Permit MECHANICAL PERMIT
CITY OF TIGAR®
COMMUNITY DEVELOPMENT Permit# MEC2010- 00025
IFIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639 Date Issued: 0171,9/2010
Parcel. 2S103BB11900
Jurisdiction: Tigard
Site address: 12120 SW ANN PL
Subdivision: YE OLDE WINDMILL Lot: 38 •
Project: Leathers
Project Description: Replace gas insert.
Owner: FEES
LEATHERS, DONNA Description Date Amount
12120 SW ANN PL
TIGARD, OR 97223 Gas Fireplace 01/19/2010 $33.39
Chimney /Liner /FlueNent 01/19/2010 $33.39
PHONE: 12% State Surcharge - Mechanical 01/19/2010 $10.80
Minimum Fee Adjustment - Mechanical 01/19/2010 $23.22
Contractor:
ALL WAYS WARM INC.
.324 SE 82ND AVE
•
PORTLAND, OR 97216
PHONE: 503 - 777 -6000
FAX:
Type of Use: SF •
Class of Work: ALT Type of Const:.
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
Total $100.80
Required'Ite'ms, and Reports (Conditions)
This permit is issued subject to the regulations contained'in,the Tigard Municipal Code, State ofOR. Specialty Codes and all other
applicable law. All'work,will be donein,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 -0100. You may obtain'a copy of therules •
or direct questions to OUNC by calling 503. &AltsoD 246.6699 oor 1.800.332.2344,
Issued By: vs n Permittee Signature:
CaIf503.639.4175 by 7:00, a.m. for an inspection that'business day.
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.'
'Wchamical Permit A licatio D Received FOR e
City of Tigard RECEIVE s Date/By: Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960
JAN 19 2010 Date/By: Other Permit:
a Inspection Line: 503.639.4175 Date Ready/By: t ri ' 0 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
PUll DING DIVISION
TYPE OF WOR 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
r_1 Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
'~l- and 2-family dwelling E] Commercial/industrial E] Accessory building
For special information use checklist.
❑ Multi-family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
i~bnv~ ~1 Air conditioning
Job site address: S Z1 'ZO S( ,D (requires site plan showing placement) 46.75
City/State/ZIP: tic act ope Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 1001000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: Project name: Heat um 61.06
Cross street/directions to job site: Duct work 23.32
` H dronic hot waters stem 23.32
(+.1 1- "i t L Residential boiler (radiator or
h dronic 23.32
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue/vent for an of above 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39 -33.3
Flue vent for water heater or gas
fireplace 23.32
Lo lighter (gas) 23.32
Wood/ pellet stove 33.39
Wood fire lace/insert 23.32
❑ PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 73.32 Z,3.3'7-
Other: 23.32
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawls ace fans 23.32
Other: 23.32
Business name:
Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat um
City/State/ZIP: Wall/sus ended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E-mail: Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
t'1 Other:
Address: MECHANICAL PERMIT FEES*
City/State/ZIP: Subtotal 5 (p .
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) CIO -JU
Plan review (25% of permit fee)
CCB lic.: I Mo 7 State surcharge (12% of permit fee) ( 4v
TOTAL PERMIT FEE /0 % • FEU
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print nam Date: * Fee methodology set by Tri-County Building Industry Service Board
1:\Building\Permits\MEC-PermitApp.doc 10/01/09 440-4617T (I 1/02/COM/WEB)
Mechanical Permit Application - City of Tigard •
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
TAtal.Valuation: Permit Fee 4- •
$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
feaction thereot-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.
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