Permit CITY OF TIGARD MECHANICAL PERMIT
1111 m. ' COMMUNITY DEVELOP Permit #: MEC2012 -00273
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/24/2012
Parcel: 2S110BB05500
Jurisdiction: Tigard
Site address: 14210 SW 121ST AVE
Project: Elliott Subdivision: ARLINGTON RIDGE Lot: 32
Project Description: Gas line for dryer
Contractor: REFINERS FIRE SERVICES Owner: ELLIOTT, RICH & BRENDA
OREGON CITY, OR 14210 SW 121ST AVE
TIGARD, OR 97224
PHONE: 971 - 275 -7592 PHONE:
FAX: 971 - 223 -3232
FEES
Specifics: Description Date Amount
Clothes Dryer Exhaust 05/24/2012 $33.39
Type of Use: SF 12% State Surcharge - Mechanical 05/24/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/24/2012 $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 yo to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -00 0090. You m obtaii a c•,: of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: •Atid 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 Applica hOli Ol l 1( ;1: ust. ( I.v'
CEIVEI) Received .,, r
1,1 City of Tigard Date/By: 5/ 0 S� Permit* (aQ(1- D0a - L.3
a 1312 SW Hall Blvd., Tigard, OR 97223 Plan Review
l7 Phone: 503.718.2439 Fax: 503.598.19 4y 2 4 2012 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date
kris: I I G n 1Z D Internet: www.tigard - or.gov CITY OF TIGARD Notifieed/Met P Supplement od: f( !_ lemental Information
BI HIDING DIVISION `
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: $ ,A:23
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES'
Ekr 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special informarlon use checkllsL
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: ( ■(7 1 t/l) 121 - j f (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City /State/ZIP: T1 G t r 0 « el- }ZZ(-}- Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: ,L 4 / ! ! 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
CAS L iel e fol., � v y er • Gas fireplace/insert ent 33.39
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
la PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32
Name: 14.icn B re..A4 ao, ELL(0 Environmental exhaust and ventilation:
Address: (Ut 2. () 5 .0 t7-1 •- S 7'N e-- Range hood/other kitchen
equipment 33.39
City /State /ZIP: i LGA 0C c1 224- Clothes dryer exhaust 33.39
Fax: Single -duct exhaust (bathrooms,
Phone:
( ) ( ) toilet compartments, utility rooms) 23.32
, APPLICANT (- ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name: E g , Coy, S4- - HC p Vt � . ..
Lo+ Other: 23.32
M Fuel piping:
Contact name: ` 4 t it -K RA) t /, c r- `< $14.15 for first four; $4.03 for each additional
Address: l Q 4^i a., S0.tn ai? r, p ev. 9r , Gas heat e P ump
City/State /ZIP: La ¶ t? Gt -' p t OR 4 k1-p'� s Wall /suspended/unit heater •
Phone: (� ) rl =e I1 17.0 -I 3 O j 1 h Fax:: ( ) Water heater
E -mail: Efi1 w ca v, a-v i o citok t Gt '' Range
I . co -,
Fireplace
Range e
CONTRA OR Barbecue
Business name: R Q 4 iy e-, F/PC. tceVV t LeS Clothes dryer (gas) I 1
Other:
Address: MECHANICAL PERMIT FEES'
City /State /ZIP: OREGO C ; OIL
Subtotal
Phone: ( I) /.?"6 . ? - 9, a Fax: (Cr?-1 2 - 32,3.1._ Minimum permit fee ($90.00)
) 2
3 Plan review (25% of permit fee)
CCB lic.: 190 T H Ef- 4/Alit State surcharge (12% of permit fee)
TOTAL PERMIT FEE (��$Q
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: P" l t Ra vd is S Date: 5/24/ 2(!lti • Fee methodology set by Tri -County Building Industry Service Board
I :[ Building \Permits\MEC- PennitApp.doc 09/09/10 44 /T(II /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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