Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00428
T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/15/2012
Parcel: 2S 102BC00102
Jurisdiction: Tigard
Site address: 12595 SW BROOKSIDE AVE
Project: Winter Subdivision: WALNUT ACRES Lot: 1
Project Description: (1) water heater installation including new dedicated gas line
Contractor: STAN THE HOT WATER MAN Owner: WINTER, RAVEN
PO BOX 33157 12595 SW BROOKSIDE AVE
PORTLAND, OR 97292 TIGARD, OR 97223
PHONE: 503 - 760 -2992 PHONE: 503 - 804 -7643
• FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 08/15/2012 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 08/15/2012 $10.80
Class of Work: ALT Type of Const: Minimum Adjustment - Mechanical 08/15/2012 $75.85
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: . tL L 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 Application FoR of i IcE usi: QNI.I'
t'1.ved
City of Tigard
RECE �!.Ir`;y. r i d (Sl I a- Permit N '.o I a- 00 1/4
. a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review • Phone: 503.718.2439 Fax: 503.598.1960 te Other Permit:
l- i < A It Inspection Line: 503.639.4175 AUG 1 21: ;,y: 6 .te Ready/By: 3uris: RI See Page 2 for
Internet: www.tigard - or.gov Notified/Method: / - IA Supplemental Information
Cdt 1 OF IG •J'.?
TYPE OF WORK BUILDING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New const ruction .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*
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: 42 I (requires site plan showing placement) 46.75
C� ` Furnace 100,000 BTU ( ducts/vents) 46.75
City/State /ZIP:
�j % A 1 - L -7 �� 3 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: 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
t - - , / Gas fireplace/insert 33.39
1 NYl4 -fA. `T.4 -�I vu_ 5 g'/. -G L vik—r Yl' » 1Z j _. Flue vent for water heater or gas
Mie w►lSl4 g( .) i — - ibl a.� ain Li4g- fireplace 23.32
� Q Al lighter (gas) 23.32
L. I/M/61 i L 4 LAP /./b / e, yt4
j6 A- /l t n(0-_. Wood/pellet stove 33.39
/_ ' ° eti - / / l Wood fireplace/insert 23.32
' PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent , 23.32
Other: 23.32
Name: 4A/ ( Environmental exhaust and ventilation:
I �--� I Range hood/other kitchen
Address:
1 2 - J y" if s , 00.4 , -,&q- �l/ f equipment 33.39
City /State /ZIP: — 64 1 r• u t GI '722-, Clothes dryer exhaust 33.39
J Single -duct exhaust (bathrooms,
Phone: *5) %O - 1 0 13 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: ( ) , I Fax: : ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: 5: ... w _ _ / � 4,64,4 Clothes dryer (gas)
w Other: ,/
Address: A /5 3 1.-- MECHAfIICAL PERMIT FEES'
City/State/ZIP: r �� ,g�Q �'- 9 - 7 . 7 Subtotal
Phone: A 6 b 1'`t ! Minimum permit fee ($90.00)
( `2 Fax: ( 7 j, — (�� Plan review (25% of permit fee)
e f2CB lic.: / ` p - 7.5 .-. 14 5, � ' / State surcharge (12% of permit fee)
// TOTAL PERMIT FEE (C4) _ $IJ
ature : M v� ..0'''' This This permit application expires if a permit is not obtained within 180
Authorized si � / days after it has been accepted as complete.
Print name:,5 / r e41 E. -. ' I • te: 0 - 1 � ---/ 2 • Fee methodology set by Tri -County Building Industry Service Board
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I: \ Building \Permi.s\MEC- 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.
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