Permit CITY OF TIGARD MECHANICAL PERMIT
•
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00538
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/29/2011
Parcel: 2S 103CA00603
Jurisdiction: Tigard
Site address: 13400 SW 121ST AVE
Project: PETITT Subdivision: WOODCREST Lot: 11
Project Description: Gas fireplace insert with gas piping.
Contractor: GASPRO INC Owner: PETITT, THOMAS J & ERIN D
7603 SE LOUNSBERRY LN 13400 SW 121ST AVE
PORTLAND, OR 972056 TIGARD, OR 97223
PHONE: 503 - 775 -7020 PHONE:
FAX: 503 - 775 -7019
FEES
Specifics: Description Date Amount
Gas Fireplace 11/29/2011 $33.39
Type of Use: SF Fuel Piping 11/29/2011 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/29/2011 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/29/2011 $42.46
Stories:
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 r -s adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -00 1090. Y . 0. ain a c.py of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: , mittee Signature: I L_
Call 503.639.41700 a.m. for the next available insp-ction 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 �� Received DDate/By: , d 'i P No.: G r i' —0,3 ) 3_
�
v 13125 SW Hall Blvd., Tigard, !I ' 2 Plan Review
Phone: 503.718.2439 Fax: 51.:, '60 01, Date/By: Other Permit:
TI G A R D Inspection Line: 503.639 q 9 Date Ready/By: ® See Page 2 for
Internet: www.tigard- or.gov 'IC\� , ��G 0� Notified/Meted /Met hod: II Supplemental Information
TYPE OFC,'
m •
'„ + � COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
` Mechanical permit fees* are based on the value of the work
❑ New construction . Addition/a D kte ation /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*
A 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: [ J / S 4 vZ / (requires site plan showing placement) 46.75
/State /ZIP: Furnace 100,000 BTU (ducts /vents) 46.75
Cit
y 7i 0 , 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: 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
c Gas fireplace i 33.39 33.3°(
i t/ , J i / Flue vent for water heater or gas
fireplace 23.32
I .-- ' 4
II Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood /other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT I/ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: ardriellariMMIII F uel r piping: 23.32
Contact name: / t^ /, - e ) $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 I / i 5
E -mail: i % °� '• r 1I . ' O �i Range
CONTRACTOR Barbecue
Business name: ft5 Clothes dryer (gas)
` Other:
Address: a-' f L 4 MECHANICAL PERMIT'FEES*
City /State /ZIP: / V 'k q 2 a 6, Subtotal
Phone: ( ) S - 7�� O Fax: ( ) Minimum permit fee ($90.00) 70,00
Plan review (25% of permit fee)
CCB lic.: (, State surcharge (12% of permit fee) I 0 _
• '_.— TOTAL PERMIT FEE l 6 0 , $- )
_ This permit application expires if a permit is not obtained within 180
Authorized signs re:
� r � days after it has been accepted as complete.
Print name: L / Date * Fee methodology set by Tri- County Building Industry Service Board
I \BuildingWermits\MEC- PermitApp doc 09/09/10 440 -46i7T ' i /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