Permit t. r� CITY OF TIGARD MECHANICAL PERMIT
` ! " COMMUNITY DEVELOPMENT Permit #: MEC2009-00255
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.639.4171 Date Issued: 06/02/2009
;,„ Parcel: 2S114BA14000
Jurisdiction: Tigard
Site address: 16250 SW COPPER CREEK DR
Subdivision: Lot: 0
Project: Carpenter
Project Description: Install tankless water heater
Owner: FEES
CARPENTER, CAROL J TRUSTEE Description Date Amount
16250 SW COPPER CREEK DR Water Heater 06/02/2009 $10 00
TIGARD, OR 97224 12% State Surcharge - Mechanical 06/02/2009 $8 70
PHONE Minimum Fee Adjustment - Mechanical 06/02/2009 $62.50
Contractor:
NICHOLS PLUMBING
PO BOX 68551, 4375 SE MARK KELLY COURT
MILWAUKIE, OR 97268
PHONE 503 - 653 -2069
FAX• 503 - 513 -6402
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_issuedd subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
app' • . Ib a law All work will be de e - in accordance with approved plans This permit will expire if work is not started within 180 days of
.suance, or if work is susp -r fo me - - 180 days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center hese ru- - -re set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
Issued By( �` /_ /. d � / , Permittee Signature: _ �� , J �� ".
mss' —
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.
r Mechanical Permit Application ° } ° .FORAFFICE USE ONLY . '
City of Z'lgai'd (1 Date/By Received &flo % Permit No c � / •∎ 9 /oa�
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
e�J
t ' Phone 503.639 4171 Fax 503 598 1960 Date/By Other Permit
T I GARD Inspection Line. 503 639 4175 Date Ready /By ® See Page 2 for
Internet www tigard -or gov Notified/Method Supplemental Information
. , TYPE O F WORK ` .,. - _ ' - - COMMERCIAL FEE* SCHEDULE - USE.CHECKLIST.
❑ 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 - .,v ^ ' '� - . . , Value $
RESIDENTIAL EQUIPMENT /SYSTEMS SYSTEMS FEES *'
''.--------❑ I - 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 LO_ CATI Heating/cooling
Job site address: A i� Q,� ��
Air conditioning or heat pump
�" (requires site plan showing placement) 14 00
City /State /Z ': T � 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
Subdivision: Lot no.: Flue /vent for any of above 6 80
Other 10 00
Tax map /parcel no.: Other fuel appliances
' DESCRIPTION OF WORK, Water heater 10 00
Gas fireplace 10 00
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
PROPE$TI, OR ., ID TENANT,'
( Other ] 0 00
�' \\
Name: 0 G Q V Environmental exhaust and ventilation
Address: Range hood /other kitchen
equipment 10 00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6 80
. ° w':. ; ; 4 ❑ .APPLICANT ° ', ' ' ' El' ;CONTACT PERSON ' . -: � : " - Atti / p ace fans 10 00
Other 1600
Business name:
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: ( ) Fax:: ( )
Water heater
Fireplace
E - mail: Range
Barbecue
Clothes dryer (gas)
Business name: V Other
Address: . MECHANICAL PERMIT FEES* `
City /State /ZIP: `� Subtotal
Phone ��
) f �o \4 Fax: V i " 9 \� -- I0� U 19" Minimum permit fee ($72 50) 7A' Sr)
Plan review (25% of permit fee) -e
CCB lie.: \ State surcharge (12% of permit fee) i' . 7O
TOTAL PERMIT FEE V •
This permit application expires if a permit is not obtained within 180
Authorized signatur:
11 �ii,,,� days after it has been accepted as complete.
Print name: i scie mat, VA� Date: • * Fee methodology set by Tn- County Building Industry Service Board
I \Buddmg\Permns\MEC- PermitApp doe 01/19/07 440 -46 7T (11/02/ OM/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 \Budding \Permits \MEC- PermitApp doc 01/19/07 2