Permit CITY OF TIGARD MECHANICAL PERMIT
C • COMMUNITY DEVELOPMENT Permit #: MEC2009 -00252
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/01/2009
Parcel: 1 S134CB02300
Jurisdiction: Tigard
Site address: 12235 SW SUMMER CREST DR
Subdivision: Lot: 0
Project: Robertson
Project Description: Install gas water heater and related gas piping.
Owner: FEES
ROBERTSON, JOSHUA B & CHELSI A Description Date Amount
12235 SW SUMMER CREST DR Water Heater 06/01/2009 $10.00
TIGARD, OR 97223
Fuel Piping 06/01/2009 $5.40
PHONE: 12% State Surcharge - Mechanical 06/01/2009 $8.70
Minimum Fee Adjustment - Mechanical 06/01/2009 $57.10
Contractor:
OWNER •
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
Total $81.20
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. •
Issued By: y �j- , ) Permittee Signature:
` �
Call 503.639.4175 by 7:00 a.m. for an inspection that busin ss day.
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.
:Mec'ianical Permit Application FOR OFFICE USE ONLY
r 1 of Tigard '� EI ! Rec eived
City gar Date/By: ._ - Permit No. f ��� ' 25
' 4
° 13125 SW Hall Blvd., Tigard, OR 97223 JUN 0 2009 Plan Review
C ' Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Inspection Line: 503.639.4175 DateBy:
TIGARD CITY OF TIGARD Date Ready/By: ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
BUILDING DIVISION NMI
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
ID New construction Wddition /alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
7S 1- 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
l /� 'T J '^ Air conditioning or heat pump
Job site address:
1 7_2_3 . v✓ . V pv.v' (fest VI' (requires site plan showing placement) 1 4.00
City/State /ZIP: 01 - ? Furnace 100,000 BTU ( ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: 121 S twit V (1-€ j ,� Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) ' 14.00
Unit heaters,(fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Flue/vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater I 10.00
f Gas fireplace 10.00
,,,; hi/ f'aJ y� 1► ;,e AV 140- Wl�t/{J' Imo,/. yf�, Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
Chimney/liner/flue/vent 10.00
p T PROPERTY OWNER ❑ TENANT Other: 10.00
Name: `,O f I g() yy 1■ Environmental exhaust and ventilation
�� Range hood/other kitchen
Address: 1 ; w- j VY1 Vt+-7f f-1'e f r' Ci l' equipment 10.00
City/State /ZIP: A ?22 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone:
(S ) b'fs/ - K . s.6 Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: Fuel piping
Contact name: e ee ,160 v� $5.40 for first four; $1.00 for each additional
Address:
Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
r Fireplace
E-mail: j b r 36.3 6/ V P A Range
CONTRACTOR Barbecue
Business name:
Clothes dryer (gas)
�y U1/41 v K r\ Other
Address: V MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) 7'.Sc)
Plan review (25% of permit fee)
CCB lie.: State surcharge (12% of permit fee) F:/. 78
C .� TOTAL PERMIT FEE ®l • ? U
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: l L ,b4 v'zvk^ Date: S/1/01 • Fee methodology set by Tri- County Building Industry Service Board
1:t Building \PermitsUMEC- PermitApp.doc 01/19/07 4404617T (t 1 /07/COM/WEB)
Mechanical Permit Application - City of Tigard y _ •
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
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