Permit L % •
CITY
O F TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2005 -00603
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/26/2005
PARCEL: 1 S136AD -00700
SITE ADDRESS: 10470 SW 67TH AVE ZONING: R -4.5
SUBDIVISION: VILLA RIDGE NO. 2 LOT: 006 JURISDICTION: TIG
Project Description: Gas line for stove.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: •
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
PATRICK SIMMONS Description Date Amount
10470 SW 67TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 9/26/200f. $72.50
[TAX] 8% State Surcha 9/26/200`. $5.80
Total $78.30
Phone: 503- 246 -1764
Contractor:
LARSON & SON PLUMBING
8537 SW 54TH
PORTLAND, OR 97219 REQUIRED ITEMS AND REPORTS
Phone: 503- 246 -7004
Reg #: LIC 37650
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: -2Z114.., Permittee Signature: SC:(.—
PS� .
Call 503 - 639 -4175 by 7:00 a.m. for inspections 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 hanical Permit A • t li _ , " X. '"' ,"-,;-'0,' y, `'
• City o f Tigard Recei
' Date/By..� r;2 0.5 .- Permit No. N‹ c4,2_CA 0 03
, O 2 3
13125 SW Hall Blvd., Tigar Plan Review C/
Phone: 503.639.4171 Fax: 503.598.1960 1 , . y . ;,. ,•,
, Date/By. Other Permit:
Inspection Line: 503.639.4175 [ Z 6 ��05 ��
S L 1 'i 1 ►� Date Ready/By: !tins: ® See Page 2 for
Internet: www.ci.tigard.or.us - V
GARD Notified/Method: ' Supplemental Information
CITY OF TI viSiOP VV
. BUILQ# L�' O WORK . • COMMERCIAL FEE* SCHEDULE -' USE CHECKLIST
❑ New construction lI Addition/alteration /replacement 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: $
ISil 1- and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial/industrial ❑ A ccessory building
For special information use checklist.
❑ Multi - family ❑ Master builder
❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
L / Air conditioning or heat pump
Job site address:
107 70 f ) of 7 (requires site plan showing placement) 14.00
City /State /ZIP: 77 7,4/a d Orf . Fumace 100,000 BTU (duds/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street /directions to job site: , 0i4h Duct work 14.00
• Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
' Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
• " DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
/1( J, ( / A/S /,,;(i4, bA )Q// 6 Flue vent for water heater or gas
J fireplace 10.00
• • Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
•
❑ PROPERTY OWNER I ❑ TENANT Chimney /liner /flue/vent 10.00
Other: 10.00
Name: f',4 �'� � 440�) , ' -F , Environmental exhaust and ventilation
Address: p Range hood/other kitchen
V equipment 10.00
City /State /ZIP: _ / Clothes dryer exhaust 10.00
// ® '�/ Single -duct exhaust (bathrooms,
Phone: (S'3) - 441:_61.4--5-2:- 2 7C F : ) toilet compartments, utility rooms) 6.80
• ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address:
Fumace, etc.
Gas heat pump
City /State/ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range 1
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: / w 3 ... /. 1 ' � . 5. d A / p/6
• Other:
Q
Address: IS -y 7 JG.J S Y "J MECHANICAL PERMIT FEES*
City /State /ZIP: f,R7 /4....1d 9 2,2/ Subtotal
/ / q Minimum permit fee ($72.50)
Phone: (5'x3) y6. 7�o ' Fax: ( ) Plan review (25% of permit fee)
CCB lic.: J - ? �,a State surcharge (8% of permit fee)
o TOTAL PERMIT FEE "n J O
Authorized signature: J i This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: T -1 /_ , � Ja� Date: 1.} a . • Fee methodology set by Tri- County Building Industry Service Board
\ B P
i:uilding\ erm \ M
its EC- PennitApp.doc 440-46617T (11 /02/COM/WEB)
�•
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information •
Commercial Fee Schedule:
• Total :�Valuation: • Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to.$5,000.00 $72.50 for the first $2,000.00: d $2.30
. for each additional $100.00 • fraction
thereof, to and including $5 100.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,01 and •
$1.80 for each additiona $100.00 or
fraction thereof, to and ncluding
1 000.00.
$10,001.00 to $50,000.00 $231.51 e firs ',10,000.00 and
$1.35 for each a • • • •onal $100.00 or •
fraction thereof o an. i = ding •
$50,000.00.
$50,001.00 to $100,000.00 $771:50 for i e first $50,000.00 an.
$1.25 for • .ch additional $100.00 or
fractio • ' ereof, to and including •
$100 000.00.
$100,000.01 and up $1 .96.50 for the first $100,000.00 and
.10 for each additional $100.00 or
fraction thereof.
Note: All new c • mercial buildings require 2 sets of plans.
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