Permit • ,
a CITY OF TIGARD MECHANICAL PERMIT •
• - COMMUNITY DEVELOPMENT Permit #: MEC2009 -00241
T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/28/2009
Parcel: 25111 BC04900
Jurisdiction: Tigard
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Site address: 10205 SW MURDOCK ST
Subdivision: Lot: 0
Project: Mitchell
Project Description: Install gas line from furnace to kitchen for cooktop.
Owner: FEES
GALICH, PATRICIA & Description Date Amount
MITCHELL, MICHAEL W, 10205 SW MURDOCK Fuel Piping 05/28/2009 $5.40
ST 12% State Surcharge - Mechanical 05/28/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 05/28/2009 $67.10
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
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
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 Notifi - - - r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of tale r -s
Issue = � �/ Permittee Signature: /
Call 503.639.4175 by 7:00 a.m. for an inspection that . • mess 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.
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Mec' ianical Permit Application FOR OFFICE USE ONLY
'' ._ ` Received it
1S6 of Tigard Date/By: f 2 ,)9 PennitNo.: r lSC a . - '00 /
III 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
e Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639
T I G n R D Date Ready /By: rurt ' RI See Page 2 for
Internet: www.tigard - or.gov Notified/Method: /C' Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ddition/alteration / replacement 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*
51-1- 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
Job site address: 0 2',s' S64...) f' }1. LJ/Z1 LL_ Sr— Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State /ZIP: ri cA/ti) az ? u41 Furnace 100,000 BTU ( ducts/vents) 14.00 •
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: i TL' Gas heat pump 14.00
Cross street/directions to job site: /03 r-d_ Jn 04-10/C Duct work 10.00
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. 14.00
Subdivision: 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
12 UA) 64 L/ &) rgew ' 7 4't / V Flue vent for water heater or gas
s / fireplace 10.00
�//Ctf��K • /0 ( `�'I 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: )i1 / /r ` l ,r1 *PZ m ZL Environmental exhaust and ventilation
Range hood/other kitchen
Address: /0 ? O j S t.() ill U/::AGCi-t 4 equipment 10.00
City/State /ZIP: /64-4 DX- 70-Z,1 Clothes dryer exhaust 10.00
SG ) �� 3 Single -duct exhaust (bathrooms,
(S
Phone: 3 �OJ Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans . 10.00
Other: 10.00
Business name: s'6.L Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone:( )
Fax:: ( ) • Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: 5-?;,.4.,..,,p Other:
Address:, MECHANICAL PERMIT FEES*
City /State/ZIP: Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee)
TOTAL PERMIT FEE S/ •
Authorized signature: This permit application expires if a permit is not obtained within 180
/ r/ days after it has been accepted as complete.
Print name: l a Hill?, /11,//04711(: Date: , .5 / Gzi • Fee methodology set by Tri -County Building Industry Service Board
I:\ Building \Permits'MEC- PermitApp.doc 01/19/07 440-4617T (I 1/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 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.
1:\Building \Permits \MEC- PermitApp.doc 01/19/07 2
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