Permit •
! `� ' CITY OF TIGARD MECHANICAL PERMIT
�° '. ,` COMMUNITY DEVELOPMENT .Permit #: MEC2010-00318
Date Issued: 07/08/2010
AICARD 13125 SW Hall.Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S136CA04000
Jurisdiction: Tigard
Site address: 11170 SW 79TH AVE
Subdivision: FRIENDLY ACRES Lot: 8
Project: Gearhart
Project Description: Replacing existing wood stove.
Owner: FEES
PALCIC, LILLIAN S Description Date Amount
11975 SW KING JAMES PL
KING CITY, OR 97224 Wood /Pellet Stove 07/08/2010 $33.39
12% State Surcharge - Mechanical 07/08/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 07/08/2010 $56.61
Contractor:
JAMMING SERVICES
14770 SW KILCHIS
BEAVERTON, OR 97007
PHONE: 503- 970 -2321
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 ob : n a copy of the rules
or direct questions to OUNC by calling 503. • • • • or .:
Issued By: _Alk`■ Permittee Signature: Al is I di #' - 4 I
Call" P0 by 7:00 a.m. for an inspection that business : ay.
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 ' • � a� 7,„, , , , F*oi i ci �us i;oN � ' " s a ' ', „:' „ °
Received ♦ Permit No:
13 L 2 5 Of 'Tigard � �'� DateBy B / ' PYI
t. 4010"
Hall Blvd., Tigard, OR 97223 "I
C ' Phone. 503.639.4171. Fax: 503.598.19.1' Plan Review
Date/By: Other Permit: .
`I.1 6 R D . Inspection. Line: 503.639.4175 0- 'a Date Ready /By: ® See Page 2 for - .
Internet: www.tigard - or.gov CIr i Notified/Method: Supplemental Information
oV
��� >. D
2
w • � � , _ .. • . TYPE OF WORK � A I COM ME 1d RCL FEE,'., d>� re SCHEDULE = A USE�CHECKLIST � '
❑ New construction al Addition /alteration /repl * an the value of the work
performed. lue (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
i ° - CATEGORY: CONSTRUCTION .` r- .. y Value $ N
' R ESID EN TI A L E QUI P ME T / F EES, %.4
0 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
• • • For special information use checklist.
F® Multi- family ❑ Master builder ,❑ Other: Description Qty. Ea. Total
i' JOB 'SITE INFORMATION AND LOCATION J Heating/cooling
Job site address: / v Air conditioning
��f , s fit/ (requires site plan showing placement) 46.75
City /State /ZIP: 7 7/ 19 Z e' i
0 . ‘,,
Furnace 100;000 BTU "(ducts /vents) 46.75
^ � Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project. name: W � . D .5 7D vet, r Heat pump 61.06 '
Cross' street/directions'to job site: �* ywc� e ,� To4 1 `/ Ductwork 23.32
�y .... Hydronic'hot water system 23.32
70 — $` PP,4 `' I 44,4- Residential boiler (radiator or
r hydronic) 23.32
/5.1;;;') j eke - Unit'heaters (fuel -type, not electric),
`' ' in wall, in -duct, suspended, etc. 46.75
? �! Flu
e /v"ent for any of above 23.32
Tax
Subdivision:
map/parcel no.: Lot no.:
Other 23.32
p p Othe'rlfuel appliances
" .' _ - ' ` Waterheater 23:32
- , � ° - s: r - z i . � DESCRIPTION OF��WORKs, - .
..n' n �, ( _ - Gas fireplace 33.39
� 1 tv 5 ex t Si,�N ( di- SJznjc Flue vent for water heater or gas
• fireplace 23.32
. Log lighter (gas) 23.32
. Wood/pellet stove , 33.39 3'3,3 e i
f . Wood, fireplace /insert 23.32 '
1 t . Chimney /liner /flue /vent 23.32 '
''•,' ," ,..r. PROPERTY.OWNER , ® TENANT - . ”
Other: 23.32
'Name:
2, /LEA /1/ PA G EC-
Environmental exhaust and ventilation Range hood/other kitchen
Address
// 9 7 , / . i',57.,,,,,/.! pi , equipment 33.39
City /State /ZIP: ie/ l l/G c , 7- y t, � . - Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
'' Phone: ( ,j3) 7'7 3 / Fax: ( ) toilet compartments, utility rooms) 23.32
s - , t Attic /crawls ace fans 23.32.
I i 'RI': APPLICANT `° ® CONTA PE - P
Other: 23.32
Business name:- . —T S• t /
e%/C
3/�'t /4 Ili Fuel tin
P�P 1;
Contact - name: A/c H• ,fD 2e NO $14.15 for first four; 54 :03.for'each, additional
Furnace, etc.
Address: /i/ 7 2 t). E Cc) / L / /L G',//S ' .77
Gas heat pump
City /State /ZIP: A / l 4 . +--, 7 ,.r/ 6 - Wall /suspended/unit heater
Phone: ( 3) Q O - a 3, Fax: : ( ) • Water heater
Fireplace
E - mail: Range
• x;
4 CONTRACTOR' Barbecue
Business name: Clothes dryer (gas) •
?A ./ry s to
Other:
Address: / ,9 2 2 0 5 c _.,} / a,.. ell"' S S T ` PERMIT T,ES* o
fir! v�
City/State/ZIP: / ;27cexv 0—,--e_ �7 GCJ 7 . Subtotal 3 ..7 8 c
Phone: (o3) Fax: ( ) Minimum permit fee ($90.00) �j'O,,,. f) )
q 70 - .23„2 / /// Plan review (25% of permit fee)
CCB Iic.: 5• 9" 4 7 ‘. ` l �/ / 14 State surcharge (12% of permit fee) •1 ,
( TOTAL PERMIT FEE 'Ll)O
This permit application expires if a permit is not obtained :within 180
Authorized signature:!/� days after it has been accepted as complete.
Print 'narne. ; 1/e9' ,fc i2 ,4, Date: 'f /0 * Fee methodology set byTri- County Building Industry Service Board
Ia Building \Perniits'MEC PermitApp. 10/01/09 440- 4617T(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 $100:007ir • \ is
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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