Permit 7 1 ' CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00564
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/07/2011
Parcel: 25111 CC01300
Jurisdiction: Tigard
Site address: 10195 SW CENTURY OAK DR
Project: Lockyear Subdivision: SUMMERFIELD Lot: 10
Project Description: Install gas fireplace insert and venting.
Contractor: EVERGREEN GAS INC. Owner: LOCKYEAR, NORMA
PO BOX 388 10195 SW CENTURY OAK DR
WEST LINN, OR 97068 TIGARD, OR 97224
PHONE: 503 - 407 -9542
PHONE: 503 - 443 -4160
FAX: 503 - 344 -6345
FEES
Specifics: Description Date Amount
Gas Fireplace 12/07/2011 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 12/07/2011 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: 12% State Surcharge - Mechanical 12/07/2011 $10.80
Stories: Minimum Fee Adjustment - Mechanical 12/07/2011 $33.29
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
issuan =, . i wo suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
U Notification Center. Those ules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules
.r direct questions to OUNC b - in. 503 32.1987 or 1.800.332.2344.
Y
Issued By: , Permittee Signature: I IA/4
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 OFFI USE ONLY
• City of Tigard Received ip Date /By: /A 7 // AM Permit No.: Pee � I i�XD A
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date /By: Other Permit:
T I GA R D Inspection Line: 503.639 Date Ready/By: Juris. Ei See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction S ddition/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.
C ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: /9 / i 5 ° e�J t. f , f7 , b . k t >Z (requires site plan showing placement) 46.75
City /State /ZIP: �- D Furnace 100,000 BTU (ducts /vents) 46.75
/ 1 `,' `. ` 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
.c1-1-1... 1 ` I ( '- " 3 / S Q-2� t- tl e--, l Gas fireplace for 1I 33.39
y J�'r -, Flue vent for water heater or gas r
fireplace • 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
LL� Other: 23.32
Name: Nor-v_ f,, 4 � '_l`e4 Environmental exhaust and ventilation:
Address: 1 t'� / �7 ..5 / C—e ,, 0 'VI( (e.-- - Range hood /other kitchen
equipment 33.39
City /State /ZIP: PQ 49(1---- Clothes dryer exhaust 33.39
L Fax: Single -duct exhaust (bathrooms,
Phone:
CSJ3) ' /�3 Y)d ( ) 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
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: .4-t) �e.e 61 s � L Clothes dryer (gas)
Other:
Address: 7 .) ,‘::.) ` -r g MECHANICAL PERMIT FEES*
City /State /ZIP: c L t y ,� h G Subtotal
Phone: (�i ) L r G Fax: ( ) Minimum permit fee ($90.00) q o
3 1� Plan review (25% of permit fee) *------"
CCB lic.: / 1 5 - i 9, o - / State surcharge (12% of permit fee) f 0 ' O \
TOTAL PERMIT FEE XU
Authorized signature: 61.....,e/-1_- This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: C `]v C '. 1 l i 4, e ,.... Date: /� �/l ( * Fee methodology set by Tri- County Building Industry Service Board
C\ 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.
1: \ Buildin g \Permits \MEC- PermitApp.doc 09/09/10 2