Permit •
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00002
Date Issued: 01/05/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S134DB01700
Jurisdiction: Tigard
Site address: 11200 SW 115TH AVE
Project: Hufford Subdivision: WINTERS ADDITION Lot: 6
Project Description: Install tankless water heater with associated gas line and venting.
Contractor: STAN THE HOT WATER MAN Owner: HUFFORD, ARLY R & ANNETTE J
PO BOX 33157 11200 SW 115TH AVE
PORTLAND, OR 97292 TIGARD, OR 97223
PHONE: 503 - 760 -2992 PHONE:
FAX: 503 - 761 -0159
FEES
Specifics: Description Date Amount
Water Heater 01/05/2012 $23.32
Type of Use: SF Chimney /Liner /FlueNent 01/05/2012 $33.39
Class of Work: ALT Type of Const: Fuel Piping 01/05/2012 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 01/05/2012 $10.80
Stories: Minimum Fee Adjustment - Mechanical 01/05/2012 $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
issuan • i •. • is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uti • Notification Cente . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the r les
o direct questions to OUNC • c- ` g • • '2.1987 or 1.800.332.2344.
I .ued By: � Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspe . .n
This permit card shall be kept in a conspicuous place on the job site it completion of the project:
Approved plans are required on the job site at the time of each inspection.
ci
Mechanical Permit Applicat;i i FOR OFFICE USE ONLY
R eceived �/
City of Tigard DateBy: Aram"
Permit No.: / ee g n
1,
Jrvti/1
v 13125 SW Hall Blvd., Tigard,OR 97223- vt ar'�UC��
2 JAN Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit.
® C
2012 Date/By: - T1 G A R D Inspection Line: 503.639.4175 J Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard- or.goV CITY O F TIGIA. iDp� Notified/Method: Supplemental Information
TYPE OF
WI RING DIrVISION 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*
lg 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 t Z v 5j 1 ! Ains- (requires site plan showing placement) 46.75
City /State /ZIP: r.a-n.� 9/1, 9772-2.3 Furnace 100,000 BTU (ducts /vents) 46.75
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
Gas fireplace 33.39
j N 5 -7 k4- es 's Ci✓)47 46;s4 7 ZVL- Flue vent for water heater or gas
c`o * i N� A414/ � Y t � , K n (JAI �. fireplace 23.32
ili
'J JT77 't>►� 1� /y Log lighter (gas) 23.32
A[&v�' ,sj7 S yr�- l/M�✓i^'4 7 i ' 6 ti"Ol/ Wood /pellet stove 33.39
y , Mavo-a L > Wood fireplace /insert 23.32
/� 7 ❑ 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 ❑ 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 r
Phone: ( ) Fax: : ( ) Water heater r
Fireplace "
E -mail: Range
CONTRACTOR Barbecue
• Business name: 57,4Ni --rd ,, p(, ,,,,„, L 4,(4,,,./ Clothes dryer (gas)
Other:
Address: ®> / ' 1 — is ` 3.7/5 - 7 MECHANICAL PERMIT FEES*
City /State /ZIP: p 72 _ m j on 4 j�.2' 2 Subtotal 99e, ,D
Phone: r 5) 0 - Fax: (0 ) 7 ' j- (j'G3' Minimum permit fee ($90.00)
'/ 76 � �! �? l Plan review (25% of permit fee) .,-------
CCB lie.: /30-7 30'7 '� / State surcharge (12% of permit fee) /e. ga
TOTAL PERMIT FEE mp gd •
iaf: ✓e % / This permit application expires if a per is not obtained withi n 180
Authorized sgn
days s after r it has been accepted as complete.
mplete.
Print name: :��a * Fee methodology set by Tri- County Building Industry Service Board
T /��rC',,�1/� -cam Date: / " �' 12
1•\ Building \Permits\MEC- PermitApp.doc 09/09/10 440 -4617T (I I /02 /COM/WEB)
a
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.
C\ Bui ding \ Perm its\MEC - PermitApp.doc 09/09/10 2