Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00422
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/21/2011
Parcel: 1 S134ACO5400
Jurisdiction: Tigard
Site address: 10932 SW GENEVA ST
Project: Wolf Subdivision: HART'S LANDING Lot: 25
Project Description: Replacing gas fireplace.
Contractor: EVERGREEN GAS INC. Owner: WOLF, JASON /HEATHER
PO BOX 388 10932 SW GENEVA ST
WEST LINN, OR 97068 TIGARD, OR 97223
PHONE 503- 407 -9542 PHONE:
FAX 503 - 344 -6345
FEES
Specifics: Description Date Amount
Gas Fireplace 09/21/2011 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 09/21/2011 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: 12% State Surcharge - Mechanical 09/21/2011 $10.80
Stories: Minimum Fee Adjustment - Mechanical 09/21/2011 $33 29
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• � — / . i r ittee- Sig nature:
Call 503.639. :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 04‘)4C) Received
Date/13y. 4(f %�17 Permit No . .`/ 1 _ + 012.
' 1 13125 SW Hall Blvd., Tigard, OR 97223
a Phone: 503.718.2439 Fax: 503 598.1960 Plan Review Other Permit
TIGARD Inspection Line: 503 639 4175 � .. DateBy
D ate Ready /By Jun ® See Page 2 for
Internet. www tigard -or gov 1 Notified/Method' Trc Supplemental Information
TYPE OF WOR 4c)% COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction dition/alteration/ eaent 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*
--g 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
Multi family 0 Master builder 0 Other: Description Qty Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: /09,32_ ,,) G( e 0 e 4- ,�' (requires site plan showing placement) 46.75
9 Furnace 100,000 BTU (ducts /vents) 46 75
City /State /ZIP: �`' (• / •7 7 7 3 Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: / Project name: w01 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
Gas fireplace I 33.39 33 .,9
'1 54-4- 41 2-C.ro C leA-r4 --te e 41.- _ Flue vent for water heater or gas
fireplace / 23.32 12-3
f I ce (e f 1: .-- Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
[PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: .t. 1 L4 / F Environmental exhaust and ventilation:
ve�S _ Range hood/other kitchen
t`)
Address: f J 3 - z___ 6 1..._,) 6-e v 1 e v •.e equipment 33.39
City/State/ZIP: 1 c• , 7-_J 6 5 7 2 t j Clothes dryer exhaust 33 39
Single -duct exhaust (bathrooms,
Phone: Sj i 3) 4, 7 0 -- / 5.5 ( 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: 6 / ;�Le —' - GAS ,Z7-'(e--- Clothes dryer (gas)
VVV Other:
Address: �G 0 , 3 °p 3 MECHANICAL PERMIT FEES*
City /State /ZIP: 1/3C54 G„ _ A--2. 76 4 c2 Subtotal ,")!
t J _5 Z Fax: ( ) Minimum permit fee ($90.00) q0 ., c o
Phone: (5/3) / 7 Plan review (25% of permit fee)
CCB lie.: . / S 9 0 3 I State surcharge (12% of permit fee) (() F6
TOTAL PERMIT FEE /WIU.p)
• This permit application expires if a permit is not obtained within 180
i
Authorized signature: / / / � ` . days after it has been accepted as complete.
Print name: Vt j I ) i cc !A g / U` _ Date: 9 ze t`( * Fee methodology set by Tri- County Building Industry Service Board
I \Buildmg\Permits\MEC- PermiiApp doe 09/09/10 id
440 -4617T I l /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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