Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: MEC2012 -00291
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/04/2012
Parcel: 2S112BD05800
Jurisdiction: Tigard
Site address: 14736 SW 76TH AVE
Project: Safstrom Subdivision: PROSPECT MEADOWS Lot: 1
Project Description: Install wall heater in downstairs bath
Contractor: Owner: SAFSTROM, NICHOLAS
14760 SW 76TH AVE
TIGARD, OR 97224
PHONE: PHONE: 503 - 572 -4869
FAX:
FEES
Specifics: Description Date Amount
Unit Heaters (Fuel - Type, Not Electric) 06/04/2012 $46.75
Type of Use: 12% State Surcharge - Mechanical 06/04/2012 $5.61
Class of Work: Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $52.36
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to ALA OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: JQJ 4f Permittee Signature:
�// i '�� 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.
REC EiV ' .. Mechanical Permit Application ....H.: usi.: „Nix
Ci of Ti and JUN 0 4 2O�2 Received / /q/
tY g Date/By: ( L ( Y � Permit • X ,� EG J!f LAZ I
a 13125 SW Hall Blvd., Tigard, OR 97223 _Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TIGAR aat�Y: Other Petinit:g2
I - I It D Inspection Line: 503.639 BUILDING DIMS Ready/By: Juris: ® See Page 2 for
Internet: www.tigard -or.gov �` . ' fied/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"
-i1- 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:
/ Air conditioning
Job site address: 1If 736 S� 76 I I / Aye ( (requires site plan showing placement) 46.75
City/State /ZIP: i � ' 7j2 9
Furnace 100,000 BTU ( ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: EvyliZA 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. I 46.75 i
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
IA) Gas fireplace/insert 33.39
I 'VS TftL[_. 4.J/9 LC_ /#9 72- IA Flue vent for water heater or gas
s
/1 S Tom- /ZS Qr fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
g ROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Midi" Other: 23.32
Name: �� ic-s - r 22" r Environmental exhaust and ventilation:
Address: /(17f‘ � Range hood/other kitchen
7 fW �� ?'"B equipment 33.39
City/State /ZIP: 77,3 a/ , 9222 /V Clothes dryer exhaust 33.39
(/ Single -duct exhaust (bathrooms,
Phone: ( j ) 572- #867 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
��A/6. <'Z Clothes dryer (gas)
Business name:
Other:
Address: MECHANICAL PERMIT FEES"
City/State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) )
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) )
TOTAL PERMIT FEE 512- 3(0 we
./ This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
- Print name: ,(% tfAFS ffee *1 I Date: l L/_ 2 • Fee methodology set by Tri -County Building Industry Service Board
1:t Building \PermitsVMEC- PemtitApp.doc 03/07/12 440-4617T (I 1/02/COM/WEB)
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. 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 $69:06for 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.
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- Note: All new commercial buildings require 2 sets of plans.
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1:\Building\Permits\MEC- PermitApp.doc 03/07/12. 2
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