Permit CITY OF TIGARD MECHANICAL PERMIT
1111 -
COMMUNITY DEVELOPMENT Permit #: MEC2013 -00398
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/16/2013
Parcel: 2S 110DD04600
Jurisdiction: Tigard
Site address: 15635 SW OLD ORCHARD PL
Project: Cook Subdivision: SUMMERFIELD NO.3 Lot: 148
Project Description: Replace gas furnace, add a /c, gas piping for furnace, water heater, range, and gas fireplace. Install new gas
fireplace.
Contractor: SWANSON HEATING Owner: COOK, MIKE
PO BOX 441 15635 SW OLD ORCHARD PL
CORNELIUS, OR 97116 TIGARD, OR 97224
PHONE: 503 - 357 -5098 PHONE:
FAX: 503 - 992 -0718
FEES
Specifics: Description Date Amount
Air Conditioning 07/16/2013 $46.75
Type of Use: SF Furnaces < 100K BTU 07/16/2013 $46.75
Class of Work: ALT Type of Const: Gas Fireplace 07/16/2013 $33.39
Occupancy Grp: Fuel Piping 07/16/2013 $14.15
Stories: 12% State Surcharge - Mechanical 07/16/2013 $16.92
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $157.96
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 s suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a o rules
or d' ct questions to OUNC C. . 503.232.1987 or 1.800.332.2344. ao•
Is ued By: / / 0/ ,/ / / 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 ApplicaRCEIVED FoR OFFICE USE ONLY
City of Tigard Received --
^
Date/By: ��
Permit No.: �' / Nee A/5.40 3 / S
° 13125 SW Hall Blvd., Tigard,OR 9722iiI... 1 6 2013 "�
1 4 lIl Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
TI G A R D Inspection Line: 503.639.4175 CITY OFTIGARID Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gov BUILDING DIVISION . Notified/Method: 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: $
CATEGORY OF CONSTRUCTION • RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
)4 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling: '/
��636" S. b `, L , £ � Air Furnace 1 conditioning 46.75 y(6 ' 6."
Job site address: 66,36
J t W /v'lll J , Furnace 100,0000 BTU (ducts /vents) i 46.75 1 /6.7`r
City /State /ZIP: 1 ! %�,( OF_ Furnace 100,000+ BTU (ducts /vents) 54.91
Heat pump 61.06
Suite/bldg./apt. no.: Ilroject name: Duct work 23.32
Cross street/directions to job site: 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
Flue /vent for any of above 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 r 33.39 35 -V
l Flue vent for water heater or gas
0 g \a S q S - c - )•\\( V\ c f fireplace 23.32
Log lighter (gas) 23.32
CA C�� Q � 6u � ,� t Wood/pellet stove 33.39
1SC(- � �� � OA eV �eC.( L°% (�{,AC�� Wood fireplace /insert 23.32
k A& 1 Q 5 i � 11— Chimney/liner /flue /vent 23.32
❑ PROPERTY`DWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City /State /ZIP: Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
Phone: ( ) Fax: ( ) Attic /crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
$14.15 for first four; $4.03 for each additional
Contact name: Furnace, etc. k
Address:
Gas heat pump
Wall /suspended/unit heater
City /State /ZIP: Water heater 'f
Phone: ( ) Fax: : ( ) Fireplace t
Range I _
E -mail: Barbecue
CONTRACTOR Clothes dryer (gas) �/
Business name: a
`` -
Other /' y• '
�� �- " ` (tie :CA- l MECHANICAL PERMIT FEES*
Address: ? N56 l £ j Subtotal /4/1.0% ` l�D� e � ���5 , 17 1 13 Minimum permit fee ($90.00) -
'
Phone: Fax: Q 2� C Q Plan review (25% of permit fee)
�) •3 T7 - 7 (6D) l 1 ( (S State surcharge (12% of permit fee) /c: .
CCB lic.: V ? Li_ 44 .5 ao f/ TOTAL PERMIT FEE / 57•942
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized Signature: • Fee methodology set by Tri- County Building Industry Service Board
Print name; (�ew U ( n � Dater/Z4/1______:
I:\ Building\ Permits \MEC_PermitApp_040113.doc `" ° 1 440 -461Tr (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: \ Building\ Permits \MEC_PermitApp_040113.doc 2