Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00078
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/09/2012
Parcel: 2S109AA01900
Jurisdiction: Tigard
Site address: 14434 SW 130TH AVE
Project: Riodil Subdivision: WOODFORD ESTATES Lot: 7
Project Description: Gas line for range and range hood ventilation.
Contractor: AMBIENT AIR HEATING & COOLING LLC Owner: RIODIL, KRIS A T & ADELBERT R
29460 S ROYAL OAKS DR 14434 SW 130TH AVE
MULINO, OR 97042 TIGARD, OR 97224
PHONE: 503 - 756 -4915 PHONE: 503 - 970 -1888
FAX:
FEES
Specifics: Description Date Amount
Range Hood /Other Kitchen 02/09/2012 $33.39
Type of Use: SF Fuel Piping 02/09/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 02/09/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 02/09/2012 $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 rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules
or direct questions to OU C by calling 503.232.1987 or 1.800.332.2344.
Issued By: - . — �t Permittee Signature:
T 411IFI
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 OFFICE USE ONLY
City of Tigard � ��� Date/By: ' c , ` PermitNo.: , yL . -
III 13125 SW Hall Blvd., Tigard, OR 97 - ., t Plan Review
C ` Phone: 503.718.2439 Fax: 503.598. 119 % ��1 Received 1
Date/By: Other Permit:
�5 �ial •
T l G A R D Inspection Line: 503.639 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov 0 q� �� �� r b8S) l a Notified/Method: i�I'�Lit Supplemental Information
TYPE OF WOR , � , S J
r,i \1L COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
M Mechanical permit fees* are based on the value of the work
❑ New construction 0 /alteratib'ft7replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
if CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 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: / & /L/ 7i,/ Li, /3 0 (requires site plan showing placement) 46.75
I Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP:
��G/+) Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: E I'Q , I 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
...-- ` PICA Gas fireplace 33.39
= i 1 °' `` - � C I'44 / EYO0f*1 Flue vent for water heater or gas
.- t fireplace 23.32
i :5/Ctt , 0 Li /V All i(*
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: k cad ( Environmental exhaust and ventilation:
Ur Range hood/other kitchen
��
Address: �+( ` 3 Z.' !� �r.F equipment { 33.39 3 3 •3 I
City /State /ZIP: r k % � OA Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
R] APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: 1,) 4/1 - A l piping:
�'1 r'G Fuel i m g:
Contact name: .' r $14.15 for first four; $4.03 for each additional
j Furnace, etc.
Address: ((0 g �� I ,- ,),
Gas heat pump
City /State /ZIP: (rot0 //( r � Oft Wall /suspended/unit heater
Phone: ) -7 .i (..� /C//c Fax: : ( ) Water heater
Fireplace
E -mail: C ,( �yV` � �1 , vi. i f Range I /ii:I
CONTRACTOR Barbecue
Air- Clothes dryer (gas) „
Business name:l��f V
Other:
Address: / /yam A _ . _, MECHANICAL PERMIT FEES*
/MO I� r
City /State /ZIP: Y � Subtotal
Phone: ( ) Fax: ( ) _ Minimum permit fee ($90.00) TO_ ckJ
Plan-review (25% o €permit -fee)- — —
CCB lic.: /zcr--' 6 19 * State surcharge (12 %ofpermit fee) JQ .'0 // I TOTAL PERMIT FEE /(k.), Rb
Authorized signature:
PERMIT This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
h
Print name b ) �w""" Date: // * Fee methodology set by Tri- County Building Industry Service Board
I:t Building \Permits\MEC- PermitApp.doc 09/09/10 40- l7T (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:\ Building \Permits \MEC- PermitApp.doc 09/09/10 2