Permit
q CITY OF TIGARD MECHANICAL PERMIT
ss COMMUNITY DEVELOPMENT Permit#: MEC2009-00602
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/12/2009
Parcel: 2S110BD02300
Jurisdiction: Tigard
Site address: 11949 SW BULL MOUNTAIN RD
Subdivision: SHADOW HILLS NO. 2 Lot: 55
Project: Hunt
Project Description: Run gas line for new tankless water heater.
Owner: FEES
HUNT, HOLLY Description Date Amount
11949 SW BULL MOUNTAIN RD Flue Vent for Water Heater or Gas 11/12/2009 $23.32
TIGARD, OR 97224 Fireplace
PHONE: Fuel Piping 11/12/2009 $14.15
12% State Surcharge - Mechanical 11/12/2009 $10.80
Contractor: Minimum Fee Adjustment - Mechanical 11/12/2009 $52.53
PLEASANT VALLEY PLUMBING INC
13540 SE ELLEN DR
CLACKAMAS, OR 97015
PHONE: 503-380-8124
FAX: 503-658-5576
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
utility ication ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules
or d' ect questions to NC by calling 503.246.6699 or 1.800.332.2344.
Iss ed By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
q " Wi a 1 l � r ,h i A � �� I '�"'b l ".- it P T �
Mechanical Permit A lication_ �j +s : �� "'� `FOR.:P*If C0.,$ . , o ONLY� ?. . r ; r + L i , i
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Cl of Ti and Ap RECEIV Re
Date/By: e7 M 01,
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1 1N
' I ° 13125 SW Hall Blvd ,'Ttgazd, QR 97223 Plan Review
Phone 503.639.417 Fax 501598A96"1" V I 2 2009 Date/By: Other Permit:
. 1 - 1 G A R p 4173
Inspection. Line: 503.639. Date;Ready /By: )ons: Iii See Page 2 for
IA Internet: wwW.tigard- or.gov Notified/Method: Supplemental. Information
CITY OF TIGARD
RING DIVISION _
G. TYPE'3O .. •- M
' 'COMMERCIAL FEE* SCHEDULE U SE: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) ofall'.
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
' 7 , • CATEGORY OF CONSTRUCTION. ° . '` Value $
RESIDENTIAL EQUIPMENT /SYSTEMSFEES* .''
A l- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
l M builder For special information use checklist.
Multi-family ❑ ❑ Other:
❑ Description I Qty. Ea. Total
3.. c JOB: SITE INFORMATION1AND LOCATIONS 4 ' Heating/cooling
Job.site address: / / 9 L g 5 {�,, ® , ! Air conditioning
Tres ste p
f !! �(1 (� /�' J� liLi1 (requires site plan showing placement) 46.75
City /State /ZIP: 77 4, g, 0 el— Furnace 100,000 BTU (ducts /vents) 46 "75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite /bldg. /apt. no.: Project name: Heat pump 61.06
Cross street/directions tojob site: Ductwork 23:32
Hydronic hot water system 23:32
Residential boiler (radiator. or
• hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.:
Flue /vent,forany of •above 23.32
Other: _ 23 "32
Tax map /parcel no.: Other fuel appliances
." •;� w r•°= DESCRIPTION 'WORK" r „ % Water!heater I 23.32
Gas ' fireplace 33:39
-1 U h, / / " 1 4(' hi -C' -(Or' a Flue vent for water heater or gas
T fireplace 23.32
'. e j (roc ell, he4.$-1 ✓'
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood.fireplace /insert 23.32
® ° PROPERTY, a OWNER �" ' y ❑ TENANT . .
Chimney /liner /flue /vent 23.32
Other: 23 "32
Name: 14-0 /, r H tot t Environmental exhaust and ventilation
Address: Range hood/other kitchen
�� 5. U 3t4J equipment 33.39
• City /State /ZIP: T1 i c 1, 4 aft, Clothes dryer exhaust 33.39 '
8 Single -duct exhaust (bathrooms,
Phone: ( ) . Fax: ( ) toilet compartments, utility rooms) 23.32
■ :APPLICANT ID. ''CONTA'CT PERSON ' '' Attic /crawlspace fans 23.32
Other: 23 :32
Business, name: .
. Fuel piping
Contac•name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
` .. ^, Barbecue
Business name: k UPII f kb. �y l Clothes dryer (gas)
f,LG`3��r Other:
Address: e
,� ,j JL{® 1E. LFs 11.,�,� p, _ ,MECHANICAL PERMITuF _b.y _ ,
City /State /ZIP: I46, 140%4 ,4' D • Subtotal O�
Minimum permit fee ($90.00) I'D
Phone: (5.A t G Fax: U ) ^�—
51� 7 � � ' �� �`f 5 9 5s it, t Plan review (25% of permit fee)
CCB lic.: 1 L iii, 1. S ' State surcharge (12% of permit fee) /
TOTAL PERMIT FEE / nQ . ?Co
AuthorjZed Si nature: This permit application expires if a permit is not obtained within 180
g days after i t has been accepted as complete.
Print-name: t� "c an T 44 10le Date: // 1 < i 1 o * Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Permits\MEC- PermitApp.doc 10 /01/09 440 -4617T (11 /02 /COM/WEB)
, •
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
: ' Perniiffee:.. .
$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.
1.13uilding\Pemuts \MEC-PermitApp doc 10/01/09 2