Permit CITY OF TIGARD MECHANICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: MEC2010 -00388
T [ GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2010
Parcel: 2S103BB02500
Jurisdiction: Tigard
Site address: 12115 SW 124TH AVE
Subdivision: BROOKWAY Lot: 25
Project: Howsen
Project Description: Gas piping for range, barbecue and clothes dryer.
Owner: FEES
HOWSON, BRIAN C & GRACE A Description Date Amount
PO BOX 4017
BEAVERTON, OR 97076 Fuel Piping 08/04/2010 $14.15
12% State Surcharge - Mechanical 08/04/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 08/04/2010 $75.85
Contractor:
MALLARD PLUMBING COMPANY
17011 SE TENEYCK
SANDY, OR 97055
PHONE: 503 - 593 -7878
FAX: 503 - 668 -7325
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 :11 4.
Issued By: . Permittee Signature: /�— i C ,CD
d
Call 51 .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 1 t)R t) l ICI.1 Sl ()NIA . .
Cl of Tigard Received Permit o.:
13125 SW Hall Blvd., Tigard, OR 97223 \ r" )
`J g Date/By: lb ` P i N ' if 0 C. 1i`.
C 40, Plan Review
'
Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit:
1 ' 1,; A 1:1 1 Inspection Line: 503.639.4175 0C1 r:`,;t0 Date Ready/By: : Fin ® See Page 2 for
Internet www.tigard- or.gov Q r ��� Notified/Method: Supplemental Information
� \`r
*TYPE OF WORK N, Mechanical permit fees* are based on the value of the work
❑ New construction ❑ Addition/alteratiolt/e performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: $vl) mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS. FEES* .
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
V' Air conditioning
Job site address:
Z / / s • L. -- f' Z 7 (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP: t �� 9 7 Z 3 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
• // 9 Gas fireplace 33.39
p dO i� r Cl. C�4 S P// u, G.e 5 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
❑ PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32 _
Name: R/ //{ i,•J Al w S a v../ Environmental exhaust and ventilation
Range hood/other kitchen
Address:
/Z /1 S S_ t ✓ - / 2 9 equipment 33.39
City /State /ZIP: / e • p, d_ Q /� 9 7 - Z 3 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
dm/A_ / Other: 23.32
Business name: m 4 ? L LL Vn IO t K $ Fuel piping
Contact name: Nt p`1-.e_ 12_ o 1-- Z t ,e r■/ S14.15 for first four; $4.03 for each additional
p Fumace, etc.
Address: I
7 u l ( S'. (- - f V/ 'e v 4 t' I- Gas heat pump -
City /State /ZIP: StA..� ALL / t? jZ 9 7 O S S Wall/suspended/unit heater
Phone: (57.'31 5 f 3 }f-7 F (55z3) 6,5 - 1// 7.s'?- wat eate
Fireplace
E -mail: Range
CONTRACTOR Barbecue I
Business name: yy � J� / /� Clothes dryer (gas) t i.
/i.74 /%9.11 / �t,, �s- [- O , Other:
o / 5: (-
Address: / � 7; N ,e y C „*._.z MECHANICAL PERMIT FEES'‘
City /State /ZIP: c k L e /L 9 7e 5" g Subtotal
Phone: O Fax: Minimum permit fee ($90.00) 10 ._ k_4.-) ( 5 e1 7 f l 7 (� 0 (p S to - ' 7 S Plan review (25% of permit fee)
CCB lic.: / 7 �3 y Z State surcharge (12 %ofpermit fee) 1)
TOTAL PERMIT FEE (Up Z-z )
T his permit application expires if a permit is not obtained within 180
Authorized signature r days after it has been accepted as complete.
Print name a,,,, t L I kj, t-I- - Date: t - / - /0 * Fee methodology set by Tri-County Building Industry Service Board
1:\ Building \PermitsUMEC- PermitApp.doc 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 $100.00 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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