Permit CITY OF TIGARD MECHANICAL PERMIT
Q COMMUNITY DEVELOPMENT Permit #: MEC2012 -00395
T (GA R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/26/2012
Parcel: 2S112BB00200
Jurisdiction: Tigard
Site address: 14010 SW HALL BLVD
Project: LaDuca Subdivision:)NITA FIRS VILLAGE CONDO (PHASE Lot: 73
Project Description: Installation of Wood Stove
Contractor: OWNER Owner: LADUCA, MICHAEL T
PO BOX 3006
WOODINVILLE, WA 98072
PHONE: PHONE: 206- 930 -2563
FAX:
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 07/26/2012 $23.32
Type of Use: SF 12% State Surcharge - Mechanical 07/26/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/26/2012 $66.68
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 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 OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: Alt A Phi 64 T1iOi
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 Application rOIZ orrlcf: usl: oNI.V
City of Tigard Received 1 4 y s't Permit No. , # ' a . - 3 q s'
III 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
a Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
TI G A R a Inspection Line: 503.639 Date Ready/By: Juris: RI See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 0 Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ?Slt dition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
tr sa 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For spec! a! 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 jQ 11 ) (requires site plan showing placement) 46.75
,�y,, " Furnace 100,000 BTU (ducts/vents) 46.75
City/State /ZIP: 1 IVO a7/ /G'jL
( q , -. Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: 1 Project name: 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: I 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
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
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
23.32
Name:
w Lit Other: ' Environmental exhaust and ventilation:
Address: 14€ iI tivd. Range hood/other kitchen
equipment 33.39
City/State /ZIP: a / Clothes dryer exhaust 33.39
Phone: ( )....S7 Fax: ( ) Single -duct exhaust (bathrooms,
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
E -mail: Fireplace °`
Range
CONTRACTOR Barbecue
Business name:
Q t t3 eit, Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City/State/ZIP:
Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lie.: State surcharge (12% of permit fee)
r TOTAL PERMIT FEE /�- gD
Authorized signature: This permit application aspires if a permit is not obtained within 180
d ays after it has been accepted as complete.
Print name: Date: • Fee methodology set by Tri - County Building Industry Service Board
I :\Building\PermitsVMEC- PermitApp.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.
I:Building\Permits MEC- PermitApp.doc 03/07/12 2