Permit � 1 CITY OF TIGARD MECHANICAL PERMIT
e Is„ - COMMUNITY DEVELOPMENT Permit #: MEC2010 -00595
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/18/2010
Parcel: 1S125DCO3900
Jurisdiction: Tigard
Site address: 7023 SW BARBARA LN
Project: Cox Subdivision: THE RAZBERRY PATCH Lot: 32
Project Description: Install gas insert and venting. Gas line is already existing.
Contractor: GASPRO INC Owner: COX, GARY & LEMON, PEGGY J
7603 SE LOUNSBERRY LN 7023 SW BARBARA LN
PORTLAND, OR 972056 TIGARD, OR 97223
PHONE: 503 - 775 -7020 PHONE: 503 - 293 -7845
FAX: 503 - 775 -7019
FEES
Specifics: Description Date Amount
Gas Fireplace 11/18/2010 $33.39
Type of Use: SF Chimney /Liner /FlueNent 11/18/2010 $33.39
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/18/2010 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/18/2010 $23.22
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
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 t - rules adopted by the Oregon
Utility,Notifcation Center,. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -00 -0090. Y . ay obtain a c•py of the rules
or irect questions to OUNC`t1 . i g 503.232.1987 or 1.800.332.2344.
Is ued By: /O
lt/f 1 0 Permittee Signature: ' , iiiith
Call 503.639.4175 by 7:00 a.m. for the next available inspe. , on date.
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 FOR OFFICE USE ° ONLY - . -
Received � �
City of Tigard Date /By: /I �Fj / D PermitNo.: Cl ���
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
® - Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Date/By:
. t - I G A R [� Inspection Line: 503.639.4175 Date Ready/By: furls: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — • USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ddition /alteration 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: $
0 1 and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
❑ Multi- family ❑ Master builder ❑ Other: RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
For special information use checklist.
Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
5C f
Air conditioning
Job site address:
�0�- 3 i.1, b 0 4, 4. (requires site plan showing placement) 46.75
City /State /ZIP: / t C r/ & Cl 72 3 Furnace 100,000 BTU (ducts /vents) 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 1 33.39
lam' * 5 ,7j1 f 1`''/{- i- 30...4,i 3 Flue vent for water heater or gas
fireplace 23.32
a Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
-
) ,PERTY OWNER ❑ TENANT Chimney /liner /flue /vent / 23.32
Other: 23.32
Name: e'6 4e f co ` J� � Environmental exhaust and ventilation
Range hood/other kitchen
Address: /91'4 (i equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: 3 . q 3_ 7 $//j Fax: ( ) toilet compartments, utility rooms) 23.32
I=1. APPLICANT . ` 1 ❑ 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 name: r 6S1f,� rA Clothes dryer (gas)
f� Other:
Address: 7Ld / � ° yt l .) , , y ' 1 A l MECHANICAL.PERMITFEES*
City /State /ZIP: 1 , / � C /l 6/ / • -( C °C Subtotal �Q
Phone: �) ,V,__
/� ✓ �/h ) Minimum permit fee ($90.00)
�" 3 7.7c 7 v 0 Fax: ( f 1 / 7 �`� Plan review (25% of permit fee) i
CCB lic.: `/ ' L 9 3 State surcharge (12% of permit fee) /Q . 0}
(.� r TOTAL PERMIT FEE /or,_ 80
�-^- This permit application expires if a permit is not obtained within 180
Authorized signature _ ......iiiiim p"....--• • days after it has been accepted as complete.
Print name: ,. . / 0 / B \ M G. 7 //1 ' `>. Date: / / ( * Fee methodology set by Tri- County Building Industry Service Board
1:\ uilding 'PermitsEC- 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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