Fillable OFFICE USE ONLY www.BeavertonOregon.gov/bib 12725 SW Millikan Way (City of Beaverton)

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OFFICE USE ONLY www.BeavertonOregon.gov/bib 12725 SW Millikan Way (City of Beaverton)

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Mechanical Permit Application
Community Development Department, Building Division
12725 SW Millikan Way / PO Box 4755
Beaverton, OR 97076
Phone: (503) 526-2403; Fax: (503) 526-2550
www.BeavertonOregon.gov/bib
OFFICE USE ONLY
Date Received: Permit No.:
Date Issued: By:
Payment Type:
TYPE OF WORK
New construction Addition/alteration/replacement
Demolition Other, Specify:
CATEGORY OF CONSTRUCTION
1- and 2-family dwelling Commercial/industrial Accessory building
Multi-family Master builder Other, Specify:
JOB SITE INFORMATION AND LOCATION
Job site address:
City/State/ZIP:
Suite/bldg./apt. no.: Project name:
Cross street/directions to job site:
Subdivision: Lot no.:
Tax map/parcel no.:
DESCRIPTION OF WORK
PROPERTY OWNER TENANT
Name:
Address:
City/State/ZIP:
Phone: Fax:
E-mail:
APPLICANT
Business name:
Contact name:
Address:
City/State/ZIP:
Phone: Fax:
E-mail:
CONTRACTOR
Business name:
Address:
City/State/ZIP:
Phone: Fax:
E-mail:
CCB lic.: City or metro lic.:
COMMERCIAL FEES
Mechanical permit fees are based on the value of the work performed. Indicate the
value (rounded to the nearest dollar) of all mechanical material
s, equipment, labor,
overhead, and profit.
Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES
For special information use checklist.
Description
Qty.
Ea.
Total
Heating/cooling
Furnace, incl. ductwork, vent, and liner
Air conditioner
46.75
Heat pump
61.06
Duct work, alterations and additions
23.32
Hydronic piping system
23.32
Boiler, incl. vent**
Gas heaters/unit in-wall, in-duct,
suspended, etc. not incl. vent.
46.75
Other:
23.32
Other fuel appliances
Water heater
23.32
Gas fireplace/insert/stove
33.39
Gas log/log lighter
23.32
Pool or spa heater, kiln*
23.32
Wood/pellet stove/insert
33.39
Wood fireplace
33.39
Chimney/liner/flue/vent w/o appliance
33.39
Oil tanks/gas/diesel generators
23.32
Other:
23.32
Environmental exhaust and ventilation
Range hood/other kitchen equipment
33.39
Clothes dryer exhaust
33.39
Single-duct exhaust (bathrooms, toilet
compartments, utility rooms)
23.32
Attic/crawlspace fans
23.32
Whole house ventilation or Radon
mitigation
23.32
Other:
23.32
Fuel piping
$14.15 for first four; $4.03 for each additional
Furnace
#/outlets
Wall/suspended/unit heater
#/outlets
Water heater
#/outlets
Fireplace/log lighter/gas log
#/outlets
Range
#/outlets
Barbecue
#/outlets
Clothes dryer
#/outlets
Other:
#/outlets
MECHANICAL PERMIT FEES
Subtotal
Minimum permit fee
97.63
Plan review ( 25% of permit fee)
State surcharge (12% of permit fee)
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:
Print name: Date:
Form B70-1003 REV 11/19
Clear Form
>>CLICK HERE TO DETERMINE IF A PLAN REVIEW IS REQUIRED<<
**For Furnace, select>>
Select One
**
1
46.75
1
61.06
23.32
23.32
2
Select One
46.75
23.32
23.32
33.39
23.32
2
23.32
33.39
33.39
33.39
23.32
23.32
33.39
33.39
23.32
23.32
23.32
23.32
Total # of
fuel piping
outlets:
0
Total cost for
fuel piping
outlets:
CALCULATE MECHANICAL PERMIT FEES
Calculate Fees
97.63
Check for Plan Review (25% of permit fee)
11.72
0.00
$109.35
1 - Site plan required for an outdoor unit.
2 - Requires approval from Building Codes Division.
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OFFICE USE ONLY www.BeavertonOregon.govbib 12725 SW Millikan Way (City of Beaverton)

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Completed 2 August 2020

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