Permit •
'' CITY OF TIGARD MECHANICAL PERMIT
` - ` a ' ' - COMMUNITY DEVELOPMENT Permit it: MEC2012 00535
Ti ARID 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/17/2012
Parcel: 2S 104AD03401
•
Jurisdiction: Tigard
Site address: 12828 SW WALNUT ST
Project: Lewis Subdivision: BELLWOOD Lot: 50
Project Description: Remove woodstove and install freestanding gas stove and gas line.
Contractor: OWNER Owner: LEWIS FAMILY REV TRUST
BY LEWIS, BRIAN C & CHRISTINE C TR
12828 SW WALNUT ST
TIGARD, OR 97223
PHONE: PHONE: 503 - 590 -5890
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 10/17/2012 $33.39
Type of Use: SF Fuel Piping 10/17/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 10/17/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 10/17/2012 $42.46
Stories:
Fuel
Fuel Types: Natural Gas
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 No ' enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You ma _ .tain a copy of the rules
or dir questions to O calling 503.232.1987 or 1.800.332.2344.
Is ued By: AO/ , Permittee Signature: \ # ! 4 16.1. 4 16.1. .
/11
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 OFFICE USE ONLY
II City of Tigard E Date/By: /a Permit No.: the �� , /a- 535
n 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
T I G A R D Inspection Line: 503.639 II T 1 F r� . 2012 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
CITY OFTIGARD
TYPE OF IT131 m( DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction )4 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*
I - 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: ) 2_s ? s �/V ` , 9 2-31\3 n \ )-T (requires site plan showing placement) 46.75
City /State /ZIP: ""\---\ �`�� ^_ , c .1p \1 ` 7 V ��
Fumace 100,000 BTU ( ducts/vents) 46.75
s Fumace 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
C Z�I E. J ` ^ 1 $``5` \ 1 Gas fireplace/insert ent or wter heater or gas
1 - 7
1 33.39
\�� v V Flue vent for water
V p �1 ��_ ., k\ 1 G fireplace 23.32
� <- --c N A G -' ( >� J S \W v Log Wood/pellet t sto 23.32
Wood/pellet stove 33.39
` V'V ` v J cs UNe_ Wood fireplace /insert . 23.32
PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: 5:,21 N L\/\) 1S Environmental exhaust and ventilation:
Address: 12-$' 2 V V V A s U (l V \ �1-/ Range hood/other kitchen
equipment 33.39
City /State /ZIP: ---A ul)-- qR 2.2-2 Clothes dryer ex haust 33.39
��� —S c g c�^( � toilet (bathrooms,
Phone: (So3) Fax: ( ) � toilet t compartments, ents , utili 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 I
Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
�^ ,�,.� - 'Q I ^ N
, � Other:
Address: � `` � -� vv MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) 9 a°
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) /p . >ro
TOTAL PERMIT FEE /00. 8
This permit application expires if a permit is not obtained within 180
Authorized Signature: days after it has been accepted as complete.
Print name: < 1 �N 1,_._ LS Date: ICl/1 7/ l 4 * Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \Permits\MEC- PermitApp.doc 03/07/12 440-4617T(11/02/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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