Permit a CITY OF TIGARD MECHANICAL PERMIT
N 2 , . . COMMUNITY DEVELOPMENT Permit #: MEC2009 -00601
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/10/2009
TIGARD Parcel: 25111 DB01700
Jurisdiction: Tigard
Site address: 15520 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8 Lot: 445
Project: Hess
Project Description: Install new gas fireplace and run gas line to (2) other fixtures.
Owner: FEES
HESS, KEN Description Date Amount
15520 SW ALDERBROOK CIRCLE •
TIGARD, OR 97224 Gas Fireplace 11/10/2009 $33.39
Fuel Piping 11/10/2009 $14.15
PHONE: 12% State Surcharge - Mechanical 11/10/2009 $10.80
Minimum Fee Adjustment - Mechanical 11/10/2009 $42.46
Contractor:
SEYLE'S PLUMBING
PO BOX 2116
LAKE OSWEGO, OR 97035
PHONE: 503 - 209 -2594
FAX:
•
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: sC3■n 8 k n � ` Permittee Signature: 1 V
l ' `�C 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.
Mechanical Permit A lication FOR OFFICE USE ONLY
City of Tigard ECEIVED Date/By: IA Permit No:
" 13125 SW Hall Blvd., Tigard, OR 97223 ' i 00q, • • ' 1
14 Z ` Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
1 Date/By:
Other Permit:
T I G A R D Inspection Line: 503.639 CI Date Ready /By: 1131 See Page 2 for
Supplemental www.tigard or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPE OF #UMDING DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
111 New construction ' Addition/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: $
tk 1- and 2- family dwelling 1=1 Commercial /industrial 111 Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
Multi- family ❑Master builder ❑Other: For special information use checklist.
Description I Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning
Job site address: I S 520 SNel Aux-ez<tz»' C t eLc_-e - (requires site plan showing placement) 46.75
City /State /ZIP: I 1 6 Ai , p ot_ 9 - 7 ZZy Furnace 100,000 BTU (ducts /vents) 46.75
Fumace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: 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
Flue /vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
" Gas fireplace 1 33.39 33, 39
1J ST A LL /-J / 6,€) /'Z / Flue vent for water heater or gas
W TO (z) .- � _ fireplace 23.32
I Aim 6 6 s I r X Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney /liner /flue /vent 23.32
`PROPERTY OWNER ❑ TENANT Other: 23.32
Name: KpN- A. S Environmental exhaust and ventilation
— Range kitchen
_Address: I ( q / RAI Nl e0 VI 260e * C 1 I 5 — equipment 33.39
City /State /ZIP: L.14 1 rI6 5 701\ 5 i 01\5 Tt?>< A S - 773 11 Clothes dryer exhaust 33.39
/ Single -duct exhaust (bathrooms,
Phone: ( 7s-€ - S6 Z, Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name:
Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Furnace, etc.
Address:
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace A
E -mail: Range i l q, )5
CONTRACTOR Barbecue
Business name: �' �.E RC, J 11 6164 Clothes dryer (gas)
' Other:
Address: ea ,so z,1 C, MECHANICAL PERMIT FEES*
City /State /ZIP: LAt4 c t — 0 S klelb tat . e ll 035 Subtotal
/ Minimum permit fee ($90.00) q 0.0G
Phone: (913 ) Zvi _ ZST (I Fax: 5 ) 67S-- 0gg5- Plan review (25% of permit fee)
CCB lie.: I Z ($ ( IAA 5 .1 G — 7• t• it State surcharge (12% of permit fee) . go
VS `� TOTAL PERMIT FEE 100.180 c � Authorized signature: n This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: -i— 4. , - 1 / t. , t " Date: 11 . en . 01 * Fee methodology set by Tti- County Building Industry Service Board
I:\Building\Permits\MEC- PermitApp.doc 10/01/09 440 -46t7T (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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