Permit ,, CITY OF TIGARD MECHANICAL PERMIT
- COMMUNITY DEVELOPMENT Permit #: MEC2011 -00465
Date Issued: 10/21/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Parcel: 1S125DD03000
Jurisdiction: Tigard
Site address: 6805 SW VENTURA DR
Project: Schock Subdivision: WASHINGTON SQUARE ESTATES Lot: 21
Project Description: Install 35' of gas line for new cook top
Contractor: OWNER Owner: SCHOCK, CARL F & MICHELLE K
6805 SW VENTURA DR
TIGARD, OR 97223
PHONE PHONE: 503 - 245 -1396
FAX
FEES
Specifics: Description Date Amount
Fuel Piping 10/21/2011 $14 15
Type of Use: SF 12% State Surcharge - Mechanical 10/21/2011 $10 80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/21/2011 $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 ■ • 'cation - , -r Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a • • of the rules
or • ect questions to OU • by - i . e 503.232.1987 or 1 800.332 2344.
l.sued By: d !i .` Permittee Signature: .11
■
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 FO OFFICE USE ONLY
City of Tigard
14 Received /�r�� Date/By f! t Permit No �/C��/ Qo 0 " 13125 SW Hall Blvd , Tigard,OR 97223 Plan Review
• 7 , Phone: 503.718 2439 Fax: 503.598 1960 Other Permit:
DateBy
T1GARD
Inspection Line 503.639.4175 Date Ready/By. Juris 12I 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 ❑ 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 Ea Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Co � Air conditioning
Job site address: t a V L �� ,7 (requires site plan showing placement) 46 75
Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP: 7; ,,, t 9'7Z z 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: 7z t+c e. - C 7 7 1i � Duct work 23 32
Hydronic hot water system 23.32
re .t., ,t; c0. -/ 'N / e... L 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
/' r/ G fireplace 33.39
..16 / a. S �K .s... 17 ;9121( d� ' Flue vent for water heater or gas
/S J _ 1 e /'`� fireplace 23 32
!, y' I- 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: Environmental exhaust and ventilation:
Range hood /other kitchen
Address: rd s 4 /n equipment 33 39
City /State /ZIP: / �� � t�h 9 7AA 3 Clothes dryer exhaust 33 39
/
/ ( ► Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name:
Other 23 32
Fuel piping:
/
Contact name: / .4 S -c) G /
7k � O' 4 , ,A t, .(�. , d,,1 $14.15 for first four; $4.03 for each additional
X/a
Address: �CCC��� �� � //LI X �� r- r Furnace, etc
Gas heat pump
City /State /ZIP: - a , � � � � '''7,..,...2___3 Wall /suspended/unit heater
Phone: ( , 9 `2 y/a Fax: : ( ) Water heater
Fireplace
E -mail: i
Range
CONTRACTOR Barbecue
Business name: t 0 I ' � ChJ )\J (1 /2 Clothes dryer (gas)
j Other
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90 00)
Plan review (25% of permit fee)
CCB lie.: State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
�' Print name: f C SC/) ec) Date: /(0e- l * Fee methodology set by Tn- County Building Industry Service Board
7G
I \Bwlchneermits\MEC- PermitApp doe 09/09/10 440 -4617T (1 l /02/COM/WEB) /o0 L,1`
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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