Permit ai v
CITY OF TIGAR® MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00102
G ftiRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/10/2010
Parcel: 2S111DB11200
Jurisdiction: Tigard
Site address: 9385 SW Lake Side DR
Subdivision: SUMMERFIELD NO.12 Lot: 639
Project: Luscher
Project Description: Install gas insert.
Owner: FEES
LUSCHER, MARJORIE Description Date Amount
9385 SW LAKESIDE DR
TIGARD, OR 97223 Gas Fireplace 03/10/2010 $33.39
12% State Surcharge - Mechanical 03/10/2010 $10.80
PHONE: 503 - 639 -8484 Minimum Fee Adjustment - Mechanical 03/10/2010 $56.61
Contractor:
OWNER
PHONE:
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 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B I ( Perm ittee Signature: '�� J -`` `
Call 503.639.4175 by 7:00 a.m. for an inspection that business da .
This permit card shall be kept in a conspicuous place on the job site until comp -tio of the project.
Approved plans are required on the job site at the time of each ins . - • ion.
Mechanical Permit Applicatio T 1 7 , q i - ?`0 > 0 '•l ()IZ - . - -' lc 4 , - t F, '2;V', � y��}
City of Ti a nd � � R `i � �� r Received �� /� permit No.:
t
` g Date/By: : d�-� (Y1�N 70 to . 00 102
o 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Date/By: Phone: 503.639.4171 Fax: 503.598.1960 MAR 1:0 2013 Other Permit:
1;1 (.. i i\ li (Y. Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov CITY OF f I A RD Notified/Method: C� Supplemental Information
RI I 1;'::i: nfttl1
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction gAddition/alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment. labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
)gi1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. "total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: LL Air conditioning
J s..\,4 j,.,J}p( lj� (requires site plan showing placement) 46.75
City/State/ZIP: -T- 100,000 BTU (ducts /vents) 46.75 0. 1 ���� I ��2 Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: &Rs 2,,, 5 EeT Heat pump 61.06
Cross street/directions to job site: Duct work 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
Flue /vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
-�^ / _
.J Gas fireplace 33.39
NSM iS = N Sce 1 1 N EX.( N C� Flue vent for water heater or gas
"� fireplace 23.32
-- fit- , v�X - Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney /liner /Flue /vent 23.32
❑ PROPERTY OWNER ❑ TENANT
Other: 23.32
Name: ("4 c A e V, l ,VSG1-I tP� Environmental exhaust and ventilation
A J ` " Range hood/other kitchen
Address:
C{.3 a 5W . L-A . & DG ,2 Z. equipment 33.39
City/State/ZIP: 1 c a 9 Clothes dryer exhaust 33.39
1 Single -duct exhaust (bathrooms,
Phone: ( 5) ( — 04 04— Fax: ( ) NEE toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
1\.‘. Other: 23.32
Business name: t Fuel r m
P g
Contact name: (\/1 k eye kt= ie. Wbc. k.i -- ._ $14.15 for first four; S4.03 for each additional
6 � Furnace, etc.
Address: q 3gs 5 W , L.-W� -- �7 1 Da 7 > • Gas heat pump
City /State /ZIP: T'1 <0pl"r o (. 9 -7 /i_ Wall /suspende unit heater
( ) 6,39 _ 84$9- ( T . !_ .� Water h ater t P, ,,e, 6..y ��
Phone: /� Fax: MLa cJr= �-�-
Mile 1_,„ Range c (J tig -k
E -mail: - --\---------
CONTRACTOR Barbecue
C \ I , / Clothes dryer (gas)
N
4 E : name: NoE J ,/1/ _
Other:
Address: c p,h 3 ,1 t W kij z t m 1 Ilg�t.. 1,,, MECHANICAL PERMIT FEES* .
City /State/ZIP: kt q
p. q Ce Subtotal co
1 Minimum permit fee ($90.00) � 0
• Phone: (5 ) ci'71 ._ I I Fax: ( WeD^.E.— Plan review (25% of permit fee)
CCB lic.: NiQL)E State surcharge (12% of permit fee) 4 50
TOTAL PERMIT FEE /t)(9 , r(`)
Authorized signatu ' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: L GC X11 MR Y� i - H.� ate: g/ /� /i O i ,� * Fee methodology set by Tri- County Building Industry Service Board
,� " 1
1:\Building \Permits \MEC- PermitApp.do /01/09 440 -4617T (1 I /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi - Family Fee Schedule:
Total Valuation: Permit Fee:
S0.00 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.
•
l:\ Building \Permits\MEC - PermitApp.doc 10/01/09 2