Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00399
•
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/08/2011
Parcel: 1 S125DA07800
Jurisdiction: Tigard
Site address: 9185 SW 69TH AVE
Project: BROWN Subdivision: KINGS VIEW Lot: 75
Project Description: Installing gas insert with venting and fuel piping.
Contractor: EVERGREEN GAS INC. Owner: BROWN, REBECCA E
PO BOX 388 9185 SW 69TH AVE
WEST LINN, OR 97068 PORTLAND, OR 97223
PHONE: 503 - 407 -9542 PHONE:
FAX: 503 - 344 -6345
FEES
Specifics: Description Date Amount
Gas Fireplace 09/08/2011 $33.39
Type of Use: SF Chimney /Liner /FlueNent 09/08/2011 $33.39
Class of Work: ALT Type of Const: Fuel Piping 09/08/2011 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 09/08/2011 $10.80
Stories: Minimum Fee Adjustment - Mechanical 09/08/2011 $9.07
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: - Permittee Signature:
Call 503.• '.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
Receive
lig City of Tigard 1 i1� ! Permit No.: la % — o Q 25 y:
Plan Review - / � t
'I 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.19i bate/By: Other Permit:
-
Ins ection Line: 503.639.4175 v $
TIGARD p Q c.1,3", l ► ateReady/By: See Page 2 for
G
Internet: www.tigard- or.gov J° �c` _ `�S S Notified/Method: ary - Supplemental Information
sk' TYPE OF WORK ... i'l- COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
'+y Mechanical permit fees* are based on the value of the work
❑ New construction l� i
tddition/alteration/re '. cement 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*
and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION .AND LOCATION Heating/cooling:
/ ( Air conditioning
Job site address: c"-- C (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP: —/-77 ' 49-( 49-( / 4 7 7z_3 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:
//,, fr7 / DESCRIPTION OF WORK Water heater 23.32
j I Sv' - ' i S / P15 e-,--1"-- Gas fireplace vent o g as
1 33.39
P
�lf�e� iif�� D Flue vent for water heater or
r '4.. L/ ..-,.a_____ . fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
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� OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
J Other: 23.32
Name: /t,, cc. 4 _ g (-a , Environmental exhaust and ventilation:
5- 6w 6 9 -' ' Range hood/other kitchen
Address:
,>,e,.3 equipment 33.39
City /State /ZIP: `q,r -,_So Q� 5 7 oz. 3 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: Ll J 5 -" 3 S(�.v 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 t
E -mail: Range
CONTRACTOR Barbecue
Business name: �� r'� �� � ?�4`J' ��
Clothes dryer (gas)
Other:
Address: To .z — 3 ' Q MECHANICAL PERMIT FEES*
City /State /ZIP: 5 j j ` (6 Subtotal
Minimum permit fee ($90.00) qd q Li 1-.. 8 r ? 7 (� �j 00 Phone: (�;: 9Q 7 - / z__ Fax: 57) 3q'1'�3 %� (25% r
Y Plan review (25 /o of permit fee)
CCB lie.: / S8 P,` 3 ( State surcharge (12% of permit fee) 10.
II TOTAL PERMIT FEE /00, p`-0
Authorized signature: This permit application expires if a permit is notobtained within t80
g ([ l ((�//j,/j I le tjl. days after it has been accepted as complete.
�j * Fee methodology set by Tri- County Building Industry Service Board
J Print name: Date: .
1:\Building\Permits\MEC- PermitApp.doc 09/09/10 4 0-461 (I 1/02 /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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