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Permit z�'v CITY OF TIGARD MECHANICAL PERMIT 1��x COMMUNITY DEVELOPMENT Permit #: MEC2010 -00266 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/11/2010 T f GARD Parcel: 2S114BCO3000 Jurisdiction: Tigard Site address: 16657 SW RIVERWOOD PL Subdivision: Lot: 0 Project: Bradley Project Description: Gas line extension for barbecue. Owner: FEES BRADLEY, TODD Description Date Amount 16657 RIVERWOOD PL TIGARD, OR 97224 Fuel Piping 06/11/2010 $14.15 12% State Surcharge - Mechanical 06/11/2010 $10.80 PHONE: Minimum Fee Adjustment - Mechanical 06/11/2010 $75.85 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 By: Permittee Signature: Cij 0 Alb, 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 � ' i, " ,; I tr'lz Or I Ic.l L'l O��I � F t� `', • � � � .�3??e . •. * " a1w � r • x +'•8 lz ` , Received City of Tigard �� Date/By: t Ar Permit No.: /y� ti • 13125 SW Hall Blvd., Tigard, OR 9722 i ! � � /,' • i� ''� /r ® , Plan Review Phone: 503.639.4171 Fax: 503.598.19.0 1 ��© Date/By: Other Permit: u . ` „ „� ::Ii'i'( A i i�; Inspection Line: 503.639.4175 JAN Date Ready/By: ® See Page 2 for Internet: www.tigard-or.gov ` OG I Notified/Method: pi Supplemental Information 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 ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY. OF CONSTRUCTION Value: $ . RESIDENTIAL EQUIPMENT / SYSTEMS 'FEES* ❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: f j _ t' Air g conditioning lO 5 ,S `/�/ � v I/ e,,, � �, P Ilk � Q (requires site plan showing placement) 46.75 City /State /ZIP: t 7 ' / V4 OvQ 4 D ,1 4 Furnace 100,000 BTU (ducts /vents) 46.75 j � J Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name:' 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 OF °•WOR K ;i . Water heater , 23.32 Gas fireplace 33.39 . I/1 ")1 I St 1 a He, ( Flue vent for water heater or gas C C owl Ire O � ' I _ �, t , fireplace 23.32 U P /U J (�Cfs Ivwt Log lighter (gas) 23.32 far Back , Wood/pellet stove 33.39 1” Wood fireplace /insert 23.32 Chimney /liner /flue /vent 23.32 0, PROPERTY 'OWNER n - ❑ TENANT . Other: 23.32 Name: I 1)/) A w 1 7 yj I P Environmental exhaust and ventilation Address: u )1 o Range hood/other kitchen ' 1 6 5 7 5 �U J; t) W o 7) I t /D f/)( Q . equipment 33.39 City /State /ZIP: ( /1' Drell, �� 22 14 Clothes dryer exhaust 33.39 Single-duct exhaust (bathrooms, Phone: (� 6)) -)54 & ✓ E) 9 Fax: ( ) toilet t compartments, utility lity rooms) 23.32 ® APPLICANT a CONTACT PERSON Attic /crawlspace fans 23.32 < e (p_J& Ot her: 23.32 Business name: d V) Q U (o u Q \ 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 1 Business name: Sa w, e a S L7 1 V L COI Ankfe t r� Other dryer (gas) Address: - ' .MECHANICAL PERMIT FEES *. City /State /ZIP: Subtotal Minimum permit fee ($90.00) jU, c10 Phone: ( ) Fax. ( ) Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) 10 • 3.0 7 I TOTAL PERMIT FEE NO.. IN This permit application expires if a permit is not obtained within 180 � '_ � Authorized signature: aI � � / i `� days after it has been accepted as complete. Print name: J 1 J 0 1 1 e Date: I - a 0 0 * Fee methodology set by Tri- County Building Industry Service Board 4 1 . Building \Permits\MEC- PermitApp.doc 10/01/09 440- 4617T(1I /02/COM/WEB) ,?-1 t c;-- Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: Total . • 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\NEC- PermitApp.doc 10/01/09 2