Permit CITY OF TIGARD MECHANICAL PERMIT
1::.. COMMUNITY DEVELOPMENT Permit #: MEC2013 -00068
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/30/2013
Parcel: 1 S134DB06100
Jurisdiction: Tigard
- Site address: 11230 SW NORTH DAKOTA ST
Project: Freeman Subdivision: 1994 -035 PARTITION PLAT Lot: 1
Project Description: (1) gas fuel piping for water heater
Contractor: STAN THE HOT WATER MAN Owner: FREEMAN, DALLAS & RICHARD H
PO BOX 33157 11230 SW NORTH DAKOTA ST
PORTLAND, OR 97292 PORTLAND, OR 97223
PHONE: 503 - 760 -2992 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 01/30/2013 ' $14.15
Type of Use: SF 12% State Surcharge - Mechanical 01/30/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/30/2013 $75.85
Occupancy Grp:
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 • - les
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: AM bilLULt Permittee Signatur
Call 503.639.4175 by 7:00 a.m. for the next available insp' i" on 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.
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Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
Date/By: Permit No.: E C dD , 3 ' V OV �■
13125 SW Hall Blvd., Tigard, OR 97223 �� / 3
II I 111 Plan Review
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: El 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*
g l- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checktisr.
❑ 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 30 I, ( 1 4.14.41.-74- S '', (requires site plan showing placement) 46.75
City /State /ZIP: in v �' -� 2 � "� Furnace 100,000 BTU (ducts/vents) 46.75
lam, � , / 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/diredions 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
n r � u n i f N � , �� Gas fireplace/insert ent r water 33.39
n I �J vv c _ ! �s7�. .L( /�,+/t Flue vent for water heater or gas
l L/xit -!v'r 1 4-5 t (.'v JS V/Av/��„2,f(2/ , fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Phone: ( ) Fax: ( ) toilet compartments, exhaust (bathrooms,
partments, utili rooms ) 23.32
APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
^^ --`` ��/!��' �r�Q t / ,, Other: 23.32
Business name:
� �V`'I'� woy (/V �74'�l /I/t/�,..../ Fuel piping:
Contact name: /t( t /'' 6 tf $14.15 for first four; $4.03 for each additional
Address: , C cr -1 I
P `67 Furnace, etc. Gas heat pump
City /State /ZIP: (762x77 c (4-4.-1 , • ot '1 2 -c1 Z Wall/suspended/unit heater
Phone: (65)'''' L--f (• Z ) J > f ( Fax: : ( ---m- p[ 5Cj Water heater 1 (
"� / // Fireplace
E -mail: Oye I1J, i,ca ., , , / I'M 4.41...„ • cur„_____ Range
CONT ' • I ' Barbecue
Business name: )� / K k i/J .7 A/4_4.. Aj ' zNV Clothes dryer (gas)
�o e 3 (� / Other: MECHANICAL PERMIT FEES*
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City /State /ZIP: Subtotal
Phone: Minimum permit fee ($90.00)
(3) �� - _ �j 7 Fax: �� 7. Q, Plan review (25% of permit fee)
CCB lic.: ! 3p 70,4 ( I1 1 f State surcharge (12% of permit fee)
TOTAL PERMIT FEE 1(p • to
Authorize a L ur e. . This permit application expires if a permit is not obtained within 180
/' days after it has been accepted as complete.
Print name: Lori 7 y / ( ,, ,L Date: F 3o '
• Fee methodology set by Tri County Building Industry Service Board
I:\Building\Permits ' - PermiiApp.doc 03/07/12 440-4617T (II /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
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fraction thereof.
Note: All new commercial buildings require 2 sets of plans. .
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