Permit CITY OF TIGARD MECHANICAL PERMIT
. COMMUNITY DEVELOPMENT Permit #: MEC2010 -00403
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/11/2010
Parcel: 2S102BB00300
Jurisdiction: Tigard
Site address: 10080 SW KATHERINE ST
Subdivision: Lot: 0
Project: King
Project Description: Wood stove installation.
Owner: FEES
KING, JEFFREY H & SUSAN E Description Date Amount
10080 SW KATHERINE ST
TIGARD, OR 97223 Wood /Pellet Stove 08/11/2010 $33.39
12% State Surcharge - Mechanical 08/11/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 08/11/2010 $56.61
Contractor:
AMERCIAN HOMEFIRES LTD
PO BOX 1717
OREGON CITY, OR 97045
PHONE: 503 - 632 -7674
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 obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 • = e g." 344.
Issued By: ✓ , �� Permittee Signature: / /^
ir
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 OIZ c l IC '..1 Sl ()NIA
City of Tigard Received
l�� t� Date/By: 0 /1 0 /3 Permit No.: V e co(to1
IIII ° 13125 SW Hall Blvd., Tigard, OR 97223 ®g Plan Review
' a Phone: 503.639.4171 Fax: 503.598.196 DateBy: Other Permit:
•I "1 c:; A RD Inspection Line: 503.639.4175 2 �1 � Q Date ReadyBy: ® See Page 2 for •
Internet: www.tigard Fall ,, 1 Notified Method: ffl Supplemental Information
T YPE OF WORT 1 ® ��� �� � V D 1 FEE* COMMERCIAL FEE SCHEDULE —USE CHECKLIST
❑ New construction ›ddition/alteratioO�lnent Mechanical permit fees' are based on the value of the work
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*
l- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description
Qty. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION. • Heating/cooling
po _ Air conditioning
Job site address:
.O SW ���-� Sr, (requires site plan showing placement) 46.75
City /State /ZIP: --T c. RD i D R g 7 Z Z 3 Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: W S }d./ •e Vhf) Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
� l Hydronic hot water system 23.32
�:/ ow- S u-) j l eo, p t ? £ t f WX . 3 rcL tl c+ t, S •e e r. (_ Residential boiler (radiator or
hydronic) 23.32
(0 0 8 (7 S w V.: w TH g 11--f. ST . 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
in- I vt G.t e'' 'P;G..nc. W e t S ' 'P_ / Flv- boX Flue vent for water heater or gas
J fireplace 23.32
'✓1 CX iS Tin al / — / re p144Zr . Log lighter (gas) 23.32
✓ Wood/pellet stove 33.39
Wood fireplace /insert ( 23.32 )-3 , 31..
Chimney /liner /flue /vent 23.32
PROPERTY OWNER I ❑ TENANT Other: 23.32
Name: Sse Fp J'D� 0 � Environmental exhaust and ventilation
/ 4,4-A `/ Range hood/other kitchen
Address:
to D 8 0 S w v- i ti >r S T • equipment 33.39
City /State /ZIP: fi t' a r.d 6g_ q 7Z� 3 Clothes dryer exhaust 33.39
I Single -duct exhaust (bathrooms,
Phone: (953 ) 66 c(— ( 6 5 ' Fax: ( ) toilet compartments, utility rooms) _ 23.32
XAPPLICANT • ' ,CONTACT .PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name:
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
Business / Clothes dryer (gas)
usiness name:
9C 1 t I 0 rt-- Ai ✓ brM `Chit,. 1- I -9 Other:
Address: Z ( 'S 3 3 Pa '3 ( -7 1 "7 MECHANICAL PERMIT FEES*
City /State /ZIP: One c a :n c; 6e , C,• s Subtotal
Minimum permit fee ($90.00) 9
Phone: (5 [9 3Z — 7�0 Fax: ( ) Plan review (25% of permit fee)
CCB lic.: pt 09 y 3.3 ?-1/1' State surcharge (12% of permit fee) L (1,,kr)
TOTAL PERMIT FEE l (JO,. Set)
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: �/iv i D
As, Date: 8y, r i 1 p ' Fee methodology set by Tri- County Building Industry Service Board
I: \ Building \Permits\MEC- PermitApp.doc 10/01/09 440-46I7T(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.
1: \Building\Permits\MEC- PermitApp.doc 10/01/09 2