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Permit
CITY OF TIGARD MECHANICAL PERMIT 111 1- . COMMUNITY DEVELOPMENT Permit #: MEC2011 -00509 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/10/2011 Parcel: 2S112CB06800 Jurisdiction: Tigard Site address: 15443 SW 81ST AVE Project: DeSellier Subdivision: ASHFORD OAKS NO.2 Lot: 82 Project Description: Range hood installation and gas piping for range and lot lighter. Contractor: A ABOVE ALL JOHN D PLUMBING Owner: DESELLIER, GRETCHEN G 7472 SW FIR STREET 15443 SW 81ST AVE TIGARD, OR 97223 TIGARD, OR 97224 PHONE: 503 - 620 -7600 PHONE: 503 - 684 -4078 FAX: 503 - 598 -9355 FEES Specifics: Description Date Amount Range Hood /Other Kitchen 11/10/2011 $33.39 Type of Use: SF Fuel Piping 11/10/2011 $14.15 Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/10/2011 $10.80 Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/10/2011 $42.46 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: i 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, . _ ._ _ , FOR OFFICE USE. ONLY _ _ _ _ __ City of Tigard � , ;c,-,‘ Received r 0 1 Date/By: • / J PermitNo.: 13125 SW Hall Blvd., Tigard, OR 97 A ® t- 1 Plan Review ` / � - t t I. Phone: 503.718.2439 Fax: 503.5981960 w \Q\I b Date /By: Other Permit: TI GAIiD Inspection Line: 503.639.4175 \\v' �1 ;�� 0• Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov �� °C. 0 \4 \ Notified/Method: Supplemental Information C` TYPE OF WORK V'''' COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction 0-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* ) 711 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: // T S� X n Air conditioning Job site address: /'5` / (requires site plan showing placement) 46.75 CCC JJJ Furnace 100,000 BTU (ducts /vents) 46.75 / `� City /State /ZIP: � /� c Q g_ g7 2 2 / 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: /, 9 Duct work 23.32 L./� �t; (LM _ IFC ' e D / / / Hydronic hot water system 23.32 J T M7 y g-C�/1 e (/ /�1 ,,,. 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 Gas fireplace 33.39 9 , 1 p h - FLY / t, / / 9 ir.It I/?itn/fj -C- av Jc..( Flue vent for water heater or gas ( J fireplace 23.32 e---.< k A. "` s -kV- /GJ�V �.�rri ' Log lighter (gas) 23.32 V Wood/pellet stove 33.39 Wood fireplace /insert 23.32 ❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent _ 23.32 Other 23.32 Name: Envii6nmental exhaust and ventilation: Address: Range hood /other kitchen 33. equipment / 33.39 J City /State /ZIP: Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT 'ERSON Attic /crawlspace fans 23.32 ' � _ / J Other: 23.32 Business name: Cd oJr _ �_Lbt�t J "Yv---- Fuel r rn P 11: 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 ` / II • 15 E -mail: Range I CONTRACTOR Barbecue Business name: /1 v e 4 V ) ©//I 4 A -, (7&?frg/-1,---- Clothes dryer (gas) Other: Address: 7 4_ 7 2 5 ,'t) R' (2 OF MECHANICAL PERMIT FEES* City /State /ZIP: T/ 0 ,o/ a/2_ 9722 3 Subtotal 1 1 - 7, Sy (Vf Minimum permit fee ($90.00) C( 0.00 Phone: C5/`,1" ) ') O 76'd 0 Fax: (9f1)) ' Ff 73 5.--- Plan review (25% of permit fee) CCB lie.: f ?6 7 State surcharge (12% of permit fee) i 0 ,,,F-C) TOTAL PERMIT FEE I LU, E% Authorized signature: This permit application expires if a permit is not obtained within 180 A days after it has been accepted as co mplete. Print name: .. j / 1 6 /i Date: * Fee methodology set by Tri- County Building Industry Service Board I:\Building\Permits\MEC- PermitApp.doc 09 /0 //110 440 -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. I:\ Building \Permits\MEC - PermitApp.doc 09/09/10 2