Permit CITY OF TIGARD MECHANICAL PERMIT
F ; COMMUNITY DEVELOPMENT Permit #: MEC2010 00180
ate, , , t Date Issued: 04/22/2010
TEGAR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S133AD14300
Jurisdiction: Tigard
Site address: 12778 SW SORREL DOCK CT
Subdivision: SUMMER LAKE Lot: 24
Project: Bahng
Project Description: Install wood fireplace insert.
Owner: FEES
BAHNG, MOON HO & HYUN OCK Description Date Amount
12778 SW SORREL DOCK CT
TIGARD, OR 97223 Wood Fireplace /Insert 04/22/2010 $23.32
12% State Surcharge - Mechanical 04/22/2010 $10.80
PHONE: 503 - 579 -0273 Minimum Fee Adjustment - Mechanical 04/22/2010 $66.68
Contractor:
OWNER
PHONE:
FAX:
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 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 By: / j �- ! 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.
Mechanical Permit A licatioltl c)11 t PP City of Tigard E\IE Date r ' - Date/By: aoZ /� Permit No../� i
'l q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie / /C�� /D �D �O
;l `: . Phone: 503.639.4171 Fax: 503.598.1960 APR .2 2 2 0 1 0 Date/By: Other Permit:
i;'G A It i Inspection Line: 503.639.4175 Date Ready/By: -furls: ® See Page 2 for
j•: ' Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: j J Supplemental Information
BUILDING fIVISI(W
TYPE OF WORK COMMERCIAL -FEE* 'SCHEDULE USE'CHECKLIST
•
Mechanical permit fees* are based on the value of the work
❑ New constructionddition/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*
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
Multi- family 0 Master builder 0 Other: Description Qty. Ea. I Total
JOB SITE 'INFORMATION AND LOCATION . Heating/cooling
�_ / S, of , S on/e v C C
Air g conditioning
Job site address:
/ � ('� / � /� / / (requires site plan showing placement) 46.75
City /State /ZIP: 7; 9 a ,--d ox 9/7/.)-3 Furnace 100,000 BTU (ducts /vents) 46.75
f/ i '/ �, ` ` / Furnace 100,000+ BTU (ducts /vents) 54.91 •
Suite/bldg. /apt. no.: Project name: / /JUJ G1 stoke 1"/f 7 Heat pump 61.06
Cross street/directions to job site: G ,n�' tl7� Gtl V- d c 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
Gas fireplace 33.39
n t f ge 1iC.e / �j ;G'Le �b/!(µeP/r,(�, Q t f v`e- ,660 6 � [ n f /eA Flue vent for water heater or gas
siaf / Was- ' /.0,b-e i. `t- file /Ate "t,f" .co�f✓,� �e/ " f / e fireplace 23.32
Log lighter (gas) 23.32
W ■ A Sf ° {'� 6 gi " /J /e GJ / f h 'I-144 fro TOp o f Wood/pellet stove 33.39
f7€ owfi / / ¢ ' zp ieGe CU0 /76'ct - Wood fireplace /insert f 23.32
� ' I m // '/ U —` J" . / / /�(•t / q Chimney /liner /flue /vent 23.32
� '1PROPERTY, OWNER I ❑ TENANT "4
Other: Other: 23.32
Name: )v GI // /3 ,4/-//-/ Environmental exhaust and ventilation
Range hood/other kitchen
Address:
/�9� S, w . �Soyr /)J0,4 6- 7" - - equipment 33.39
City /State /ZIP: , 0-6/ 0,/?- 7,-�� Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( �S'�Q,:.2-23 Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT - ❑ CONTACT .PERSON Attic /crawlspace 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 pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
. • CONTRACTOR • . - . Barbecue
Clothes dryer (gas)
Business name: Efe----
Other. Address: ' MECHANICALTERMIT FEES*
City /State /ZIP: Subtotal .- o o
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee) IS)--
C C B lic.: State surcharge (12% of permit fee) /(). et)
TOTAL PERMIT FEE /DO. 1"0
Authorized Si at This permit application expires if a permit is not obtained within 180
d ays a it has been accepted as D ate: 7 2� complete.
`1
Print name: Yv Q/y � 8,91-/N j ` / * Fee methodology set by Tri- County Building Industry Service Board
I:\Building\Permits\MEC- PermitApp.doc 10/01/09 440 -461 (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.
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