DESCRIPTION OF WORK
PROPERTY OWNER
Email:
Addition/alteration/replacement
Project name:
Lot no.:
Authorized Signature:
Print name:
This permit is issued under OAR 918-460-0030. This permit application expires if
a permit is not obtained within 180 days after it has been accepted as complete.
Mechanical Permit Application
TYPE OF WORK
Permit No.:
New construction
Demolition
1- and 2-family dwelling
Multi-family
Commercial/industrial
Accessory building
Other:
APPLICANT
CONTACT PERSON
Email:
CONTRACTOR
Job site address:
City/State/ZIP:
Suite/bldg./apt. no.:
Tenant Improvement or change of use:
Total
Qty
Fuel piping $ 4.00 for first four; $1.05 for each additional
Subtotal
MECHANICAL PERMIT FEES*
Other
11.90
8.95
15.85
15.85
11.90
11.90
6.00
8.95
COMMERCIAL FEE SCHEDULE- USE CHECKLIST
Mechanical permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all mechanical
materials, equipment, labor, overhead. and profit.
Value: S
RESIDENTIAL EQUIPMENT/ SYSTEMS FEES
For special information use checklist.
8.95
8.95
6.00
8.95
8.95
8.95
6.00
8.95
8.95
8.95
6.00
6.00
8.95
Ea
By Outlet #
By Outlet #
By Outlet #
By Outlet #
By Outlet #
By Outlet #
By Outlet #
By Outlet #
By Outlet #
Is existing space heated or conditioned?
I
s existing space insulated?
Yes
Cross street/directions to job site:
Subdivision:
Tax map/parcel no.:
City of Cornelius
By City of Forest Grove
Yes
TOTAL PERMIT FEE
*Fee methodology set by Tri-County Building Industry Service Board
IVR Inspection request line: 1-888-299-2821
Phone: 503-992-3229 Fax: 503-992-3202
1924 Council Street/P.O. Box 326
Forest Grove OR 97116
Name:
Address:
City/State/ZIP:
Phone:
Business name:
Contact name:
Address:
City/State/ZIP:
Phone:
Business name:
Address:
City/State/Zip:
Phone:
CCB Lic No:
Email:
City/Metro BusLic No:
Date:
No
No
CATEGORY OF CONSTRUCTION
Other:
JOB SITE INFORMATION AND LOCATION
Master builder
Description
Heating/Cooling
11.90
Furnace
Air Conditioning
Heat Pump
Duct Work
Hydronic hot water system
Residential boiler
(radiator or Hydronic)
Unit Heaters (fuel-type, not electric)
in-wall, in-duct, suspended, etc.
Flue/vent for any of the above
Other
Other fuel appliances
Water heater
Gas fireplace
Flue vent for water heater or gas
fireplace
Log lighter
Wood/pellet stove
Wood fireplace/insert
Chimney/liner/flue/vent
Other:
Environmental exhaust & ventilation
Range hood/other kitchen equipment
Clothes dryer exhaust
Single-duct exhaust (bathrooms, toilet
compartments, utility rooms
Attic/crawl space fans
Other
Furnace, etc.
Gas heat pump
Wall/suspended/unit heater
Water heater
Fireplace
Range
Barbeque
Clothes dryer (gas)
Minimum Permit Fee
Plan review( % of permit fee)
State surcharge (12% of permit fee)
27.30
click to sign
signature
click to edit
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