Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2019-00785
Tigard OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 11/06/2019
TIGARDg
Parcel: 1 S126DC03002
Jurisdiction: Tigard
Site address: 9250 SW LEHMANN ST
Project: Perry Subdivision: LEHMANN ACRE TRACT Lot: 8
Project Description: Installing(1)heat pump.
Contractor: NORTHWEST COOLING Owner: PERRY, STEPHEN W
21420 NW NICHOLAS CT 9860 SW 92ND AVE
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503-317-0308 PHONE: 503-407-1115
FAX: 503-746-7526
FEES
Specifics: Description Date Amount
Heat Pump 11/06/2019 $61.06
Type of Use: SF 12%State Surcharge-Mechanical 11/06/2019 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 11/06/2019 $28.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You,may obtain a copy of the rules
or direct questions to OUNC by calling 503 2.1987 or 0. .2344.
,44":
Issued By: / Permittee Signature -
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received q
Date/By: �Lr' A_� /
II 11 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: ����> ' '
Inspection Line: 503.639.4175 �' /�
tic,;\I:l) Date Ready/By: Juris: la See Page 2 or
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical pennit fees*are based on the value of the work
0 New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: Q Z_S> E - ��..,..12. -02_.- Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 's,0-'� +N bil. - Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: , Du pump / 23.32
l Duct work 23.32
Cross street/directions to job site: C l - t 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
r �y ,, Flue vent for water heater or gas
_7:*"'00La� 1—> () pi (- - tt%��%. r`.",*'.'/- e�i.un./ fireplace 23.32
t„` T `� �-t` 1 i`-'.) -- $S 4a'N C'.f ib S t,,f/ Log lighter(gas) 23.32
11_
__ nn �nn l't`C_, Wood/pellet stove 33.39
v`N r ti A"�' N't`"'v / 4±%►.--., Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ROPERTY OWNER Other: 23.32
P
❑ TENANT Environmental exhaust and ventilation:
Name: .. �� Range hood/other kitchen
Address: - ��J l'C�w�. equipment 33.39
CI� ��
Clothes dryer exhaust 33.39
City/State/ZIP:CR®�'t,ti,.,"s, 0 lam, Z `---q-i`S Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(SO5) Itt. "1 t h 1 S Fax:( ) Attic/crawlspace fans 23.32
0 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: - A r�J Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: -4( $ SN. �, Barbecue
G 13� C!�-� 1
CONTRACTOR Clothes dryer(gas)
Business name: VJV 4,'F4''1/k- CW` • ,r k,t L. Other:
MECHANICAL PERMIT FEES*
Address: %\3 1.-,)'•`1,• Subtotal
City/State/ZIP: ‘ \ t tA.5L. tLt, Ok, q'7 ('L44 Minimum permit fee($90.00)
Phone:(SS*?) *3('1,.. 61 p-� Fax:( ) Plan review(25%of permit fee)
�� State surcharge(12%of permit fee)
CCB lic.: ' 9 l 1 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature:.. CL,,_._..,, * Fee methodology set by Tri-County Building Industry Service Board
Print name: 2 Re,4,...► 4, _ Date: ),e,.- C7L.-r�
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(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.
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