Permit •
CITY OF TIGARD MECHANICAL PERMIT
It t; COMMUNITY DEVELOPMENT Permit #: MEC2013 -00324
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/12/2013
Parcel: 2S110DD12800
Jurisdiction: Tigard
Site address: 10975 SW HIGHLAND DR
Project: Sanders Subdivision: SUMMERFIELD NO.14 Lot: 698
Project Description: Replace furnace, convert electric to gas, install vent and gas piping.
Contractor: MANFORT HEATING & AIR CONDITIONING Owner: SANDERS, JACK D TR
PO BOX 30431 10975 SW HIGHLAND DR
PORTLAND, OR 97230 TIGARD, OR 97224
PHONE: 503 - 720 -5105 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 06/12/2013 $46.75
Type of Use: SF FlueNent For Any of Above 06/12/2013 $23.32
Class of Work: ALT Type of Const: Fuel Piping 06/12/2013 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 06/12/2013 $10.80
Stories: Minimum Fee Adjustment - Mechanical 06/12/2013 $5.78
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 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 !ling 503.232.1987 or 1.800.332.2344.
Issued By: Perm ittee Signa ►� //
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 Applicat C I FOR OFFICE USE ONLY
City of Tigard JUN 1 2 2 013 Received permit No
, ° 13125 SW Hall Blvd., Tigard,OR 97223 Date/By: 0 l���oi 3 X032
Phone: 503.718.2439 Fax: 503.598.1 OF TIGARD Plan Review
Date/By: Other Permit:
I . I G A I , u Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: El See Page 2 for
Internet: www.tigard or.gov Notified/Method: r Li`' Supplemental Information
. _ TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction dition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Cher: • mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use cJS SYSTEMS
1:1 ulti- family ❑ Master builder 0 Other: Description EQUIPMENT / SYSTEMS FEES"
I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCH ION Heating/cooling:
/ , / � Air conditioning (ducts/vents) 46.75
Job site address: / G7 / �j rif/ -E � Furnace 100,000 BTU ducts/vents / 46.75
City/State /ZIP: �1 ! �1 V .�� Furnace 100,000+ BTU (ducts/vents) 54.91 iit S Heat pump 61.06
Suite/bldg./apt. no.: Project name: S�NV L--� S Duct work 23.32
Cross street/direAiuus �(o Hydronic hot water system 23.32
v t ` � �t% Residential boiler (radiator or
3. '� 5 -t /1/li hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue /vent for any of above I 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map /parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
//
f' (VA / ` Flue vent for water heater or gas
fireplace
lace 23.32
L �� C-7.7r�. ` Log lighter
23.32
�(,� ( / Q �j Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney/liner /flue /vent 23.32
❑ PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: - I2 � ��( S .5 b E.---C s Range hood/other kitchen
" equipment 33.39
Address: cA 416? Clothes dryer exhaust 33.39
City/State /ZIP: l ` Sl a/Lb Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32 •
Phone: ( ) Fax: ( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 _
Business name: Fuel piping:
$14.15 for first four; $4.03 for each additional
Contact name: Furnace, etc.
Address: Gas heat pump
Wall /suspended/unit heater
City/State /ZIP: Water heater
Phone: ( ) Fax: : ( ) Fireplace
Range
E -mail:
Barbecue
CONTRACTOR Clothes dryer (gas)
Business name: . / V/ �'� Other: _
MECHANICAL PERMIT FEES*
Address: r V!� a 2 ( Subtotal
City/State /ZIP:a w / i / 4ird. CD Minimum permit fee ($90.00) % , 176
CJ • Plan review (25% of permit fee)
Phone: (SQ 1. ,R_eD 0 Fax: ( ) _ State surcharge (12% of permit fee) 4 ik
CCB lic.: Gp g/ /y TOTAL PERMIT FEE /OQ , i)
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature
/al/ Fee methodology set by Tri - County Building Industry Service Board
Print name: r 0 il T� D ate: f / 0
I:\ Building\ Permits \MEC_PermitApp_040113.doc 44046t7T (I I /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.
I:kBuilding\ Permits UNEC_PermitApp_040113.doc 2