Permit CITY OF TIGARD MECHANICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00092
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/08/2011
Parcel: 2S104CD11000
Jurisdiction: Tigard
Site address: 13886 SW HILLSHIRE DR
Project: GRUBAUGH Subdivision: HILLSHIRE ESTATES NO. 2 Lot: 151
Project Description: Gas piping for barbecue.
Contractor: HOLMES INSTALLATION SERVICE Owner: GRUBAUGH, VAUGHN F III &
33535 NW VADIS RD GRUBAUGH, LAURA D
CORNELIUS, OR 97005 13886 SW HILSHIRE DR
TIGARD, OR 97223
PHONE: 503 - 647 -9320 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 03/08/2011 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 03/08/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/08/2011 $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 OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By L / ittee Signature: S/
\t1/4.i'I' 4 1j61 1 1
Cal 5 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 ON I.I
City of Tigard k)1° Received
C �� Daffy Permit No.:
• 131 SW Hall Blvd., Tigard, OR 97223 L is ! / "' " g � ��
Plan Review
Phone: 503.639.4171 Fax: 503.598.196
`� Date./By: Other Permit:
T I G A R n Inspection Line: 503.639 to Ready/By: Juris. 0 See Page 2 for
Internet: www.tigard - or.gov \i ` 001tified/Method; Supplemental Information
TYPE OF WORK CV (NO' COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction Addition /alteration /re Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition El Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1 - and 2-family dwelling ❑ Commercial/industrial aster b ui builder ❑ Accessory building For special information use checklist.
❑ Multi - family ❑Master blder ❑Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION LOCATI Heating/cooling
� �
Air conditioning
Job site address: / ( (requires site plan showing placement) 46.75
City /State /ZIP: ` 0..1,-11 Ore,. q77,11Z-"3 Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.:ject name: Ork bony L 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
Subdivision: I 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
a Gas fireplace 33.39
•�
A . ./t 541, A+✓�) fl '.--7 / 1- 4 --- 6,61 & Flue vent for water heater or gas
f fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
PROPERTY O ER ❑ TENANT
Chimney/liner/flue/vent 23.32
)itc �'/ Other: 23.32
Name: ii, L'l / l7 v tea A Environmental exhaust and ventilation
Range hood/other kitchen
Address: 13
j j� ! /5 5A f� i r e, On- equipment 33.39
City/State /ZIP: Q a r p/ 4 y 7 z-z-- 3 Clothes dryer exhaust 33.39
JL / / ? - / _� Single-duct exhaust (usury rooms) s,
Phone ) 7 t comp Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/cram/space 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 f /if, 1f
�n Clothes dryer (gas)
Business name: ,, t, L * Ti T� Other:
Address: fit MECHANICAL PERMIT FEES*
City/State/ZIP:�?jr c t. , 0 , 4 9W /3' Subtotal f i "P / t / L Minimum permit fee ($90.00) em „ E K)
Phone: ) .z.4 7 (i Fax: ( ) Plan review (25% of permit fee) —
CCB lic.: f O Z y 7 3 State surcharge (12% of permit fee) /77 .
. TOTAL PERMIT FEE _ /Da, kd
Authorized signature This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print nameia.
r / * 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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