Permit , . • CITY OF TIGARD MECHANICAL PERMIT
•
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=. COMMUNITY DEVELOPMENT Permit #: MEC2012 -00578
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/06/2012
T't C, I Ft L3'' 9 Parcel: 2S 104AA 11600
Jurisdiction: Tigard
Site address: 12435 SW 129TH AVE .
Project: Morgan Subdivision: BELLWOOD NO.3 Lot: 135
Project Description: (1) gas insert installation with gas pipe
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' Contractor: RICK STICKA LLC Owner: MORGAN, DANIEL
686 S 25TH CT 12435 SW 129TH AVE
CORNELIUS, OR 97113 TIGARD, OR 97223 '
PHONE: 503 - 680 -1046 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas' Fireplace 11/06/2012 $33.39
Type of Use: SF Fuel Piping 11/06/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/06/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/06/2012 $42.46
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: tk i Permittee Signature: _ _A/ `
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 U SE ONLY
RE C E IVE f •J • g I� eaOl l - ,,/
City of Tigard y: Per mit No .:Lt 0175 ? !5
n 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
0 ' Phone: 503.718.2439 Fax: 503.598.1960 NOV 0 6 2012 Date/By: Other Permit:
TI G A R D Inspection Line: 503.639 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Lp7�LCJ�IWITYOF�IGhIj �/K�J Notified/Method: i Juris: . Information
DiVigtON
T OF WORK �t I� 1 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*
- 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:
n Air conditioning
Job site address: / d` LI 3S ) 1 a q � 'L A { (requires site plan showing placement) 46.75
T G n � ^ � ^ Furnace 100,000 BTU ( ducts/vents) 46.75
City/State /ZIP: 411`0/ '2 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 ( �I 23.32
,1 n / Gas fireplace/insert 33.39
6 !ti Ase_. -� / /z- �il ! Ltl I 6 4 �/ ��- 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
OPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: � �L CI� Ld M Environmental exhaust and ventilation:
J ^ &/ 3 � <; / g �7J Q Range hood/other kitchen ■ Address: a` , equipment 33.39
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City /State /ZIP:6 air4 (/ Clothes dryer exhaust 33.39
- I Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
PPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name:
R �t- S Tt GL- L L C— Fuel r in
P�P� 1;:
Contact name: /l ; S 7 /C -- $14.15 for first four; $4.03 for each additional
Address: / .
9 S - -f7' 1
G "' c-7— Furnace, etc.
r � • Gas heat pump
/� '
City /State /ZIP: i2� i p /t) 1 l ( 3 Wall /suspended/unit heater
Phone: (y,3) / f) — D y ( Q
� C � Fax:: ( ) Water heater
(61 vv Fireplace l
E -mail: Range
CONTRACTOR Barbecue
Business name: /` + C.-/E- , c7-/ LL �. Clothes dryer (gas)
Other:
Address: /� e t a- C MECHANICAL PERMIT FEES*
City /State /ZIP: C p (N� i ! GC� 0 2 q)/13 Subtotal
Phone: (s )3 , ( -_ t9 2 / ' 6 Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: / 9 oc: 9 t q ( s. State surcharge (12% of permit fee)
TOTAL PERMIT FEE NT - FIO
This permit application expires if a permit is not obtained within 180
Authorized signature: d ays a i t has been accepted as complete.
Print name: X1 t .K . tic /CA__ Date: / f — 6 —1 a— * Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \PermitsUMEC- PermitApp.doc 03/07/12 4404617T(I1/02/COM/WEB)
Mechanical Permit Application - City of Tigard p r,
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.
1.•\Building\Pennits\MEC- PermitApp.doc 03/07/12 2