Permit CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: MEC2012 -00552
.TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/23/2012
Parcel: 2S103BB06100
Jurisdiction: Tigard
Site address: 12600 SW 124TH AVE
Project: Burdeaux Subdivision: BROOKWAY Lot: 61
Project Description: Installation of wood stove insert and chimney liner /flue /vent
Contractor: JOHN BURGER HEATING & AC Owner: BURDEAUX, DAVID
PO BOX 181 12600 SW 125TH AVE
SCAPPOOSE, OR 97056 TIGARD, OR 97223
PHONE: 503 - 333 -1704 PHONE: 503 - 327 -9401
FAX:
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 10/23/2012 $23.32
Type of Use: SF Chimney /Liner /FlueNent 10/23/2012 $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 10/23/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 10/23/2012 $43.36
Stories:
Fuel
Fuel Types: Solid Fuel
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 cop of the rules
or direct • - ions • ■UNC by calling 503.232.1987 or 1.800.332.2344.
Issued B : / 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 OFFICE: USE ONLY
Received A
IN
City of Tigard EiD Date/By: I aZ Ir Permit No.: � ` ,��OQS _
13125 SW Hall Blvd., Tigar Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TI G n R D Inspection Line: 503.639 p C T 2 3 2012 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
CITY OFTIGARD
TYPIBUIthatili DIVISION 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*
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: `'u� Sw \Z a�J`Q (requires site plan showing placement) 46.75
City /State /ZIP:' ,c Ct Q, 22:3 Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91 1
Suite/bldg. /apt.no.: Project name: 0 d Heat pump
V ^ (requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
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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
" _' QX \ - „ ^ \ % fireplace 23.32
�( �� ` �lcLy Log lighter (gas) 23.32
°F,s\. \. L )C Wood/pellet stove 33.39
■ Wood fireplace /insert / 23.32
PROPERTY OWNER l ❑ TENANT Chimney/liner /flue /vent / 23.32
Other: 23.32
Name: c) (6, ���( >� v x Environmental exhaust and ventilation:
Address: l? L S \L I Q Range hood/other kitchen
J �"'�'"\ equipment 33.39
City /State /ZIP'S\ "I CO Z2.3 Clothes dryer exhaust 33.39
`` v Single -duct exhaust (bathrooms,
Phone: (g3) _ 0� Fax: ( ) toilet compartments, utility rooms) 23.32
APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business e: / �Y\ � � �C� �t� Other:
Fuel 23.32
n � uel piping:
Contact name: I � ` ) \ � � $14.15 for first four; $4.03 for each additional
Address: 9, v - �` �/ \ ` Furnace, etc.
/� Gas heat pump
City/State /ZIP: sc., 30 _12_ Q\ UI�OS�o Wall/suspended/unit heater
Phone: (53) - -`r1 I Fax: : ( ) Water heater
� Fireplace
E- mail:„ 9� t \ �V � \�\\ . cg , r� Range
CONTRACTO Barbecue
Business name: . , _
�� _ *�` ' ` ! Clothes dryer (gas)
Other:
('�
Address: \_ ` \ ! \ MECHANICAL PERMIT FEES*
City/State /ZIP: 1 V 5(90 Subtotal q .0 0
Minimum permit fee ($90.00)
Phone: (5)3) —, a Fax: ( ) Plan review (25% of permit fee) —i'
CCB lic.: \S u, 513 1/4.1 // 3 State surcharge (12% of permit fee) to . k 0
TOTAL PERMIT FEE i t
Authorized signature: This permit application expires if a permit is not obtain th within hin 180
days after it has been accepted as complete.
Print name: Lu ( yt a 'V raer- Date: l(' ao l' * Fee methodology set by Tri -County Building Industry Service Board
I:\Building\Permits'MEC- PermitApp.doc 03/07/12 440-4617T (I I/02/COM/WEB)
Mechanical Permit Application - City of Tigard ; •.
Page 2 - Supplemental Information Y.,.
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 $10,0 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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