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Permit CITY OF TIGARD MECHANICAL PERMIT 1111 I COMMUNITY DEVELOPMENT Permit#: MEC2020-00684 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/29/2020 T f(;A It C� g Parcel: 1S133DC07200 Jurisdiction: Tigard Site address: 11765 SW 134TH TER Project: Skrobish Subdivision: WINTER LAKE Lot: 3 Project Description: Installing direct vent gas fireplace in existing cove.Frame wall,hook up vent to exterior, hook up to existing gas line. Contractor: OWNER Owner: SKROBISH,ANGELA L SKROBISH, DAVID A 11765 SW 134TH TER TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Specifics: Description Date Amount Gas Fireplace 10/22/2020 $33.39 Type of Use: SF Flue Vent for Water Heater or Gas 10/22/2020 $23.32 Class of Work: ALT Type of Const: Fireplace Occupancy Grp: Chimney/Liner/FlueNent 10/22/2020 $23.32 Stories: 12%State Surcharge-Mechanical 10/22/2020 $10.80 Minimum Fee Adjustment-Mechanical 10/22/2020 $9.97 Fuel Fuel Types: Gas Pressure: Total $100.80 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions1ioe to OUNC by calling 503.232.1987 or 1.800.332.2344. 4 Issued By: .. AV.� v (t`Q1n _ Permittee Signature: ors, G� �` �, " J Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. ' •12,i l • Mechanical Permit Application FOR OFFICE.USE ONLY City of Tigard L'rr 2 1 20'lQ Darr /0/2/ 4ZU '%' Permit No.:���f20�6 el/ 13125 SW Hall Blvd,Tigard,OR 97343 Plan Review el/ t Phone: 503.718.2439 Fax: 5(13.598.1960 Date/By: Other Permit: i i c i.\R U Inspection Line: 503.639.4175 Date Ready/By: lulls: Si See Page 2 for Internet: www.tigard-or.gov Notified/Method: f/ Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work ❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ..a'1-and 2-family dwelling 0 Commercialindustrial ❑Accessory building For special information use checklist. ❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: 1 li 7oe) 5vJ [3t�, _ Furnace 100,000 BTU(ducts/vents) 46.75 City/State/7.1P: 1GA, ©R 91`2-7 Furnace 100,000+BTU(duets/vents) 54.91 I Heat pump 61.06 Suite/bldg./apt.no.: Project name: F,R Pis Duct work 23.32 Cross street/directions to job site: t'I5 EL- try f 4. g c Hydronic hot water system 23.32 Residential boiler(radiator or seActi,e, � -iO �p„4/ - L- - Te hydronic) 23.32 ,DD / Unit heaters(fuel-type,not electric), I,�A 1 E.e. . — YK1(rtk'(--• in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 Other feel appliances: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 1 33.39 `I / p Flue vent for water heater or gas 1 IJ Aw r — .L�1 g..€C .I V i1�( C.;.-k -f g.E.Y l..ls,� fireplace , 23.32 EX f ST ( 4 Ct- c. 4E . -FeAh(. (Alr Loger(gas) 23.32 LA w J Wood/pellet stove 33.39 flook- 0> `t E13( E'c-e.1#/ 1..L> u( E)QIST t r� Wood fireplace/insert 23.32 l(Ps 1 . r ... - Chimney/liner/flue/vent I 23.32 pa PROPERTY OWNER 0 TENANT Other: 23.32 Environmental exhaust and ventilation: Name: Range hood/other kitchen �tt/� Sogly�. equipment 33.39 Address: i I /to 6 S�' 1... .4 . IE - Clothes dryer exhaust 33.39 City/State/ZIP: Q -sue Single-duct exhaust(bathrooms, �1 -I 1 / toilet compartments,utility rooms) 23.32 Phone:( .5) ci(pc, ._ t34 L Fax:( ) Attic/crawlspace fans 23.32 _ 0 APPLICANT 0 CONTACT PERSON Other: 23.32 j Fuel piping: Business name: .f / $14.15 for first four;$4.03 for each additional Contact name: Lam' / Furnace,etc. Address: Gas heat pump Wall/suspendedhmit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace i Range v E-mail: S K RO�IS 64 M4t;(1... . CCTV\ Barbecue CONTRACTOR Clothes dryer(gas) Business name: tJ IA, Other: MECHANICAL.PERMIT FEES* Address: L 1 U W 1\-),F e V Subtotal City/State/ZIP: Minimum permit fee($90.00) Phone:( ) Fax:( ) Plan review(25%of permit fee) State surcharge(12%of permit fee) CCB lic.: 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: V * Fee methodology set by Tri-County Building Industry Service Board Print name: AN. , 5 „,61'11- Date: i b I So t& '—I I: ildiag\Pwmits\MEC_PermitApp_040 n3d poc 440-4e17r UmaCOMIWEB) 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. t:\Ruilding\Permits\MEC_PermitApp_040113.doc 2