Permit CITY OF TIGARD MECHANICAL PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00339
TI GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/19/2011
. Parcel: 2S103DA03201
Jurisdiction: Tigard
Site address: 10625 SW PARK ST
Project: Winters Subdivision: Lot:
Project Description: Installatio of gas line for outdoor bar- b -que.
Contractor: OWNER Owner: WINTERS, GERRY L
10625 SW PARK ST
TIGARD, OR 97223
PHONE PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 07/19/2011 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 07/19/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/19/2011 $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 Notifi - - •er. 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 . estions to OU . by cal '4g 503.232.1987 or 1.800.332.2344.
Issued By: I / eA.LI 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
City of Tigard
Date/By: Permit No.:
y:
' I 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review .
M Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
T I G A R D Inspection Line: 503.639 D ate R ea d y /B y: 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 Kt 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. Total
JOB SITE INFORMATION AND LOCATION Heating cooling:
Air conditioning
Job site address: tcs ba s W ?„v, VZ 4 _ (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP: �g� - 1 O(� �` �� ( )
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: > J o ex:s.s \�i° ,.,,. P®-�� t 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
l R � � Gas firepla 33.39
L 0.A
c� . � Cl\r..c'v.,. \ \� �— �s \ Flue vent for water heater or gas
1 fireplace 23.32
� ` ��� Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
■
A PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: C.. -. . N .„ ...\ `�.,e:c5 Environmental exhaust and ventilation:
Address: 1 C5 va s l z ` Range hood /other kitchen
O- equipment 33.39
City /State /ZIP: G-A �� ` '\'"lSa '3 Clothes dryer exhaust 33.39
S l Single -duct exhaust (bathrooms,
r
Phone: ( ) v j , 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:
Range
CONTRACTOR Barbecue /
Business name: `,
060(0 Business Clothes dryer (gas)
v
Other:
Address: MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal Q C
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) / V ' _
�
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) /0-
TOTAL PERMIT FEE IX OQ
Authorized signature: 1� .r This permit application expires if a permit is not obtained within 180
16, Iv � days after it has been accepted as complete.
Print name: " ,� ' l �� Date:' 2 Ct \\.. * 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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