Permit CITY OF TIGARD MECHANICAL PERMIT
t:. COMMUNITY DEVELOPMENT Permit #: MEC2012 -00556
T I CARD+ 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/24/2012
Parcel: 1 S 134CA00710
Jurisdiction: Tigard
Site address: 11965 SW SUMMER CREST DR
Project: Korum Subdivision: WILLAMETTE NO.2 Lot: 9
Project Description: (1) furnace installation
Contractor: COMFORT ZONE HEATING & AIR COND Owner: KORUM, BRUCE ALLEN
1032 NW CORPORATE DR 14098 SW SPRINGBROOK LN
TROUTDALE, OR 97060 TIGARD, OR 97223
PHONE: 503 - 667 -5595 PHONE: 503 - 720 -9392
FAX: 503 -491 -8252
FEES
Specifics: Description Date Amount •
Furnaces < 100K BTU 10/24/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 10/24/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/24/2012 $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: 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 APPlicatimRECEIV 1 Folz OFFICE USE ONLY
City Cit of Tigard 1 !! ill Received
`.7 g DateBy: ( 0) • r I / L Permit N % e eh 1 1 _ Do s's'
13125 SW Hall Blvd., Tigard,OR 97223 OCT 2 4:2012 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
TI G A R D Inspection Line: 503.639 CITY OF T Date Ready/By: Jung El See Page 2 for
Internet: www.tigard - or.gov OF �{p Notified/Method: () a• Supplemental Information
BUILDING DIVISION
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: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
c o- 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:
r Air conditioning
Job site address: l 1 9 l0 S 5 W 1O W1 rite ri `D r (requires site plan showing placement) 46.75
/State /ZIP: f� Fumace 100,000 BTU (ducts/vents) i 46.75
City/State/ZIP: h % la r d � �\ 2Z. 3 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
e r 4 cur Gas fireplace/insert ent for water 33.39
1 'l. � Flue vent or 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: .1c J C.e r \ Environmental exhaust and ventilation:
Address: I I ' £ S S � S � r tes r D �
Range hood/other kitchen
1 equipment ment 33.39
City /State /ZIP: et r d d aft aa3 Clothes dryer exhaust 33.39
1 / � Single -duct exhaust (bathrooms,
Phone: (WS ) *-7@ a^ @ `r V - { rl Fax: ( ) toilet compartments, utility 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
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
7 "7 r � f G Other:
Address: r b3 a N W / 'Antpcs� , he / Or— MECHANICAL PERMIT FEES*
City /State /ZIP: --"rr 6�c. e ` 02 5 7, 0 Subtotal
Phone: (50) C Fax: ( Minimum permit fee ($90.00)
5� ) �� �ZSZ. Plan review (25% of permit fee)
CCB lic.: L \Ay.), 1 State surcharge (12% of permit fee)
TOTAL PERMIT FEE ( (O .
Authorized signature: \ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
L Print name: .---- FO vi.elci S•t - yo y b Date:to„ Z4_(Z 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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