Permit y n CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00617
'GARDi 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/29/2012
Parcel: 2S104ACO3100
Jurisdiction: Tigard
Site address: 12445 SW 134TH AVE
Project: Neet Subdivision: MORNING HILL NO.8 Lot: 175
Project Description: Installation of gas piping for new range.
Contractor: HOLMES INSTALLATION SERVICE Owner: NEET, BRIANA M &
33535 NW VADIS RD HINESLY, PAULINE M
CORNELIUS, OR 97005 12445 SW 134TH AVE
TIGARD, OR 97223
PHONE: 503 - 647 -9320 PHONE: 503 - 329 -2889
FAX:
FEES
Specifics: • Description Date Amount
Fuel Piping 11/29/2012 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 11/29/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/29/2012 $75.85
Occupancy Grp:
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 Notific. '. I 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 direc ruestions to . NC b :Ding 503.232.1987 or 1.800.332.2344.
Issue. By: / � Permittee Signature:
l •
Call 503.639.4175 by 7:00 a.m. for the next available inspection da
ir
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 / Permit No.:
City of Tigard Date/By: // A9 a Hoe_ , la - aol, A
III 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C . Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
T I G A R D Inspection Line: 503.639 Date Ready/By: Juris: RI 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 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 0 Accessory building For special information use checklist.
Multi - family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Lt +t, p ' Air conditioning
Job site address: 1 Z 11 ( 1 5,9 (3 I y l l l " JA�� (requires site plan showing placement) 46.75
v Furnace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP: 7 6 Q1'�. ' 9 '772-3 Furnace 100,000+ BTU (ducts/vents) 54.91
L
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 Gas fireplace/insert 33.39
-J�V` / � Q /� I / "'S �✓t ✓t'I- S Flue vent for water heater or gas
/ V / fireplace 23.32
• Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
R OPERTY OW ER ❑ TENANT Chimney/liner/flue/vent 23.32
{� p Other: 23.32
Name: y-t AAN.A. ��_ Environmental exhaust and ventilation:
lJ
Address: 1 • , r , r 0 f 7 /� Range hood/other kitchen
y am ` ) / t y
equipment 33.39
City /State /ZIP: ( C 04 d ►-e_ q 72 Z 3 . Clothes dryer exhaust 33.39
f Single -duct exhaust (bathrooms,
Phone: �� Fax: ( ) toilet compartments, utility 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
Fireplace
E -mail: Range
?('
CONTRACTOR Barbecue
Business name: � I ( Clothes dryer (gas)
7 �� V� r Othe
Address: 1 MECHANICAL PERMIT FEES*
City/State /ZIP: C6 V\ \. t k‘..) O ve 57/( 2 Subtotal
/ Minimum permit fee ($90.00) 90 • o
Phone: 9 3 2 _6 7 ; 75 7 y4 Fax: ( ) Plan review (25% of permit fee)
CCB lic.: ) 0 2 73 /p 7/y State surcharge (12% of permit fee) /0. PO o2v_A 1 TOTAL PERMIT FEE AU. IU
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: A
�Q�S' I Date: Hot • Fee methodology set by Tri -County Building Industry Service Board
9 /'2..o/ 'Z I:\Building\Permitts\MEC -P tApp.doc 03/07/12 4 44 o► / a6 2 17T ( 7JCOM/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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