Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2013 00145
13125 S W Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/18/2013
T I G'AR Il g Parcel: 2S 112 BD05800
Jurisdiction: Tigard
Site address: 14736 SW 76TH AVE
Project: Safstrom Subdivision: PROSPECT MEADOWS Lot: 1
Project Description: Installation of gas insert and gas piping.
Contractor: CASCADE CHIMNEY CARE Owner: SAFSTROM, NICHOLAS
P.O. BOX 775 14760 SW 76TH AVE
ESTACADA, OR 97023 TIGARD, OR 97224
PHONE: 503 - 314 -1274 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 03/18/2013 $33.39
Type of Use: SF Fuel Piping 03/18/2013 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 03/18/2013 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 03/18/2013 $42.46
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 - :.ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or d' -ct questions to O . ' calling 503.232.1987 or 1.800.332.2344.
I sued By: $ I( Permittee Signature: N `'
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 Applic FOR OFFICE USE ONLY
City of Tiga EC Date ed 2 Perm
lig ° 1 3125 S W Hall Blvd., Tigard,OR 97223 y : � .
Phone: 503.718.2439 Fax: 503.598.1AR 1 8 Plan Review
O' 3 Date/By: 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 BUILDING DIVISIOI`l 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 El Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: / l 7 36 7.W. 7C th (requires site plan showing placement) 46.75
City /State /ZIP: I 19q r d 0 r 7 2 2 L/ Furnace 100,000 BTU (ducts/vents) 46.75
J 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 23.32
• Gas fireplace/insert
/ 33.39
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
❑ PROPERTY OWNER ❑ 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
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: W. + Other: 23.32
C a' C4 de C hi limey C9 re l tic. Fuel piping:
Contact name: Ro e r // J/ 1 - $14.15 for first four; $4.03 for each additional
Address: Y D FD y‹ 7 7 /1 Furnace, etc.
Gas heat pump
City/State /ZIP: S f4 c q dQ Or 9 7 d 3 Wall /suspended/unit heater
Phone: (c3 ) 3 /lr_ 12 •7 Y Fax:: ( ) Water heater
E -mail: Fireplace 1
Range
CONTRACTOR Barbecue
Business name: .7 9 Vh a° ,?Q Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal y0 04:9
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: /IT // O 4di, State surcharge (12% of permit fee) /e". $'v
TOTAL PERMIT FEE MO. $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: 9 r /� ` der Date: 7 -1?- -/ 3 * Fee methodology set by Tri -County Building Industry Service Board
I:\ Building \Permits\MEC 03/07/12 440- 46!7T(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
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:\Building\Pennits\MEC- PermitApp.doc 03/07/12 2