Permit CITY OF TIGARD MECHANICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00519
"CIGAR) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/17/2011
Parcel: 2S112BA05100
Jurisdiction: Tigard
Site address: 14385 SW 80TH PL
Project: MICHAEL Subdivision: WAVERLY MEADOWS Lot: 5
Project Description: Gas fireplace insert with venting and gas piping.
Contractor: EVERGREEN GAS INC. Owner: MICHAEL FAMILY TRUST
PO BOX 388 BY MICHAEL, RANDOLPH & PHYLLIS E TR
WEST LINN, OR 97068 14385 SW 80TH PL
TIGARD, OR 97224
PHONE: 503 - 407 -9542 PHONE:
FAX: 503 - 344 -6345
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 11/17/2011 $23.32
Type of Use: SF Chimney /Liner /Flue/Vent 11/17/2011 $33.39
Class of Work: ALT Type of Const: Fuel Piping 11/17/2011 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 11/17/2011 $10.80
Stories: Minimum Fee Adjustment - Mechanical 11/17/2011 $19.14
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 Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0090. You•.•y obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.801 - - • • .
Issued By: _ • - mittee Signature: , '/�
Call 503.639.4 - 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.
Mechan Permit Application FOR OFFICE List O,MLI'
City of Tigard Received // Ally
Permit No.:
q 13125 SW Hall Blvd., Tigard, OR Plan Review
��,
' 172 -
II ' Phone: 503.639.4171 Fax: 51 .5! l Q \\ D Other Permit:
T I G A K D Inspection Line: 503.639 " "E ' �O Date Ready/By: INI 6f1 See Page 2 for
Internet: www.tigard or.gov 1 ® Notified/Method: Supplemental Information
" TYPE OF WOO �'" �` COMMERCIAL FEE* SCHEDULE — USE CHECKLIST'
❑ New construction Addition/alte tab' replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
. CATEGORY OF,' CONSTRUCTION .' ' ' Value: $
\®c} -and 2-family dwelling RESIDENTIAL EQUIPMENT /°SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
JOBP SITE INFORMATION AND LOCATION Heating /cooling
Job site address: F Air conditioning or heat pump
I � i (requires site plan showing placement) 14.00
City /State /ZIP: - I j ota i ac--- Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: / ") i -c Gas heat pump 14.00
Cross street /directions to job site: ` Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
" DESCRIPTION OF WORK ' Water heater 10.00
ro f A A@- 0 / hit Sfil -� 6 4 S L ,� Gas fireplace g 10.00
(.`�AC`j It Flue vent for water heater or as
(- fireplace 10.00
V I 6/(17 vy Log lighter (gas) 10.00
// Wood /pellet stove 10.00
Wood fireplace /insert f } . 0 � � a3,`",�
PROPERTY OWNER ❑ TENANT Chimney /liner /flue/vent I �.VV �j. 31
Other: 1 10.00
Name: f7 ���`� t-G �r� j,�/� i ( 1, ea _1 - Environmental exhaust and ventilation
r l v° 0 `
Address: ��j fl j Range hood/other kitchen
6 \ �/� y (� equipment 10.00
City/State/ZIP: 4 c r Clothes dryer exhaust 10.00
y I t� z i` , -� 4 ! 7' 7 1 Single -duct exhaust (bathrooms,
Phone: (56)) ( 7 i' — l 3. Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name: Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace I 1
E -mail:
Range
.- , 4 — . ' - : _ . - . - `. . -, ..:CONTRACTOR .. - -- - _ v. s Barbecue
Business name: iv( (4 rL Bv. s i Clothes dryer (gas)
Address: ?3 V jai k 3 _ MECHANICAL PERMIT FEES* . '
City /State /ZIP: (1 �s N C . VI A .D 5706 g Subtotal
Phone: (5 ) 1 f 7_ . 5 - c-/z_ Fax: (...i 5) ,./../t/..63 G S Minimum permit fee ( fee ((�(/, )
Plan review (25% of fee) )
CCB lie.: / ' 66l i State surcharge 8° rm
eit fee) 0. j
( TOTAL PERMIT FE id) I.
Authorized signature: '
' This permit application expires if a permit is not ob 'tied withir'I80
1 days after it has been accepted as complete.
Print name: I 1 i �� L1 t� e Date: 1 j f [7 " • Fee methodology set by Tri- County Building Industry Service Board
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... —to
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
.Total Valuation: Permit , - ,
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
•
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
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