Permit : CITY OF TIGARD MECHANICAL PERMIT
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'``! a .,'; COMMUNITY DEVELOPMENT Permit #: MEC2012 -00609
TIGARD- 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/26/2012
Parcel: 2S 111 C D05400
Jurisdiction: Tigard
Site address: 15945 SW BRENTWOOD CT
Project: taylor Subdivision: SUMMERFIELD NO.9 Lot: 513
Project Description: Install a gas insert and venting. Using existing gas line,
Contractor: EVERGREEN GAS INC. Owner: TAYLOR FAMILY TRUST
PO BOX 388 15945 SW BRENTWOOD CT
WEST LINN, OR 97068 TIGARD, OR 97224
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PHONE: 503 - 407 -9542 PHONE: 503 - 639 -9873
FAX: 503 - 344 -6345
FEES
Specifics: Description Date Amount
Gas Fireplace 11/26/2012 $33.39
Type of Use: SF Chimney /Liner /FlueNenl 11/26/2012 $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/26/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/26/2012 $33.29
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 • • a ion - -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or di ct questions to OUN • - fling 503.232.1987 or 1.800.332.2344.
Iss ed By: 1110 /A// ;/ ./ Permittee Signature: .S
.. 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 ONI.IV
City of Tigard Date/By: LiGJ
51 q : / Permit No.: �aO /a�O
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639 Date Ready/By: Juris: PI See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ) E t ther: ddition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
El Demolition mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
Vie and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
I■ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 9 1�C 4 4 J f j4w (requires site plan showing placement) 46.75
nt 972z3 Furnace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP: A .rt((
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
Vtf y9 TAT 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 4
J { Gas fireplace/insert 1 33.39 53.5?
vL 5 (/ / /1 a �4-J - J Flue vent for water heater or gas
eA �� - 77r ! c /J � 0C _ � 1-he fireplace 23.32
U C l/ Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
ROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent / 23.32 ,Z3.
Other: 23.32
Name: G ,,,, Ttj /e_ic Environmental exhaust and ventilation:
Address: /5 -�/C �� J e � .� „ `e er— Range hood/other kitchen
l �% C equipment 33.39
City /State /ZIP: 40 9' �Z3 Clothes dryer chaust 33.39
Phone: 51 ., a s 73 Fax: ( ) t oildet le compartments,
Single-duct (bathrooms, rooms) toilet me, utili 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name:
Other: 23.32
Fuel piping:
Contact name: 514.15 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
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: C14 /lee,,( G Clothes dryer (gas)
Other
Address: 7 . , 5 ) , :d 9 g' MECHANICAL PERMIT FEES*
City /State /ZIP: L e_ j �,,,,- 49..2 97 6 9 Subtotal 9,0.
_ ) V Fax: ( ) Minimum permit fee ($90.00)
Phone: (
�� ( ( �� Plan review (25% of permit fee)
CCB lic.: /' 5 ( (9 .3 State surcharge (12 %ofpermit fee) /D -p0
/ / TOTAL PERMIT FEE /0O. $'O
Authorized Signature:(// This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name ii � , � � I Date: r/ � • Fee methodology set by Tri -County Building Industry Service Board
I:\BuildingWermits C- PermitApp.doc 03/07/12 44 617T (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 $347.7.1 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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