Permit CITY OF TIGARD MECHANICAL PERMIT
rr COMMUNITY DEVELOPMENT Permit# MEC2011 -00467
Date Issued 10/25/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 parcel 2S112CA06800
Jurisdiction Tigard
Site address 15374 SW THURSTON LN
Project Dana Subdivision ASHFORD OAKS Lot 22
Project Description Add gasline for new gas insert, new dryer vent and new range hood
Contractor GIBB CONSTRUCTION & REMODELING INC Owner DANA, MARC R & KRISTEN L
15755 SW SERENA WAY 15374 SW THURSTON LN
TIGARD, OR 97224 TIGARD, OR 97224
PHONE 503- 407 -9686 PHONE
FAX 503 - 549 -8986
FEES
Specifics Description Date Amount
Gas Fireplace 10/25/2011 $33 39
Type of Use SF Range Hood /Other Kitchen 10/25/2011 533 39
Class of Work ALT Type of Const Clothes Dryer Exhaust 10/25/2011 $33 39
Occupancy Grp Fuel Piping 10/25/2011 $14 15
Stories 12% State Surcharge - Mechanical 10/25/2011 $13 72
Fuel
Fuel Types Natural Gas
Gas Pressure
Total $128 04
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
issue or i - • is suspended for more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Uti Notification Cen - Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0090 You may obtain a copy of the rules
direct questions to OUNt b al g 13 232 1987 or 1 800 332 2344
Issued By — / 44 ./ 1 r Permittee Signature
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" ma OFFICE USE ONLY
City of Tigard OCT 2 5 2011 Received Sr e/ q _1� / 7
Re eive /� 1 Permit No ( af0 U7
q 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
I S Phone 503 718 2439 Fax 503 598 1960 ciTY OF T IGP`i�D Plate/By Other Permit
TIGARO Inspection Line 503 639 4175 BUILDING DNlS Date Ready/By lams El See Page 2 for
Internet www tigard - 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 El Other mechanical materials, equipment, labor, overhead, and profit
Value $
CA 1'EGORY 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 Heahnpfeonhng:
Air conditioning
Job site address ( 3 S v — F - L „,. 1E (requires site plan showing placement) 46 75
Furnace 100,000 BTU (ducts/vents) 46 75
City /State /ZIP .R x/4(1.0 a.A, , al, 1 ZZ* Furnace 100,000+ B1 U (ducts /vents) 54 91
Suite/bldg /apt no Project name — I teat pump
(requires site plan showing placement) 61 06
Cross street/directions to job site Duct work 23 32
Hydronic hot water system 23 32
1/4Q_1 %tA - t { e l. 1 3 , 1) 07 Residential boiler (radiator or
hydronm) 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 2332
Gas fireplace i 33 39 .45. 3 7
A • f 7 9 6— 'c -t-f'E l erects (ifs est Flue vent for water heater or gas
/JEi - sr t4'V,, OM-1 4/ -?P-- I $Jt fireplace 2332
Log lighter (gas) 23 32
Wood /pellet stove 33 39
Wood firepiace/msert 23 32
❑ PROPERTY OWNER El TENANT Chimney /hoer / ue /vein 23 32
Other 23 32
Name Environmental exhaust and ventilation.
Address Range hood /other kitchen
equipment I 33 39 33.3
City /State /ZIP Clothes dryer exhaust I 33 39 33 •3
Single -duct exhaust (bathrooms,
Phone ( ) Fax ( ) toilet compartments, utility rooms) 23 32
0 APPLICANT IS CONTACT PERSON Anic /crawlspace fans 23 32
(�( P3,r5 6,.,,,„, 5 Other 23 32
Business name
(/h4xi( s•J / � - 'h°�Zfv/ , free Fuel mow:
T P P g:
Contact name / en a B $14 15 for first four; $4.03 for each additional
Address /n s-5-- S Oe/y+��'r a ¢ G r • Furnace, etc
Gas heat pump
City /State /ZIP Ty &a p, pa - 172-4-1 Wall /suspended/unit heater
Phone ( '-01 et g( Fax ( ) Water heater
Fireplace / / P
E-mail Range
CONTRACTOR Barbecue
Business name (...;a5 15 (pit✓(2Qn4 4 4 7) ,15D e4 .41) /'r '. Clothes dryer (gas)
-
Other
Address / i 7 (f5— S r -, ) ( pnerv4 c r_ MECHANICAL PERMIT FEES*
City /State /ZIP 7 dr4 -0-Q oil -- 972'2Tr.4 Subtotal /J
Minimum permit fee ($90 00)
Phone (17)3 11 0 - 7 _, - q ( Fax ( ) Plan review (25% of permit fee)
CCB he /gam o tee 5 State surcharge (12% of permit fee) /5.7
TOTAL PERMIT FEE 7
Authorized signature ---- 1 . This permit application expires if a permit is not obtained within ISO
�• /�' days after it has been accepted as complete
Print name / Ai £ , ( (. . a Date / 7 I ( " Fee methodology set by Tri- County Building Industry Service Board
I \Building\PermitsU4GPermiiApp dcc 09 /09/10 440 -4617T (I I COM/wLE)
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 theieof
Note: All new commercial buildings require 2 sets of plans.
I \ Budding \PeuIDts\MEC- PermtApp doc 09/09/10 2