Permit CITY OF TIGARD MECHANICAL PERMIT
a • COMMUNITY DEVELOPMENT Permit #: MEC2013 -00427
T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/29/2013
Parcel: 2S104BD09900
Jurisdiction: Tigard
Site address: 12645 SW 135TH AVE
Project: Alexander Subdivision: 2006 -043 PARTITION PLAT Lot: 1
Project Description: Install gas furnace, duct work, flu vent, A/C, and gas piping for furnace, water heater and range. Placement of A/C
or heat pump units must comply with the manufacturer's clearance requirements.
Contractor: G M H HEATING, INC. Owner: ALEXANDER, MARION & DOMINIQUE
18606 SE TIBBETTS CT 12645 SW 135TH AVE
GRESHAM, OR 97030 TIGARD, OR 97223
PHONE: 503 - 481 -9352 PHONE:
FAX: 503 - 912 -3775
FEES
Specifics: Description Date Amount
Air Conditioning 07/29/2013 $46.75
Type of Use: SF Furnaces < 100K BTU 07/29/2013 $46.75
Class of Work: ALT Type of Const: Duct Work 07/29/2013 $23.32
Occupancy Grp: FlueNent For Any of Above 07/29/2013 $23.32
Stories: Fuel Piping 07/29/2013 $14.15
12% State Surcharge - Mechanical 07/29/2013 $18.51
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $172.80
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: :9 r
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 Applicatio EI11ED • FOR OFFICE USE ONLY
City of Tigard Received
Date :7
B 2Q it or
q 13125 SW Hall Blvd., Tigard,OR 97223 J` I !
Date/By: „�� �' a
0 Phone: 503.718.2439 Fax: 503.598.1960 " L 9 � '3 Plan Review
�
n Date/By: Other Permit:
Inspection Line: 503.639
T I G A IZ D CITY OFTIG Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: /6j Supplemental Information
BUILDING DIVISION v
TYPE OF WORK , COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction On 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*
GE:j I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ M ulti- family ❑ Master builder ❑ Other: Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
4,5--- Air conditioning / 46.75
a Job site address: /G2 i S / / 354 /h-ee Furnace 100,000 BTU (ducts /vents) / _ 46.75
City /State /ZIP: ` / 9( elf 5' . 2 2� Furnace 100,000-F BTU (ducts/vents) 54.91
J ;� Heat pump 61.06
Suite/bldg. /apt. no.: 1 Project 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 33.39
P �/C n Flue vent for water heater or gas
/ G 9 E S' 6�� / /7 4--- / 9 7 --- fireplace 23.32
Aj /7 / G/ �I /� / G/9-..c �Gt 7z A7/7 6' C C_T- Log lighter (gas) 23.32
tl 7 Wood/pellet stove 33.39
l() D C 2 � / I/�/t/ j / 6 /(/ G f q /e /A //7 C Wood fireplace /insert 23.32
Ger "iiRA/,9e-/ Vn ,tAJ�� sf A./ - ,_ Chimney/liner/flue/vent 23.32
ciA PROPERTY OWNER , � I . ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: �� /1Lf G o Range hood/other kitchen
�iGG// equipment 33.39
Address: ��� S �(� / � ft-2
Clothes dryer exhaust 33.39
City /State /ZIP: / / �� OX 3 Single -duct exhaust (bathrooms,
`, toilet compartments, utility rooms) 23.32
Phone:3) �� _ � /L f 3 Fax: (5 y -,2 7 �� 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.
Address: Gas heat pump
Wall /suspended/unit heater
City /State /ZIP: Water heater / •
Phone: ( ) Fax: : ( ) Fireplace
Range
E -mail:
Barbecue
CONTRACTOR Clothes dryer i ,�' l ' ' tyt (gas)
!! �l Other:
/ Business name: , I /) f C MECHANICAL PERMIT FEES*
Address: IR6 SE 77 66E, � C--- Subtotal /5 29
City /State /ZIP: G a 9 7Wie 0 i , 97123 0 Minimum permit fee ($90.00)
Plan review (25% of permit fee)
Phone: ( 4123 ) 44 1- 93 5--g_ _ Fax: ( 3) 9 2 2 -39.9-5--, State surcharge (12% of permit fee) / I s/
CCB lie.: /9�j 6 6 y /( //y TOTAL PERMIT FEE 7,a , Q
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: �.; r * Fee methodology set by Tri- County Building Industry Service Board
•) Print name{: t/�//J 4 ��` C 'fi Date: 6 .- Z-C_- 1' 77 S y
I:\ Buil ding\P ermttS�MEC_PermitApp_040113.doc 440 -4617T (I I /02/COM/WEB) # p2 *
S J 3 y
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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