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Permit :K A - MECHANICAL PERMIT • t . CITY OF TIGARD r n 't` , �` c -,, COMMUNITY DEVELOPMENT Permit #: MEC2010 00236 •, Date Issued: 05/20/2010 'T .I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S104DB00300 Jurisdiction: Tigard Site address: 13159 SW BROADMOOR PL Subdivision: AMESBURY HEIGHTS Lot: 3 Project: Tsuruta Project Description: Replacing gas fireplace insert with wood stove insert. Owner: FEES TSURUTA, ISAO Description Date Amount 23 HILLSIDE Flue Vent for Water Heater or Gas 05/20/2010 $23.32 EAST HANOVER, NJ 07936 Fireplace PHONE: Wood Fireplace /Insert 05/20/2010 $23.32 Chimney /Liner /Flue/Vent 05/20/2010 $33.39 Contractor: 12% State Surcharge - Mechanical 05/20/2010 $10.80 IQ CONSTRUCTION & REMODELING Minimum Fee Adjustment - Mechanical 05/20/2010 $9.97 11447 SE SHERMAN CT PORTLAND, OR 97216 PHONE: 503 - 327 -4612 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, o ' or is end for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility N ification Center. T se rul- are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or dire t questions to OUNC by .fling •03 - : 6.6699 or 1.800.332.2344. i lssu d By: /f� /� A Permittee Signature: / / i coca 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 Application �� � � r � ()R �)I l I(l /fltil y t)I� � i r ">a` a k,,li & ' s. R ` �C' a 7� N,,,, . !MAIT r y, I i :: t / t ? :t'l ^ :1. , / City of Tigard �� Received j + ■ +O fV/ta: v Date/By: iL� �� Permit No.: ��� "� t ® ° 13125 SW Hall Blvd., Tigard, OR 971 1C' ii Plan Review ' i Phone: 503.639.4171 Fax: 503.598. C1. % Q D a t e B y: Other Permit //it is .- G�IY �1`K7)� Inspection Line: 503.639.4175 `�P� ' Y . �� Date Ready riA El See Page 2 for Supplemental - •. . Internet: www.tigard- or.gov \`t`• � O � `� ' �X 5 Notified/Method otified/Method: SSupplementalInformation TYPE OF W O R K O�� COMMERCIAL FEE* SCHEDULE.- USE CHECKLIST placement Mechanical permit fees* are based on the value of the work El New const ruction ZAddition /alteration/ 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* 0 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. I Ea. I Total " JOB SITE INFORMATION AND .LOCAT ON • Heating/cooling Job site address: i 51 5 SW h ^ 0c9, kr. Air conditioning (requires site plan showing placement) 46.75 City /State /ZIP: y c n , OA Cr 7 Z Z 3 Furnace 100,000 BTU (ducts /vents) 46.75 J Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: T5 (�v "'��` l 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 -{ Gas fireplace 33.39 Tit k ®wl �5 ( t� SGT ✓r� �� QCQ� Flue vent for water heater or gas 1 / fireplace ( 23.32 Z3.7Z /H(l o r6z- ct.1 Gtc s�ove_ Log lighter (gas) 23.32 r m e �- � Wood/pellet stove 33.39 Wood fireplace /insert / 23.32 Z 3.3Z • ❑ PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 23.32 Z3. )' Z Other: 23.32 Name: Environmental exhaust and ventilation Range hood/other kitchen Address: 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 /crawlspace fans 23.32 / Other: _ 23.32 � � Business name: X ✓ t' 'ti` r L'Tr <r9' --t ,I piping (e�tct, Fuel P I io g JJ J Contact name: C Gt. ✓t c Cg,. t� 1 t'�l $14.15 for first four;' $4.03 for each additional / / L4 Li ^� C1 Fumace, etc. Address: ` ! ( ic 54. �✓ u..Q� Gas heat pump City /State /ZIP: A9,4--(, e5'/. 7C (, Wall /suspended/unit heater Phone: (5;3) j) y Z 7 - ( Z_ Fax:: ( ) Nate_..- Water heater Fireplace E -mail: � 1,v 5 �- ' �y Ce`' �"1 ctc C (:)V( .r C fxt c_ Range CONTIt CTOR Barbecue Business name: 5 pe_ 6,,J Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal (,q, (p Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) cia Plan review (25% of permit fee) _ CCB lic.: J $ Z z ,, 7 v ./ 0 _ State surcharge (12% of permit fee) l 1 TOTAL PERMIT FEE (co , ) This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name: C.._-4t vt t 5' C ©n k 1 Date: 512 & /0 * Fee methodology set by Tri- County Building Industry Service Board I:\ Building \Permits\MEC- PermitApp.doc 10 /01/09 440- 4617T(1I /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. l:\ Building \Permits\MEC- PennitApp.doc 10/01/09 2