Permit p CITY OF TIGARD MECHANICAL PERMIT
1111 I COMMUNITY DEVELOPMENT Permit #: MEC2011 -00089
T IC; gyp L) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/03/2011
Parcel: 2S102CA00225
Jurisdiction: Tigard
Site address: 13195 SW ASH AVE
Project: Cooper Subdivision: VIEWCREST TERRRACE Lot: 20
Project Description: Extend gas line for new range.
Contractor: PAUL SOUZA PLUMBING INC Owner: COOPER, MICHAEL F & KATHY A
1434 SW 5TH PL 13195 SW ASH AVE
GRESHAM, OR 97080 TIGARD, OR 97223
PHONE: 503 - 740 -6311 PHONE:
FAX: 503 - 661 -9777
FEES
Specifics: Description Date Amount
Fuel Piping 03/03/2011 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 03/03/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/03/2011 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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, • if •rk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N. ification Ce -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direc questions to OU ' b ailing 503.232.1987 or 1.800.332.2344. 2herioee
Iss ued B Permittee Signature: Z c
...■A
Call 503.639.4175 by 7:00 a.m. for the next available inspection 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
City of Tigard �� PermitNo.: ��7�Q/ /_
IM II
�
" 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
T I G A R D Inspection Line: 503.639 Date Ready/By: Juris El 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 ❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory 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:
Air conditioning
Job site address: /3/ 9 4 56 0 / J 5 / / / (requires site plan showing placement) 46.75
-y Furnace 100,000 BTU (ducts/vents) 46.75
City/State /ZIP: .-
/ 7 4. C d 69Y Q / 2 .2 -3 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: 7 60, .P fa Heat pump
v (requires site plan showing placement) 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
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
�' // Gas fireplace 33.39
£ x. T t�/C.,/J ( 's4 Z /Nei 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 I ❑ TENANT Chimney/liner /flue/vent 23.32
Other: 23.32
Name: ,/J .e /
/ ._ 4,��`,,-- Environmental exhaust and ventilation:
Address: / 3/ 9 f 5"4) s a L Range hood/other kitchen
equipment 33.39
City/State /ZIP: 77 4- r G7 j /� 9722-3 Clothes dryer exhaust 33.39
/) �� Single -duct exhaust (bathrooms,
(
Phone: ;7 �,/ Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name: Other: 23.32
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: t
Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
Other:
Address: / (/ 3 y S� 5 ,� i c'/ a � i e MECHANICAL PERMIT FEES*
City /State /ZIP: �ve-. j i ,1-p , 40 9 U
F Subtotal ,..0) Minimum permit fee ($90.00) / l�. W
Phone: ( t>r, 3) 7yp 6 3 i 1 . ---- 1 Fax: ( ) Plan review (25% of permit fee)
CCB lic.: l 9 e/9 L' 2. State surcharge (12% of permit fee) f d. Qd
Y---(1------- TOTAL PERMIT FEE //2",) Authorized si afore: f ` This permit application days after it expires has been it a per i s as not comobtaplete ined within 180
a ccepted m it
Print name: .. /0/ �, / / ,t Date: a.V.'' * Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \Permits\MEC- PermitApp.doc 09/09/10 / _ 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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