Permit CITY OF TIGARD MECHANICAL PERMIT
- < COMMUNITY DEVELOPMENT Permit# MEC2011 -00483
Date Issued 10/28/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S104AD00900
Jurisdiction Tigard
Site address 12790 SW MARIE CT
Project Barmettler Subdivision BELLWOOD Lot 6
Project Description Install gas piping for gas range
Contractor HOLMES INSTALLATION SERVICE Owner BARMETTLER, KEVIN P & MARY C
33535 NW VADIS RD 12790 SW MARIE CT
CORNELIUS, OR 97005 TIGARD, OR 97223
PHONE 503 - 647 -9320 PHONE 503 - 579 -6461
FAX
FEES
Specifics Description Date Amount
Fuel Piping 10/28/2011 $14 15
Type of Use SF 12% State Surcharge - Mechanical 10/28/2011 $10 80
Class of Work ALT Type of Const Minimum Fee Adjustment - Mechanical 10/28/2011 S75 85
Occupancy Grp
Stories
Fuel
Fuel Types Natural Gas
Gas Pressure
Total $10080
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 Pp__
UNVtC&4_3_'
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 Applicatit aEnri; ✓; ..-
- FOR OFFICE ISE ONLY
City 8 d i- 1 j I Received 4
t3 of Tigard Date /By /4 zie /, train enmtNod7 I -QDyf3
liq
° 13125 SW Flail Blvd, Tigard, OR 97223 O 2S 11 Plan Review v
Phone 503 718 2439 Fax 503 598 1960 2 t1
Date/By Other Permit
T i GA Inspection Line 503 639 4175 r Date Ready/By inns ® See Page 2 for
Internet www tigard -or goy CITY OF TIGAi�L; Notified/Method Tu.- Supplemental Information
BUILDING DI ViS101
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
, Mechanical permit tees' are based on the value of the work
El New New construction - Addition/alteration /replacement performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition It Other mechanical materials, equipment, labor, overhead, and profit
Value $
CATEGORY OF CONSTRUCTION RESIDENTIAL, EQUIPMENT / SYSTEMS FEES*
l- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist
❑ Multi-family ❑ Master builder El Other Description I Qty F La Total
JOB SITE INFORMATION AND LOCATION _ I tea hnPJcouhnp:
Air conditioning
Job site address 1Z 7 1 0 5-,J uJ tin oIT • \ .2, (requires site plan showing placement) 46 75
,,(� Furnace 100,000 BTU (dums/sents) 46 75
City/Staler/1P ///
�\5 �0( 0 y v' Furnace 100,000+ B FU (ductshents) 5491
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
Hydronlc 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 2332
i ., t � T � U � k i r „ A /) Gas fireplace 3339
t / 1 "0 /i* C Flue vent for water heater or gas
fireplace 23 32
I og lighter (gas) 23 32
Wood/pellet stove _ 33 39
Wood fireplace/insert 23 32
PROPERTY OWNER ❑TENANT Chimney /hoer /Flue /vent 23 32
Other 23 32
Name ' Er/ /I N Sf M A R y RA Rh - r -)'�t_ R Environmental exhaust and ventilation •
a G S I.1/ Range hood/other kitchen
Address
7 9 ill {� t I^ C I equipment 33 39
City/State/ZIP TIGARh o R 77,n3 Clothes dryer exhaust 33 39
Single -duct exhaust (bathrooms,
Phone (5c.#1) 577.- 6y6/ 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 ( ) 1 Fax ( ) Water heater
Fireplace
E-mail Range (\`/•
CONTRACTOR Barbecue
Business name b �c� Ns (G ( ( Clothes dryer (gas)
Other
7
^` S "tj14
Address � \ I MECHANICAL PERMIT FEES`
City/State/ /"LIP C 3 f1 x (Ae L •r 1 -e_ 9 7 (( Subtotal
Phone (cw ) b1 75 7L/ Fax ( ) Minimum permit fee ($9000)
--7 Plan review (25% of permit fee)
CCB he (0 2 4 f / \ Authorized State surcharge (12% of permit fee)
'TOTAL PERMIT FEE /do „Pa
AuthO[Cd SI 81ure This permit application e xpires if a permit is not obtained within 180
/ This
/' in days after it has been accepted as complete.
Print name O/ i ( Q eV) Date I • Fee methodology set by Tn- County Building Industry Service Board
I \Bmldmg\permits\MEC -P iiApp doe 09 /09/10 440 -4617T /COM/WFB)
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.
I \BuddingWermits\ EC- PemiltApp doc 09/09/10 2