? p 2� 1.'7 Fax:: ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
� �J Clothes dryer (gas)
Business name: i y " ' '" // a TQ / Other:
Address: MECHANICAL PERMIT FEES*
•
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) 9 0 •
Plan review (25% of permit fee)
CCB lic.: /i /D 7 L/- State surcharge (12% of permit fee) ---/€740 / b / TOTAL PERMIT FEE /Q2 . V
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: � 41 / 7 ,N. / Date /D r• Sr- `2 * Fee methodology set by Tri County Building Industry Service Board
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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 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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