Permit CITY OF TIGARD MECHANICAL PERMIT
1 7 • COMMUNITY DEVELOPMENT Permit #: MEC2011 -00123
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/24/2011
Parcel: 2S112CB08600
Jurisdiction: Tigard
Site address: 15072 SW KENTON DR
Project: Fries Subdivision: Lot: 0
Project Description: Replace existing pellet stove insert with gas fireplace insert.
Contractor: FIRESIDE DISTRIBUTORS Owner: FRIES, PATRICIA
18389 SW BOONES FERRY RD 15072 SW KENTON DR
PORTLAND, OR 97224 TIGARD, OR 97224
PHONE: 503 - 684 -8535 PHONE: 503 - 639 -8974
FAX: 503 - 670 -7285
FEES
Specifics: Description Date Amount
Gas Fireplace 03/24/2011 $33.39
Type of Use: SF Fuel Piping 03/24/2011 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 03/24/2011 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 03/24/2011 $42.46
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 Co. - , le of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit -dl expir: if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law req ires you is follow the rules adopted by the Oregon
Utility ication Ce - Those - - = set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0/90. You may obtain a copy of the rules
or ' ect questions to OUNC b a ' g 51 32.1987 or 1.800.332.2344.
Is ued By: • / 2.� Permittee Signature: + '
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
Mill I I }a� g Received .. A l( tk e // �_ / � 3
Cl of Tigard Re e ive 2 f Permit No.: j/ C
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R O Inspection Line: 503.639 Date Ready/By: runs 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*
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: ) C��Z < ` l/ , , r - 1 F (requires site plan showing placement) 46.75
/ �Fumace 100,000 BTU (ducts vents) 46.75 City /State /ZIP: 1T�+ ° o t ' 1 ' 7 0- �t9 Q
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump
(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 ff
f C Gas fireplace 33.39 dtj•
r ( ✓1 (� d 4 1 J +71 ye4t....ic
j /1 r �/ Flue vent for water heater or gas
`� fireplace 23.32
-12 il U.) Log lighter (gas) 23.32
t CV'� Wood/pellet stove 33.39
rt S' ,N Wood fireplace /insert 23.32
PROPERTY ER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: _ 23.32
Name: 'lLA Environmental exhaust and ventilation:
Address: /� -- S r�, l Range hood/other kitchen
1 � 4 1� ->�. /(� _ equipment 33.39
City/State /ZIP:(t c 04 tp S „ C n Q � v Clothes dryer exhaust 33.39
t I J J Single -duct exhaust (bathrooms,
Phone: (T7) ( ^ T 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 /
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: -t - A f,(,S bc 1 =■iSk (3% e_ ` a'�
t
Other
Address: 03731 S' c,,., G -4 teit0 MECHANICAL PERMIT FEES*
City/State /ZIP: Sfr:.;,c lam. A. c-2 Gt1 Z:1 y Subtotal 90.
Phone: (:03)5c Fax: ( ) Minimum permit fee ($90.00) ,
l 3 ? Z� Plan review (25% of permit fee) _ .-----
CCB lic.: Li M State surcharge (12% of permit fee) l0, $o
( TOTAL PERMIT FEE /Op , g0
This permit application expires if a permit is not obtained within 180
Authorized signature: . i days after it has been accepted as complete.
Print name:
r Vi: Date: 2`i 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
$5,000.0x.
$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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