Permit CITY OF TIGARD MECHANICAL PERMIT
a • COMMUNITY DEVELOPMENT Permit#: MEC2013-00531
T t G AR D 13125 SW Hall Blvd,Tigard OR 97223 503.718.2439 Date Issued: 09/19/2013
Parcel: 2S110DD10600
Jurisdiction: Tigard
Site address: 10940 SW HIGHLAND DR
Project: HIX Subdivision: SUMMERFIELD NO 6 Lot: 322
Project Description: Gas piping for range.
Contractor: NATURAL GAS CUSTOM PIPING INC Owner: HIX, BETTY J
1014 NE 177TH AVE 10940 SW HIGHLAND DR
PORTLAND, OR 97230 TIGARD,OR 97224
PHONE: 503-319-6557 PHONE
FAX: 503-335-9950
FEES
Specifics: Description Date Amount
Fuel Piping • 09/19/2013 $14 15
Type of Use: MF 12%State Surcharge-Mechanical 09/19/2013 $10 80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 09/19/2013 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types.
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION. Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800 332.2344.
•
Issued By: Permittee Signature: ,1111111111..--i -......_-
.!� �.///r���i :mil _
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Mechanical Permit Application FOR OEEICE USE ONLY
City of Tigard � Received q iii Permit No. rze /10( 3 -<. s
. n 13125 SW Hall Blvd.,Tigard,OR 97_-, 0�
Phone: 503.718 2439 Fax: 503.59:1 1i D
Plan ate/By Other Permit:
T I G A R D Inspection Line: 503.639.4175 ` 9 1013 Date Ready/By. VI See Page 2 for
Internet: www tigard-or gov C Q > ^� Notified/Method Supplemental Information
_ IC% I ' MI
T r E OF W I . , , , COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees are based on the value of the work
❑New construction E Addition/alteral$ es acement 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*
L 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: r A ..—_. � ' (/ _ 4, j Ue Furnace 100,000 BTU(ducts/vents) 46 75
City/State/ZIP: ./ ,z A- 1 / ..2-. Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: J_ Duct work 23.32
Cross street/directions to job site: _ 7i// ' , mil' 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
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
i , _ , / 1`` /�� fireplace 23 32
Log lighter(gas) 23 32
Wood/pellet stove 33 39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other 23.32
■ ROPERTY QWNER 0 TENANT Environmental exhaust and ventilation:
Name: f ` , / / �/J Range hood/other kitchen
'J/1.- ■ , I</ /// _ i//. ,1 Z
equipment 33 39
Address: I i Q i%e A // "v - Clothes dryer exhaust 33 39
City/State/ZIP: u ` 4re� Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23 32
Phone:(52 8,) - •Zo,. Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name: $14.15 for first four;54.03 for each additional
Contact name: -Furnace,etc
Address:
Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
Range / 1 /S'
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
MECHANICAL PERMIT FEES*
Address: __ 7 7 - _ Subtotal /p,17
i
City/State/ZIP:69j .1 /` / ��' Minimum permit fee($90.00) 90 Cl.,
Phone:( 1 ) i.. Fax:( ) Plan review(25%of permit fee) -
�/ State surcharge(12%of permit fee) /Q_iv
CCB lie.: —r� � / • TOTAL PERMIT FEE MO,po
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signatur • • Fee methodology set by Tri-County Building Industry Service Board
Print name: j�� Date: 1//4243
I\Building\PermitsVV�. C_PermitApp_040113 doc 44046177(11/02/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 1'
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\Permits\MEC_PermitApp_040113.doc 2