Permit Iii CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC201000602
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2010
TlGftRD; Parcel: 2S103CA04800
Jurisdiction: Tigard
Site address: 11560 SW TERRACE TRAILS DR
Project: Knipe Subdivision: TERRACE TRAILS Lot: 4
Project Description: Install pellet stove insert.
Contractor: EMERALD OUTDOOR LIVING INC Owner: KNIPE, RALPH H AND LOIS D
2520 SILVERTON RD NE 11560 SW TERRACE TRAILS DR
SALEM, OR 97301 TIGARD, OR 97223
PHONE: 503 - 370 -9355 PHONE: 503 - 639 -9344
FAX:
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 11/19/2010 $23.32
Type of Use: SF Chimney /Liner /FlueNent 11/19/2010 $33.39
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/19/2010 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/19/2010 $33.29
Stories:
Fuel
Fuel Types: Other
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 t follow the rules adopted by the Oregon
Utility i icatio -nter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 -001- 0• S. You ay obtain a copy of the rules
or ect questions to 0 C b g 503.232.1987 or 1.800.332.2344. Aq �
I sued By: • I // /' / Permittee Signature: A. L "` —
. IM
Call 5 03.639.4175 by 7:00 a.m. for the next available inspec ion 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 Applic.ifFECEIVE '. . - .012.,OTFICE . USE ''
Received
k
City of Tigard Date/By: I t Q
f I 10 C.99 Permit No.: / ,900Q —/
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a 13125 SW Hall Blvd., Tigard, OR 9722QV 19 2010 Plan Review
' Phone: 503.639.4171 Fax: 503.598.1 Other Permit:
. , Date/By:
'f I G A R D Inspection Line: 503.639 CITY OF TIGARD Date Ready/Ely: Juris: iZI See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* ,SCHEDULE - USE CHECKLIST
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Mechanical permit fees* are based on the value of the work
❑ New construction El Addition/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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning
Job site address:
11 5(nD ---r Q ( ,,c, ` � ha_ (requires site plan showing placement) 46.75
City /State /ZIP: — r - 6 001 �� C� 7 . ) 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 33.39
„IV\51 0.:I 5 KM vr2 �vSJQ.2 j Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert P 23.32
❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 1 23.32
Other: 23.32
Name: ��1 vht Pte- Environmental exhaust and ventilation
Address: ( 1 5 (.D 0 S L..) Tr. I c o . ac i equipment Range hood/other kitchen
nt 33.39
City /State /ZIP: -T- 0(L_ R -7 ^-� ^ 3 Clothes dryer exhaust 33.39
c�ra'- Single -duct exhaust (bathrooms,
Phone: (5 3) 4 ' 3i - 9 54-� Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ 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
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Business name: t �k� �o�r>_ Lf ` U i / ij Clothes dryer (gas)
l Other:
Address: t ,- 0 S l 1 v..e4uro r‘ 0`_S MECHANICAL PERMIT FEES*
City /State /ZIP: S ,„„ on- 97301 Subtotal y/), 00
Phone: (503 p Fax: ( ) Minimum permit fee ($90.00) -�---
l7 / ��� Plan review (25% of permit fee)
CCB lic.: ) 41 5 9 4.16 I. f State surcharge (12% of permit fee) (Q, ?c)
TOTAL PERMIT FEE /06, O .
This permit application expires if a permit is not obtained within 180
Authorized signature: ..- M2e1--- days after it has been accepted as complete.
Print name: ox," D b001 Date: / f.— / 9 Jo * Fee methodology set by Tri- County Building Industry Service Board
C\Building\Permits\MEC- 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 $10,000A0 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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