Permit •
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CITY OF TIGARD MECHANICAL PERMIT
e _ COMMUNITY DEVELOPMENT
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COMMUNITY MEC2009 -00258
T ( GARD 13125 SW Hall Blvd.. Tigard OR 97223 503.639.4171 Date Issued: 06/03/2009
Parcel: 2S 110BA04000
Jurisdiction: Tigard
Site address: 14380 SW MCFARLAND BLVD
Subdivision: Lot: 0
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Project: Jenkins •
Project Description: Change out existing gas insert & fkue.
Owner: FEES
JENKINS, ROBERT EBEN & Description Date Amount
WENDY MK, 14380 SW MCFARLAND Gas Fireplace 06/03/2009 $10.00
TIGARD, OR 97224 Flue Vent for Water Heater or Gas 06/03/2009 $10.00
PHONE:
Fireplace
12% State Surcharge - Mechanical 06/03/2009 $8.70 •
Contractor: Minimum Fee Adjustment - Mechanical 06/03/2009 $52.50
NW GAS LINES •
16731 NE WASCO ST
PORTLAND, OR 97230
PHONE: 503 - 256 -2436
FAX: 503 - 256 -2245
Type of Use: SF
Class of, Work: ALT Type of Const:
Occupancy Grp:
Stories:
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Fuel
Fuel Types: •
Gas Pressue
Total $81.20
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
issua , r i w issuspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uti • y Notification Cente T• .se ul are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You m- obtain a copy of the rules
Is ued By: ` �� Permittee Signature:
• Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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
a .1 � 1\t ED DateB
City of Tigard y: 1 o,
� ' � Y / _ D Permit No.: ._ 00 5g
• 13125 SW Hall Blvd., Tigard, OR 7223
C Phone: 503.639.4171 Fax: 503.598.1%0 Plan Review Other Permit:
Inspection Line: 503.639.4175
I N 0 3 2009 Date/By:
T I G A R D Date Ready/By: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
C ?`tY �:-= i GARD
TYPE di R'ORI CniG DIVISION
COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ❑ Addition/alteration/replacement Mechanical permit fees are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ 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
�1�J �- j_ J Air conditioning or heat pump
Job site address:
4?) 00 c c `!� 1 .keto 3) 12f - (requires site plan showing placement) 14.00
City/State /ZIP: 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: 41 fe, Duct work 10.00
Hydronic hot water system 14.00
/1 1 C Y 144 B)U4 % Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: c L Ow /PO Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace ) 10.00
Cif 0A14.- /6 I
i,S+1 . . r t Flue vent for water heater or gas
f fireplace ' 10.00
frle(.t 114 ..-e'1 +011 Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue/vent 10.00
Other: 10.00
Name: f et( , - W y C -art' I IV Environmental exhaust and ventilation
�J Range hood/other kitchen
Address: i 14? _�'-- `0 C I i t l equipment 10.00
City/State/ZIP: t 0A C, ri /1 7 � Clothes dryer exhaust 10.00
(� Single -duct exhaust (bathrooms,
Phone: (50, ) 6 - -0-7) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name: ,� ���� Other: 10.00
YZZOYI yUY� IVtc_ Fuel piping
Contact name: JIJGN vt kS i(1 tadC-1 $5.40 for first four; $1.00 for each additional
Address: c VV � Furnace, etc.
J ��L(� ► L� Si Gas heat pump
City/State/ZIP:—.- Wall/suspended/unit heater
y — r�� . � ' � D 22. p
Phone: ) 3 Fax : :( g6 ,..-7 LIG 1 Fireplace ater
E -mail: Range
CONTRACTOR Barbecue
/ s- Clothes dryer (gas)
Business name:
�� (r l Other:
Address: 1 03 1 / jC W ser (.1-� MECHANICAL PERMIT FEES*
City /State /ZIP: P Y r tei OR q-7230 Subtotal
�v� a Fax: ( ) ^ ';� Minimum permit fee ($72.50) 7a, 5
Phone:
W �— ti 3 ( 2"t✓ Plan review (25% of permit fee)
CCB lic.: /5)4 Sf (43' State surcharge (12% of permit fee) g , 7 0
TOTAL PERMIT FEE �� i ae
signature: Aviii ,��� T his permit application expires if a permit is not obtain within 180
Authorized si !'n / U"u 6 days after it has been accepted as complete.
Print name: D et/l�i 6D LIY2'e 0 I Date: C - 3 - 0 y • Fee methodology set by Tri -County Building Industry Service Board
IABuilding\Permits\MEC- PermitApp.doc 01/19/07 44046I7T(I1 /02/COM/WEB)
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Mechanical Permit Application - City,. -of Tigard
Pag 2 = Supplemental Information •
Commercial Fee Schedule:
Total Valuation: 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.
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1:\Building\Pernits MEC- PermitApp.doc 01/19/07 2
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