Permit CITY OF TIGARD MECHANICAL PERMIT
11 4 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00084
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/24/2011
Parcel: 2S 115AD04600
Jurisdiction: Tigard
Site address: 16674 SW 108TH AVE
Project: MACDONALD Subdivision: DOVER LANDING Lot: 29
Project Description: Gas piping for range.
Contractor: HOLMES INSTALLATION SERVICE Owner: MACDONALD, MARK & PAMELA K
33535 NW VADIS RD 16674 SW 108TH AVE
CORNELIUS, OR 97005 TIGARD, OR 97224
PHONE: 503 - 647 -9320 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 02/24/2011 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 02/24/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 02/24/2011 $75.85
Occupancy Grp:
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 the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules
or direct questions to OU C by calling 503.232.1987 or 1.800.332.2344.
i �,
Issued By: ' � �l�� -r / � Permittee Signature:
C. 13.639.4175 by 7:00 a.m. for the next available inspection ate.
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 e�1\ FOR OFFICE USE ONLY
,r, �! ^
1111111 City of Tigard \� � t o Received �� // PerntitNo. l
• - " 13125 SW Hall Blvd Tigard, OR 97223 �, \ • Date/By: `� )�f� — :�(j�� . vC11 .
Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 ;" -- ta�� Date/By:
T I G A R D Inspectio Line: 503.639.4175 �`, Date Ready/By: Juds: ® See Page 2 for
11 Internet: www.tigard- or.gov \ \,%- r _ ` 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 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: $
R ESIDENTIAL EQUIPMENT / SYSTEMS FEES*
I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
Multi family ❑ Master builder ❑ Other: For special information use checklist.
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND AND LOCATION Heating/cooling
Job site address: b '� 7 Su.) 1 v �/�_ Air conditioning
(requires site plan showing placement) 46.75
City /State /ZIP: a,- `) C>Y� 9 2_2._ /
Furnace , (ducts /vents)
Furnace 100 000 BTU BTU (ducts/vents) 46.75 1
54.9
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
,1 Gas fireplace 33.39
—1f - " /J / o ■c3 - , ✓, Q, Iv% � 1-60-- .9 � U leave e. 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 0 Chimney/liner /flue /vent 23.32
! I r `, 1l,� Other: 23.32
Name: IV y' r / (�/ Environmental exhaust and ventilation
Address: l b 67 41 Sw ( b.}, y4 f
.(.- _ Range hood/other kitchen
equipment 33.39
City /State /ZIP: [ Gam+- D G Ye_ q 7 27- 4 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone) 6,0 430. 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 X
CONTRACTOR Barbecue r `
I � S , ' ��� t 5,,e_.
Clothes dryer (gas)
Business name: `
Other:
Address: �� dl, i S MECHANICAL PERMIT FEES*
City /State /ZIP: C 0'0A-411 Q ( J A-81 (Jr 0 1g_ q' "7/ / 3 Subtotal
Phone: (5 7 5 7 (1' Fax: ( ) Minimum permit fee ($90.00) `() (,
Plan review (25% of permit fee)
CCB lic.: f '0 Z 9 7 3 /0/-7//). /,. State surcharge (12% of permit fee) to _ oz.) } ` TOTAL PERMIT FEE l �,+
Authorized signature: a'+' This permit application expires if a permit is not obtained within in 18 180
� days after it has been accepted as complete.
Print name: ! "� ^ a NJ 2t .—s Date: Z Z f f * Fee methodology set by Tri- County Building Industry Service Board
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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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