Permit Support Document Mechanical Permit Application FOR OFFICE USE 011.1
City of Tigard Dace/By:By: /�
Er
Date/ 1 �j �; c zr .��
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 i .- Date/By. Other Permit:
T I GA R D Inspection Line: 503.639.4175 ' Date Ready/By: Juris 0 See Page 2 for
Internet: www.tigard-or.gov .tified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction 0 Addition/alteration/replace -40. ii(` performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition El Other: 1 1, mechanical materials,equipment,labor,overhead,and profit.
r' Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑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 I 46.75
Job site address: j I 349 <,U/ F(15-4 Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 1 - r)/ 0 R Furnace 100,000+BTU(ducts/vents) 54.91
� � Heat pump 61.06
AL
Suite/bldg./apt.no.: Project name: I}fr ,, 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
9 ' //�� tt Flue vent for water heater or gas
i t itC. ? ec.:vw.:t` d .M) i L.c) 1 —eo l j 4- fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Oth
❑ PROPERTY OWNER 0 TENANTS' 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
Address: equipment 33.39
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
0 APPLICANT 0 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(gas)
Business name: //' L -7 Other:
t olla'Y�' �/e
'/ MECHANICAL PERMIT FEES*
Address: I O3"Z N k/ ( v paygh c I" Subtotal
City/State/ZIP: 1-1, �, l(e U� q 70 Minimum permit fee($90.00)
Phone:(CjU7j ) (07—t /Q r Fax:( ) Plan review(25%of permit fee)
J 1 l State surcharge(12%of permit fee)
CCB lic.: 1 i O O41 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: / //4,e9----- * Fee methodology set by Tri-County Building Industry Service Board
Print name: JD gel- Date: 'Z(//2_ci
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/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