Permit Support Document Mechanical Permit Applicati n FOR OFFICE USE ONLY
Eril City of Tigard �.; y, (0 le (Y PermitNo.: � _��f�.or iv 13125 SW Hall Blvd.,Tigard,OR 97223 �,' Plan Review
Phone: 503.718.2439 Fax: 503.598.19603 /� ei' Date/By: Other Permit:
r 1 G A R D Inspection Line: 503.639.4175 V` Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov ^ � �O`� Notified/Method: Supplemental Information
TYPE OF WORK:IN e. -��O \G�P�Q` COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
's V xJ Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/repla w`�'C performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: 6 O\\ mechanical materials,equipment,labor,overhead,and profit.
ak?\\- Value:$
CATEGORY OF CONSTRON RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-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 46.75
Job site address: //p 575 g`�_ €_,
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: c cc D 9 7)a V Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: 1\12.4 M,tQy 1 4.TH i d_ Duct work 23.32
Cross street/directions to job site: /49 1.kie.A 1.t LI C R 12 I TY Hydronic hot water system 23.32
/t{,.l fig.cNIE.Ill ix.),s Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,no4
in-wall,in-duct,suspe • .1 46.75
Flue/vent for any of .. 23.32
Subdivision: I Lot no.: Other: 23.32
Other fuel a. L'an ,s:
Tax map/parcel no.: Water heater, r/ 23.32
DESCRIPTION OF WORK Gas fi„ ' sert ■ 33.39
L Fl , v- ! water h a r or gas
Ct7SFr.,/t- eL ///(aolik/of 6s 1 /1f Ste-re iv to f •.I• .- 23.32
v{k7 e/ 1'1 a l" d�/10 f$111 (t �j� Lo• r _ 23.32
W',.d/.ell•t• o e PA�A�t! 33.39
ood f e. :ce/inse • !!� 23.32
�/✓ y; r mer/fl lye 1 23.32
ig PROPERTY OWNER I ❑ T-, `PPF �,n 1 ex gust and ventilation:
23.32
Name: C/?r-. liAt /(✓ S.ffvtt-YS 1 ` R. ge t o rkitchen
■ equi 33.39
Address: ! (�G(� 34/ S ✓e- (0/ Clo s dryer e•dtaust 33.39
City/State/ZIP: �` 4 0/q 7 7 tV 2 \ -ng uct exhaust(bathrooms,
t S `K/ '9 ile compartments,utility rooms) 23.32
Phone:(Sp`S ) S9 4/ 7S Fax:( ) c/crawlspace fans 23.32
❑ APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name: G/0-1 w 1 kt-- S i r✓• e-rj $14.15 for first four;$4.03 for each additional
Contact name: Toe'r I /1 c rt I rrS L Furnace,etc.
Address: ) 6 0 4 0 Sy y g S.''t Ave Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: '-r S ry 0/2. 77�a I Water heater -
/ •Phone:(S�) 3-4 7- �- /77 Fax::( ) Fireplace •Range
E-mail: bor(krrSJ Q e /es.1w71t(f e"ti.\Cr'S, 0 fj..s Barbecue _
CONTRACTOR Clothes dryer(gas)
Other:
Business name: Ff C on tri trots 1 11 G MECHANICAL PERMIT FEES*
Address: 11117 E. 19.c1----1 Subtotal
City/State/ZIP: po p t--)1,.1 0 1793 a Minimum permit fee($90.00)
Phone:( v Plan review(25%of permit fee)
3 ) 9 g y- Z 0 2. O Fax:( ) State surcharge(12%of permit fee)
CCB lic.: g U 2 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized Signat C / r Fee methodology set by Tri-County Building Industry Service Board
Print name:jc,e C' 6o rC^/*r-S Date: 3/16/7 6
1 I:1 Building\PennitaVcC_Pernimpp_0401 I3.doc 440-4617r(I 1/02/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