Permit a CITY OF TIGARD MECHANICAL PERMIT
III IS COMMUNITY DEVELOPMENT Permit #: MEC2012 -00103
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/23/2012
Parcel: 2S114AB13100
Jurisdiction: Tigard
Site address: 9410 SW MARTHA ST
Project: KNAUSS Subdivision: KNEELAND ESTATES NO.2 Lot: 116
Project Description: Gas fireplace insert with gas piping.
Contractor: EVERGREEN GAS INC. Owner: KNAUSS, JOHN W AND WENDY L
PO BOX 388 9410 SW MARTHA ST
WEST LINN, OR 97068 TIGARD, OR 97224
PHONE: 503 -407 -9542 PHONE:
FAX: 503 - 344 -6345
FEES
Specifics: Description Date Amount
Gas Fireplace 02/23/2012 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 02/23/2012 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel Piping 02/23/2012 $14.15
Stories: 12% State Surcharge - Mechanical 02/23/2012 $10.80
Minimum Fee Adjustment - Mechanical 02/23/2012 $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
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 OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: • ermittee Signature:
ri/l
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 rolz orrlcl: us': o:Nix
City of Tigard R eceived
� `mi Permit No.: G I 0
a 13125 SW Hall Blvd., Tigard, OR 972'k
1111 el CE
Date/By:
Phone: 503.718.2439 Fax: 503.598. : n Plan Plan Review
Date/By: Other Permit:
Tr I G A It D Inspection Line: 503.639 Date Ready/By: RI See Page 2 for
Internet: www.tigard FEB 2 3 2012 Notified/Method: IM Supplemental Information
TYPE OF Y o ' <I F TIGARD COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
�,I q I , I � n � i � {oN Mechanical permit fees* are based on the value of the work
El New construction PaAdditio a e 8ti6 Cmtitl 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*
and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 9`�� t , J -� , (requires site plan showing placement) 46.75
� � � 72 Z / Furnace 100,000 BTU (ducts/vents) 46.75
City/State/ZIP: /State /ZIP: f � ' v( Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name:iAA4 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
A � Gas fireplace I 33.39 3313
:�5 -/? C./I !h S� .F v I eY u 4'- Flue vent for water heater or gas
A �`� fireplace 4 I 23.32 f. 3)-
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
**PROP OWNER I ❑ TENANT Chimney /liner /flue /vent 23.32
PROPERTY Other: 23.32
Name: �tikt. llI (4 Environmental exhaust and ventilation:
/J l e 5 ' _ i- 1/ Range hood/other kitchen
Address: %_/ ! W A _�'r 1T`r - '� equipment 33.39
- City /State /ZIP: ' - 1 , g 722 ( Clothes dryer eirhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (5)3 ) (e 3 9 1/ 70 > 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
Phone: ( ) Fax: : ( ) Water heater
E -mail: Fireplace f /y. 6—
Range
CONTRACTOR Barbecue
Business name: _ ,art -,� s �(/tL Clothes dryer (gas)
';, Other:
Address: ?-j as a c 1 5 •S MECHANICAL PERMIT FEES*
City/State /ZIP: (A leS (- L 1...-,. ` 4 97a b €s Subtotal
Phone: �5) d 7 -c sit Z.- Fax: ( 5 - 03 ) 3tfC/. -6 3 Minime (25% of Cld� t1V
Plan review (25% of permit fee)
CCB lic.: / 5e v 3 >, State surcharge (12% of permit fee) f , O
�J TOTAL PERMIT FEE lWd/?3 3
Authorized signature: U L This p ermit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
1 Date: ) 6Ifl 2 3 1 __ ' Fee methodology set by Tri Building Industry Service Board
1:uildingrmite \C- PermitApp.doc 09 /09/10 44 ( 1 /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.
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