Permit n CITY OF TIGARD MECHANICAL PERMIT
- �. COMMUNITY DEVELOPMENT Permit#: MEC2013-00494
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/26/2013
Parcel: 2S 104AA90302
Jurisdiction: Tigard
Site address: 12646 SW KAREN ST 30
Project: Bellwood Terrace, Unit 30 Subdivision: BELLWOOD TERRACE CONDO Lot: 30
Project Description: Install dryer and bathroom exhaust vent
Contractor: RELIABLE HOME IMPROVEMENT INC Owner: BELLWOOD TERRACE LLC
PO BOX 230815 PO BOX 189
TIGARD, OR 97281 YAMHILL, OR 97148
PHONE: 503-481-0240 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Clothes Dryer Exhaust 08/26/2013 $33.39
Type of Use: SFA Single Duct Exhaust(Bathrooms,Toilet, 08/26/2013 $23.32
Class of Work: ALT Type of Const: Utility Rooms)
Occupancy Grp: 12%State Surcharge-Mechanical 08/26/2013 $10.80
Stories: Minimum Fee Adjustment-Mechanical 08/26/2013 $33.29
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of O' Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if w• is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to f• ow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y•u may obtain a copy of the rules
or direct questions to OUNC by c•(ling 503.232.1987 or 1.800.332.2344.
Issued = , ,` Permittee Signature:
i
Call 503.639.4175 by 7:00 a.m.for the next available inspe, ion date.
This permit card shall be kept in a conspicuous place on the job site up d completion of the project.
Approved plans are required on the job site at the tinle-6f each inspection.
Mechanical Permit Application • FoR OFFICE USE ONLY
IN q City of Tigard Date/By: •� Permit No.: a/. 2O4/ '
13125 SW Hall Blvd.,Tigard,OR 97223 plan Review
a Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G°A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
• TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction 154ddition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
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 I Qty. Ea. Total
/ `t JQB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: S /(4-4,-71--) � ✓�� I A - Air conditioning 46.75
/IiCX/' Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: L /tip d� . 97��-� Furnace 100,000+BTU(ducts/vents) 54.91
9' 6�„ Heat pump 61.06
Suite/bldg./apt.no.: "I Project name: + /l_Lv Duct work 23.32
Cross street/directions to job site: 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
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32 '
DESCRIPTION OF WORK Gas fireplace/insert 33.39
�/ n
Flue vent for water heater or gas
R JNy Devi, (/,•t0 // fireplace 23.32
n j Jam — "tAi 7- Log dghtee(gas) 23.32
��/ Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: i 23.32
440-PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:
Name: Ai p 24eoe 5 Range hood/other kitchen
equipment 33.39
Address: ('n • 0 c /3 9 54- ' '�' Clothes dryer exhaust - / 33.39
City/State/ZIP: 1� Gee Single-duct exhaust(bathrooms,
/�7�)r/I�� toilet compartments,utility rooms) / 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
APPLICANT ❑ CONTACT PERSON Other: 23.32
� Z,t Agin #e)0 e 7iH��l) / �,o_ Fuel piping:
Business name: t j �'^
� $14.15 for first four;$4.03 for each additional
Contact name: 6 e/ -N, Furnace,etc.
Address: 02 1 8 23 0 -/� Gas heat pump
Q Wall/suspended/unit heater
City/State/ZIP: `O p 7G�/,1•,,,�d, ,I , Water heater
r �/ Fireplace
Phone:&3) 4/. /_G,?y c. Fax: :( )
Range
E-mail: e L„L &- `r�v7•�� G Barbecue
J - CONTRACTOR Clothes dryer(gas)
Business name: �/' Other:
/” Gt��/ /Tv'�tt� /� � r MECHANICAL PERMIT FEES*
Address: ;9 i U t 023057 Subtotal
City/State/ZIP: (tog_ L 6,- 0II-- 9 Z20)- 5 Minimum permit fee($90.00) 90.00
Phone:0-rj 3) 7S-/ _002 y U Fax:( )
Plan review(12%of permit fee) 0
State surcharge(12%of permit fee) /O
CCB lie.: y8'(p 3 7 ( " TOTAL PERMIT FEE 100•gU
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: /.,I4 * Fee methodology set by Tri-County Building Industry Service Board
Print name: 6Q t_tti t�OZ n Date: 3-26 , /3
1'\Building\Permits\MEC_P- .' •pp_040113.doc s 440-46177(I I/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.
I:\Building\PermitAMEC_PermitApp_040I 13.doc 2