Permit CITY OF TIGARD MECHANICAL PERMIT
114 = COMMUNITY DEVELOPMENT
P ermit #: MEC2013 -00006
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/03/2013
Parcel: 2S 104AC 13200
Jurisdiction: Tigard
Site address: 12860 SW 135TH AVE
Project: Sarich Subdivision: 1997 -031 PARTITION PLAT Lot: 1
Project Description: (1) gas furnace replacement
Contractor: ACCURATE HEATING INC Owner: SARICH, BOSILJKA
19450 SW MOHAVE CT 12860 SW 135TH AVE
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 650 -1229
PHONE' 503 - 524 -2615
FAX: 503 - 650 -4845
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/03/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/03/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/03/2013 $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: I I / Permittee Signature: I '�
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 RECEIVE I ()K Ol I I( I ,, I () \ l 1
����LLii R e ceived / Permit N
City of Tigard Date/By: l / 3 / 1 3 i A EC ", 3 - 0000(4,
11 • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
a Phone: 503.718.2439 Fax: 503.598.1960 JAN 0 3 2013 Date/By: Other Permit:
1 I c. ,A h 1) Ins Line: 503.639 Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard - or.gov CITY OFTIGARD Notified/Method: -n ( gyp Supplemental Information
BUILDING DIVISIO
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*
® 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: 12860 SW 135 Avenue (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 1 46.75
City / State/ZIP: Tigard, Oregon 97224 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Sarich Residence Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: West on Walnut, south on 135 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 furnace with new. Gas fireplace/insert 33.39
p 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
Other: 23.32
Name: Betty Sarich Environmental exhaust and ventilation:
Address: 12860 SW 135 Avenue Range hood/other kitchen
equipment 33.39
City/State/ZIP: Tigard, Oregon 97224 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)524 -2615 Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name: Accurate Heating
Fuel piping:
Contact name: Mike Blackmon 514.15 for first four, 54.03 for each additional
Address: 19450 Sw Mohave Ct Furnace, etc.
Gas heat pump
City/State/ZIP: Tualatin, Oregon 97062 WalUsuspended/unit heater
Phone: (503) 650 -1229 Fax: : (503) 650 -4845 Water heater
Fireplace
E -mail: mikeblackmon @accurateheating.com Range
CONTRACTOR Barbecue
Business name: Accurate Heating Clothes dryer (gas)
Other:
Address: 19450 Sw mohave Ct MECHANICAL PERMIT FEES*
City /State/ZIP: Tualatin, oregon 97062 Subtotal
Minimum permit fee ($90.00)
Phone: (503) 650 -1229 Fax: (503) 650 -4845
Plan review (25% of permit fee)
CCB lie.: 88423 State surcharge (12% of permit fee)
TOTAL PERMIT FEE (01) $D
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: Michael Blackmon I Date: 1 - 3 • Fee methodology set by Tri -County Building Industry Service Board
1: 1Building \Pennits\MEC- PermitApp.doc 03 /07/12 440 -4617T (I1 /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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