Permit CITY OF TIGARD MECHANICAL PERMIT
111111 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00504
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/08/2011
Parcel: 2S104AB05000
Jurisdiction: Tigard
Site address: 13136 SW CHIMNEY RIDGE ST
Project: BASSETT Subdivision: MORNING HILL NO.4 Lot: 79
Project Description: Wood stove installation.
Contractor: FIRESIDE DISTRIBUTORS Owner: BASSETT, KEVIN S & JACKIE M
18389 SW BOONES FERRY RD 13136 SW CHIMNEY RIDGE ST
PORTLAND, OR 97224 TIGARD, OR 97223
PHONE: 503 - 684 -8535 PHONE:
FAX: 503 - 670 -7285
FEES
Specifics: Description Date Amount
Wood /Pellet Stove 11/08/2011 $33.39
Type of Use: SF 12% State Surcharge - Mechanical 1 110 8/2 01 1 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/08/2011 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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: - Signature: „r
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 ��j . H Oii OFFICE USE,ONLV
J ,�. Permit No !)' "t Tc��`
IN
City of Tigard �� �p ' N 'N
Date/By: y: / , inp /fir t i
13125 SW Hall Blvd., Tigard, OR 97223 �
0 Phone: 503.718.2439 Fax: 503.598.1960 �� Q� � Other Permit:
T I G A R D Inspection Line: 503.639 (S.. tit• te ReadyBy El See Page 2 for
Internet: www.tigard ^ � 0 �� �` No Supplemental Information
TYPE OF WORK �.) A5) � 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:
Air conditioning
Job site address: /3/36 560 Ll j r4�., v J .j t c .5 (requires site plan showing placement) 46.75
City /State /ZIP: �/ � � � / Furnace 100,000 BTU (ducts /vents) 46.75
/ -,-,„, »t' ,9 "7„a-.3
, 5 Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: 04s-see- 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
t' Gas fireplace 33.39
1 -. >fc•t.fin A but C / .(,il I,t/t CNI S /c ' -(. Flue vent for water heater or gas
f fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove I 33.39 33,
Wood fireplace /insert 23.32
Chimney /liner /flue /vent 23.32
DX PROPERTY OWNER ❑ TENANT
Other: 23.32
Name: k / W- I f- 0, 61 5 Environmental exhaust and ventilation:
Address: s Range hood/other kitchen
/3J3(� . (1 IC/Vls✓ �� c �l equipment 33.39
City/State /ZIP: �, C , at , 55-2.2.23 Clothes dryer exhaust 33.39
✓
fJ Single -duct exhaust (bathrooms,
Phone: (5113 ) e,,g --1 .2 ) 7 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
r "Lis /` j�,s l�i� t t E�,,,-f,e/L Clothes dryer (gas)
Business name: F !
Other:
Address: / '3 c, 5 - bc,l T V. HUL' y MECHANICAL PERMIT FEES*
City /State /ZIP: 'a,, t- L J,� y� Q,/_, c 7 70°3-- Subtotal 33,,3°1
P / /}` G Fax: ( ) Minimum permit fee ($90.00) y('), c )
hone: ( ) c✓ L!! �! Plan review (25% of permit fee)
CCB lie.: 1/6C.7 . 7 State surcharge (12% of permit fee) I/) 6
/ l TOTAL PERMIT FEE / j(). en
Authorized signature: �_� This permit application expires if a permit is not obtained within 0
, / e . � days after it has been accepted as complete.
Print name: r t ' )5 / Date: iV /) * Fee methodology set by Tri- County Building Industry Service Board
t.\ Building \Permits\MEC- PermitApp.doc 09/09/10 440 -4617T (11 /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.
L\ Buildin \Pennits \MEC- PermitApp.doc 09/09/10 2