Permit CITY OF TIGARD MECHANICAL PERMIT
` °• g . COMMUNITY DEVELOPMENT Permit #: MEC2012 -00119
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued:- 03/06/2012
Parcel: 1 S126DC01003
Jurisdiction: Tigard
Site address: 9415 SW LEHMAN ST
Project: Lehman Street Property LLC Subdivision: LEHMANN ACRE TRACT Lot: 5
Project Description: Installation of gas insert into existing fireplace..
Contractor: SHAMBURG HEATING LLC Owner: LAYMAN, DEBORAH J S TRUSTEE
PO BOX 829 3216 SW SCHOLLS FERRY CT
TUALATIN, OR 97062 PORTLAND, OR 97221
PHONE: 503 - 692 -5563 PHONE:
FAX: 503 - 691 -6855
FEES
Specifics: Description Date Amount
Gas Fireplace 03/06/2012 $33.39
Type of Use: SF 12% State Surcharge - Mechanical 03/06/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/06/2012 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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 ification ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or • ect questions to O C • ca 'n. 503.232.1987 or 1.800.332.2344.
•
Iss ed By: /40-/064110 Permittee Signature:
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 ONI.\
City of Tigard - Date/By: aceivd phm Permit No.: / DO /l
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C . Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Date/By:
T I G A R D Inspection Line: 503.639 Date Ready/By: kris: ® 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 ❑ 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*
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For spedai 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: ci y i s SLO Lek of \ 0 r (N-0-4- (requires site plan showing placement) 46.75
Furnace 100,000 BTU City /State /ZIP: T- .. c.r v P- T/2?-3 Furnace c 100,000+ BTU (du s 54.91
Suite/bldg. /apt. no.: Project name: L � m c„,,-, C f — P Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: L. 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 1 33.39
9 G-S t c"1.4 J ' l A " e _ r (ce k...L- Flue vent for water heater or gas
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
Other: _ 23.32
Name: �� t ,P ( r h'1 H� Environmental exhaust and ventilation:
Address: � t. ) ` - '? L tr� Range hood /other kitchen
Z Le S - equipment 33.39
City /State /ZIP: P c 01 7--22 ( Clothes dryer exhaust 33.39
( 9 Zt�� Fax: ( ) toile compartments, exhaust (bathrooms, rooms) s,
Phone: (
S Z partments, utility ro 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: C 1 gte;c H -c_c— r Clothes dryer (gas)
Address: t� xl q Other:
�2 I MECHANICAL PERMIT FEES'
City/State /ZIP: , ` (>2 5 706,2 Subtotal 90
( ) (.09),- 5 - 5 t ( ) Minimum permit fee ($90.00)
Phone: J Fax:
Plan review (25% of permit fee) 1 J g CCB lic.: /9\62 / $ ( State surcharge (12% of permit fee)
TOTAL PERMIT FEE �
/ /CV- 0 ; Authorized signature: D ( C^ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: ��� t t'Y� }! J. Date: . 4L . 0 7 7/1,...--- ----- ' Fee methodology set by Tri -County Building Industry Service Board
1:1Building\Permits C- PermitApp.doc 09 /09/10 440 -461 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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