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Permit t 4 `° CITY OF TIGARD MECHANICAL PERMIT k w Q COMMUNITY DEVELOPMENT Permit #: MEC2010 -00367 T f G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/28/2010 Parcel: 2S103AB01100 Jurisdiction: Tigard Site address: 11100 SW WALNUT ST Subdivision: Lot: 0 Project: Kahn Project Description: Replace gas furnace, gas line and gas venting. Owner: FEES KAHN, STEPHEN M AND ANN L Description Date Amount 11100 SW WALNUT ST TIGARD, OR 97223 Furnaces < 100K BTU 07/28/2010 $46.75 FlueNent For Any of Above 07/28/2010 $23.32 PHONE: 503 - 598 -0658 Fuel Piping 07/28/2010 $14.15 12% State Surcharge - Mechanical 07/28/2010 $10.80 Contractor: Minimum Fee Adjustment - Mechanical 07/28/2010 $5.78 EVERGREEN GAS INC. PO BOX 388 WEST LINN, OR 97068 PHONE: 503 - 407 -9542 FAX: 503- 344 -6345 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 N ''cation Cent- Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or dire questions to OUN b - ing 503.246.6699 or 1.800.332.2344. Issue By: , / I4/ ' 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 Application ...•l of � ii I It I ; 1J51 ,oiNl.l CI of Ti and Received n C/ permit No : q �' g pp Date/By: I C ! N>GL 0/0-.00 u c0 7 1 : 1 ' 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C '' Phone: 503.639.4171 Fax: 503.598.1901 ' ti / % sq . Date/By: Other Permit: T i It A i) Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for ' Internet: www.tigard- or.gov JUL 2 8 2010 Notified/Method: Supplemental Information TYPE OF WOj (Jr § IGY e lD 'COMMERCIAL FEE* SCHEDULE - USE CHECKLIST era Peal I . i'1;tia .: i ; -'1 Qtru r Mechanical permit fees* are based on the value of the work ❑ New constructions {ddition /alteraUon/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 ❑ Commerciallindustrial ❑ Accessory building For special information use checklist. R Multi - family ❑Master builder ❑Other: Description I Qty. ' Ea. Total JOB SITE INFORMATION AND LOCATION . Heating/cooling Air conditioning Job site address: / / © 0 L f ST � t J C � (� w�' �V (requires site plan showing placement) 46.75 1 City /State /ZIP: f 1/ �/f Fumace 100,000 BTU (ducts/vents) i 46.75 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 DESCRIPTION OF WORK . Water heater 23.32 `' Gas fireplace 33.39 � i L r' ✓J✓t Cc C L . f f S L � 1 ,[ i' - """"A-1. c e- - Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 � Chimney /liner /flue /vent 23.32 Jam^ PROPERTY OWNER ❑ TENANT Other. 23.32 Name: 4 A AL t^ Environmental exhaust and ventilation Range hood/other kitchen Address: ///60 St tJ C .✓ .4 I Gt vF equipment 33.39 City/State/ZIP: �P..- -! cJy� Clothes dryer exhaust 33.39 ` T T� Single -duct exhaust (bathrooms, Phone: (j 1 S) Sf8 © 6 5 Fax: ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT . ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Other: 23.32 Business name: Fuel tin P g Contact name: $14.15 for first four; 54.03 for each additional Address: Fumace, etc. Gas heat pump City /State /ZIP: WalUsuspended/unitheater Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range CONTRACTOR . Barbecue Business name: Clothes dryer (gas) -1/(.vi f-@ Other: Address: - p o i, 3 ez • MECHANICAL PERMIT FEES* . City /State /ZIP: CA) es f-. 14 t.. o- 1/4. c9-a_ - 9 ?© 6. ? . Subtotal /� _ Minimum permit fee ($90.00) 9(J - Phone: (C�3) //a 7 9 Fax: (�.) �� � t z73 Plan review (25% of permit fee) -.ems CCB lic.: / 5 5 6 3 1 State surcharge (12% of permit fee) M . Se 1 TOTAL PERMIT FEE /00 . g ) This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name:/ , ,it I +uAw`,ei� Date: 772. 4 C 0 * Fee methodology set by Tri -County Building Industry Service Board 1:\ Building \PermittAMEEC- PermitApp.doc 10 /01/09 440 -4617T 11 /07JCOM/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. I:\ Building \Permits\MEC- PermitApp.doc 10/01/09 2