Permit CITY OF TIGARD MECHANICAL PERMIT
;N a_ COMMUNITY DEVELOPMENT Permit#: MEC2013-00460
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/07/2013
Parcel: 2S103BC04900
Jurisdiction: Tigard
Site address: 12625 SW 124TH AVE
Project: Shults Subdivision: BROOKWAY Lot: 3
Project Description: Install gas line only for future fireplace insert. (Fireplace insert under separate permit)
Contractor: OWNER Owner: SHULTS, BRUCE L
BRUCE L SHULTS 12625 SW 124TH
12625 SW 124TH AVE TIGARD,OR 97223
TIGARD, OR 97223
PHONE: 503-730-2954 PHONE: 503-730-2954
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 08/07/2013 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 08/07/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/07/2013 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuan , r if wo • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili Notification Center. T e les are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain/i copy of the rules
or rect questions to OUNC >s calling • .232.1987 or 1.800.332.2344.
Issue By: j I/ Permittee Signature: 4
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
/J�
11,1 City of Tigard DacerB Received , Permit No /M ce,e2/3-60 60
° 13125 SW Hall Blvd.,Tigard,OR 97�f' y Iral
Phone: 503.718.2439 Fax: 503.598.19. � � Plan Review Date/By: Other Permit:
"r I G A R D Inspection Line: 503.639.4175 r Date Ready/By: Juris: ® See Page 2 for
A.Internet: www.tigard-or.gov ' '? 1 Notified/Method: Supplemental Information
TYPE 011 `•�� OFTIGARD COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
G DIVISION Mechanical permit fees*are based on the value of the work
❑New construction J Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$•
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
" 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: ,7_6,1 S s b j l -LW"II V� Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 4 O`/` _ Furnace 100,000+BTU(ducts/vents) 54.91
J 1 Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
WResidential boiler(radiator or
W a VI v k- 1-0-11'k hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Lot no.: Other: 23.32
Subdivision: el
r�d v�S� Other fuel appliances: __
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
Q CC S N ti E To - - 1 v-c Ip 1Ch C P cotr ill (�Y� fireplace 23.32
�J �Q V Log lighter(gas) 23.32
�{ RA.'Q� `^�� 7 pn,c( Wood/pellet stove 33.39 V Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
[l PROPERTY OWNER ❑ TENANT Other: 23.32
` �1,—t Environmental exhaust and ventilation:
Name: 6 U C 1V1 J Range hood/other kitchen
�Address: Z(p-.2., -. s W Z 1,� )4. •, v___ equipment
Clothes dryer exhaust 33.39
33.39
City/State/ZIP: -\-- ` /G Ava ) O r c{ 77 123 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503) -..r 30. Z 9 5 4 Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32 .
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail:
Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: R , kOl d t 14 e Q t I MECHANICAL PERMIT FEES* •
Address: Q 0. R O A 'l e 7
( Subtotal
City/State/ZIP: e4 vie/. C v -Q2/ ' (3 r 77 Q cut Minimum permit fee($90.00) 9�.�
Phone:(�` ) �1 Fax:( ) cut review(25%of permit fee)
�3 K -1 State surcharge(12%of permit fee) /0-VO
CCB tic.: ( '7 2 U 9 7 TOTAL PERMIT FEE /00•gJ
(% This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature:
� �� ) • Fee methodology set by Tri-County Building Industry Service Board
Print name: � ►v � ,I Date: 5 / 7 f 1 1:\Building\PermitsU�CPermilApp_040 113.doc 440 4/6171(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
fractionrthereof,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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