Permit 41;,
CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00803
` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/8/2004
PARCEL: 2S111 BC -00500
SITE ADDRESS: 10055 SW INEZ ST
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -3.5
BLOCK: LOT: 019 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 2
Remarks: Relocate gas piping for new cooktop and reconnect old gas line.
Owner: FEES
JOHNSON, MELISSA & ED Description Date Amount
10055 SW INEZ ST [MECH] Permit Fee 12/8/200 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 12/8/200 $5.80
Phone: 503 624 - 5003 Total $78.30
Contractor:
MP PLUMBING CO
PO BOX 393
CLACKAMAS, OR 97015 -0393 REQUIRED INSPECTIONS
Phone: 503 655 - 9161 Gas Line
Final Inspection
Reg #: LIC 5002
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. T l ose rules are set forth in OAR
952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503 6 -669
9.
r Iss e d By: 62440 Permittee Signature: Li, i j_- Z —
Call (503) 639 -4175 by 7:00 P.M. for inspections neede a the next business day
Mechanical Permit Application FOROFFICE USE ONLY ' Received
City Of l Date/By: (0-401, WW Permit No g.L1 „_.‘68-6,3 13125 SW Hall BI'vd., Tigard, OR 97223 Plan Review
Phone: 503.639.41 +71 Fax: 503.598.1960 0/44
+71 Date/By: Other Permit:
Inspection Line: 503.639.4175 �,� t' Date Ready /By: El See Page 2 for
�tif1L .W
Internet: www.ci.tigard.or.us Notified/Method: ♦ Supplemental Information
.
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' s ., ;• .ct${ , ;.t�:' An .. P y , .,. r `.FtT FEE *`SCfIEDULE "`'•UE�CH•ECktisT
� �'M t :: -:ate � �' ��� -._ �1r"YPE OFWORK'� � ... C AL . �.:.. �,.�. � ,_•.., _ ... , n ..
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.
� �.. .� * I Value: $
�, °` � �`** � ''��';'�: "' ' CATEGORY +OF�CONSTRUCTION�'',ik �; �� �' �`
R QUIPME
RESIDENTIAL' =EQ NT/ SYSTEMS FEES*
❑ 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. I Total
a '' ' , w' JOB SITE IN FOR M ATrION AN D; ) . I , Heating/cooling
a.
Job site address: Air conditioning or heat pump
Does S\A) -I e Z S � (requires site plan showing placement) 14.00
City/State /ZIP: 5< OR al-- -2 D-c)-Li Furnace 100,000 BTU (ducts /vents) 14.00
Furnace 100,000+ BTU (ducts /vents) 17.90
' Suite/bldg. /apt. no.: Project name: 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
Flue /vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
POR` � '.� t 5 i .. . sV 4 DESCRIPT O /OT WORKz ., � - , n Water heater 10.00
(� Gas fireplace 10.00
— � (5C S l , ^t ) r r a A ,,� Flue vent for water heater or gas
n _ _ fireplace 10.00
()t7k e ��n W Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
, � r . § .. .r. # Chimney /liner /flue /vent 10.00
.' _ ,-.„A..FROPERTTY OWNER , i =. - ,41 i : i� .... . *: ` , ® T � . . +rx Other: 10.00
Name: rY1 e tl SS ek cl - (7cA Jp sew\- Environmental exhaust and ventilation
Range hood /other kitchen
Address: k. DDSs S1,7) `T -2 -. equipment 10.00
City/State/ZIP: 1 y-. 6R C -aay Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (6 3) (pa _ s� 3 Fax: ( ) toilet compartments, utility rooms) 6.80
i :0i _ °s$' I - ,t mss,:. „,,,,,, ,,
Attic /crawls ace fans 10.00
Other: - , rliii xAPPLC�VT : _. L � ... I . � CO AC CT 'P , , :, - e p 10.00
r
Business name: Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: •
Gas heat pump
City/State /ZIP: Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E - mail: Range /
�, - 0 • .t '• CONTRACTOR' � , fi 1 °� �` ” �� Barbecue
at yg g �
.Y1 ti> _ ti. .,11'< +'�v�. ....a'. �'� ,.�. k R "t' _ . .-tI1. A 9s�' eR.- k •�`t ,G'9 e .x _�I. � 25 A'r'+.. _ ,
{� 1 Clothes dryer (gas)
Business name: m 1- 1.,u...,01.. b1 n
5 Other:
Address: ” '=.FgR "k'' = ° MECHANICAL °PERMIT FEES *';' .
City/State /ZIP: Subtotal 7�
Minimum permit fee ($72.50) �,� '.
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lie.: ) State surcharge (8% of permit fee) 8O
TOTAL PERMIT FEE n . 50
Authorized signature This permit application expires if a permit is not obtained within 180
VVV days after it has been accepted as complete.
Print name: � Y1 elLSSGI l'1 -scr. Date: f D f 6/ * Fee methodology set by Tri- County Building Industry Service Board
i:\Building \Permits \MEC- PermitApp.doc 12/03 440 -4617T (I I /02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information ^ r
Commercial Fee Schedule:
"° o; , ' i" "�un?�',�,q.,P 4:��t`�'*�'rid:� ,,, �",,'�'
Tt o gi aluahopi Permit Fee .
$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.
i:\ Building \Permits\MEC- PermitApp.doc 12/03 2