Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00236
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/11/2012
Parcel: 25111 BD00307
Jurisdiction: Tigard
Site address: 9885 SW PEMBROOK ST
Project: Pond Subdivision: PEMBROOK HEIGHTS Lot: 7
Project Description: Installation of gas fireplace insert into existing fireplace.
Contractor: OWNER Owner: POND, DUANE P M &
POND, SUSAN L VIROSTEK
9885 SW PEMBROOK ST
TIGARD, OR 97224
PHONE: PHONE: 503 - 624 -5644
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 05/11/2012 $33.39
Type of Use: SF 12% State Surcharge - Mechanical 05/11/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/11/2012 $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 e Oregon
Utility Not . ion - • er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy • he rules
or direc • uestions to OU • , . ling 503.232.1987 or 1.800.332.2344.
Issued By: / / • I / ' Permittee Signature: • IOWA
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 An L.:.. . ink, FOR O1�1 USE ONI.Y
City of Ti a l d Received
'✓ g A � � Date/By: 5 I " /� Permit No.: Neid a..er,� /
q 13125 SW Hall Blvd., Tigarb' x'1223 Plan Review ew
C Phone: 503.718.2439 Fax: 503.59,8 1 2 0 2 Other Permit:
NI T DateBy:
T I G A ti D Inspection Line: 503.639.4175 Date Ready/By: orris: ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
OF-IWORICi duly 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 sped al information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
9835 W Pe /64(00A i V 2/ Jt
Air conditioning
Job site address: (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City/State /ZIP:
M g r £ A g'' 2- 3',- Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: 11 Project name: —p (v 5 .1-. ) 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
Gas fireplace/insert 33.39 '3� 3�
":/` Flue vent for water heater or gas
r ,,eibot2eovv. fireplace 23.32
Log lighter (gas) 23.32
iii Wood/pellet stove 33.39
Wood fireplace /insert 23.32
XPROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent
Other: 23.32
' f h/ l
A o Q / C1 23.32
Name: `. Environmental exhaust and ventilation:
Address: 7n 1 S , i b i 5T' Range hood/other kitchen
v � 1 V c r equipment 33.39
City /State /ZIP: 1 o O A / 2,9- Clothes dryer exhaust 33.39
c/ � Single -duct exhaust (bathrooms,
Phone: (5 3 69, ") V- 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
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: V up / l D Clothes dryer (gas)
11 Other:
Address: MECHANICAL PERMIT FEES*
City/State /ZIP: Subtotal Y 40
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) /a o
TOTAL PERMIT FEE I 9, SU
Authorized si ature: ` `. i This permit application expires if a permit is not obtaltied within 180
• 0 VVV / days after it has been accepted as complete.
Print name: OU pNe !C Date: S / / �'�
• Fee methodology set by Tri -County Building Industry Service Board
I:\ Building \Permits\MEC- PennitApp.doc 03/07/12 440- 4617T(I1 /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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