Permit CITY OF TIGARD MECHANICAL PERMIT
14,1 s COMMUNITY DEVELOPMENT Permit #: MEC2009 -00234
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/26/2009
Parcel: 2S110AD04000
Jurisdiction: Tigard
Site address: 14647 SW 106TH AVE
Subdivision: LANG HILL Lot: 34
Project: Hartman
Project Description: Replace gas fireplace.
Owner: FEES
HARTMANN, LYNETTE Description Date Amount
14647 SW 106TH AVE
TIGARD, OR 97224 Gas Fireplace 05/26/2009 $10.00
12% State Surcharge - Mechanical 05/26/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 05/26/2009 $62.50
Contractor:
GASPRO INC
7603 SE LOUNSBERRY LN
PORTLAND, OR 972056
PHONE: 503 - 775 -7020
FAX: 503- 775 -7019
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
Total $81.20
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 -0100. You may obtain a copy of the rule
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. _
( , :5 . 1 1 1 �j
Issued By: ny ).._ Permittee Signature: t
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Mechauical Permit ApplicatiCEIVED FOR OFFICE USE ONLY
Received
City of Tigard Date/By: Permit No.: • �.
13125 SW Hall Blvd., Tigard, OR 97223
M ill �.�AY 2 ?! O9 — II
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit.
Inspection Line: 503.639.4175 Date/By: Ready/By: I GA RD CITY OF TIGARD Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental 1 nform a tion
BUILDING DIVISION Tic
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ddition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
�.L -- and 2-family dwelling Commercial/industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
`
y g ❑ ❑ Accessory buil
For special information use checklist.
ID Multi - family 0 Master builder 0 Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
J ""
Job site address: / `/ 6 . -- /a 6 � � �
Air conditioning n pump
(requires site plan shoo wing g placement) 14.00
City/State /ZIP: 77/ 0 /( y 1 Q 2� �/ ,/ Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Flue/vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace x 10.00
6 / f /7A c 6. L kerFirt(Ed E I ;kJ:. I s3 Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
PROPERTY OWNER ❑ TENANT Other: 10.00
Name: L y ti 6-- ,q , t7 L � 44 , J Environmental exhaust and ventilation
Address: 1/114 �/ Range hood/other kitchen
b equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
(� q Single -duct exhaust (bathrooms,
Phone: 7 t�3 ) 3) / - 33 st 7 , Fax: ( ) toilet compartments, utility rooms) 6.80
7 J ❑ APPLICANT + ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name: Other: 10.00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace
E -mail: Range
ONTRACTOR Barbecue
Business name: Clothes dryer (gas)
Other:
S
Address: 7 / j ,(/( t J MECHANICAL PERMIT FEES*
City/ State/ZIP: ( O� & 97a4. Subtotal
Minimum permit fee ($72.50)
Phone: %2 �f 7 �'
�. �) Fax: ( 775--76/i Plan review (25% of permit fee)
CCB lic.: )/ 7( f J State surcharge (12% of
/(O arg ( permit fee)
TOTAL PERMIT FEE 9 n
Authorized si a � . • . �� 0--- This permit application expires if a permit is not ob • within 180
L- days after it has been accepted as complete.
Print name: f` /O , Date: * Fee methodology set by Tri -County Building Industry Service Board
I:\ Building \Pernuts'MEC- PermitApp.doc 01 /19/07 440.4617T(I1/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
I: \ Building \Pennits\MEC- PennitApp.doc 01/19/07 2