Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2023-00012
Date Issued: 1/9/2023
T f t;AR17 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104DA12000
Jurisdiction: Tigard
Site address: 13031 SW MERLIN PL
Project: Ulwelling Subdivision: QUAIL HOLLOW-WEST Lot: 106
Project Description: REMOVING:gas fireplace insert and capping gas line in the wall.
Contractor: DIEGO RAY ANDERSON&COURTNEY MARIE ULWE Owner: ULWELLING, COURTNEY MARIE
13031 SW MERLIN PL 13031 SW MERLIN PL
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-574-0440 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 01/09/2023 $33.39
Type of Use: SF Fuel Piping 01/09/2023 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 01/09/2023 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 01/09/2023 $42.46
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center Those rulesare set forth in OAR 952-001-0010 through OAR 952-001-0090.)y/Y�ou may obta'i/n�a copy of the rules
Issued By: /1.71/:7.47,94efivt Permittee Signature: Ate 1,�iJ1i�,�/��„\\..11wvJ° (((11J"`-__Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
Date/By: 9 Permit No.: 11114.G?al _
• 13125 SW Hall Blvd.,Tigard,OR 97223 PlannRev Review O��
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Date/By:
T 1(,A1:i) Inspection Line: 503.639.4175 Date Ready/By: kris: ® See Page 2 fur
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE USE CHECKLIST
Mechanical permit fees*are based on the value of the work
El New construction '2 Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
O Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
El.
1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist
❑Multi-family El Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heatln>/cooling:
Air conditioning 46.75
Job site address: /3 Q,3 / LP Lt_, , DP Q li/4 P L Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 7"1 Qetz„z 04 g'?-z a, ? Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: "F112E-p mp. v , Duct work 23.32
Cross street/discetions to job site: Hydronic hot water system 23.32
1 Residential boiler(radiator or
n
Oa_� E 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
Oth
Subdivision: 6u12 i HQL,GO al &J cST Lot no.: er' 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert I 33.39
Flue vent for water heater or gas
P Fi- de./e E71( IS r (,4•6 t /AFp(. 1,c Q NA fireplace 23.32
aP-P Gi�E Log lighter(gas) 23.32
4 Wood/pellet stove 33.39
Wood frreplace/insert 23.32
Chimney/liner/flue/vent 23.32
OthPROPERTY OWNER 0 TENANTS' 23.32
Environmental exhaust and ventilation:
Name: /1 j Fl f C,
Ozd j� 4. WE'(-6/4 Range hood/other kitchen
C / equipment 33.39
Address: l3 0 g / 2tl ��>Q&/A Pc. Clothes dryer exhaust 33.39
City/State/ZIP: ac 2 Q R , 4-'-�zZ3 Single-duct exhaust(bathrooms,
Q toilet compartments,utility rooms) 23.32
Phone:tic Q/ ) - p s- Fax:( ) Attic/crawlspace fans 23.32
APPLICANT 0 CONTACT PERSON Other: 23.32
Business name: Buz, L.(D1LM no 14 60002 W C fli � Fuel piping:
S14.15 for first four;S4.03 for each additional
Contact name: rFQfr) 4bu AF.e S D A Furnace,etc.
Address: Ate. ��OOF Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:(ST' 3--"7 c,f .a y SC�� Fax::( ) Fireplace
nge
E-mail: ,L Fr 4,67_1)01�Pic;0 ( i .L Barbe
1
J a� ( 6 {/l Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: ' / ma y-t,M wd02)/L /D/Lk's Other:
�, '�' MECHANICAL PERMIT FEES*
Address: D J 3 44) 1,4E2 ,✓l Subtotal
.f ���,p City/State/ZIP: "� 0 el
f- p.t3 Minimum permit fee($90.00)
Phone:(S-624 S�kr r O /b Fax:( ) Plan review(25%ofpernit fee)
State surcharge(12%of permit fee)
CCB lic.: ;L f q Q S-C, TOTAL PERMIT FEE 100o.S'o
This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete.
Authorized signature: 0 . a. * Fee methodology set by Tri-County Building Industry Service Board
Print name:3)rt..ib .Ai SQ,0 Date:01 •OC1. ,23
L\Batlding\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.
is\Building\Permits\MEC_PermitApp_040113.doc 2