Permit q CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: MEC2013 00546
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/25/2013
Parcel: 2S 115AA02800
Jurisdiction: Tigard
Site address: 10668 SW KENT ST
Project: Courtney Subdivision: DOVER LANDING NO.2 Lot: 67
Project Description: Install gas fireplace insert
Contractor: EMERALD OUTDOOR LIVING INC Owner: COURTNEY, LILLIAN M & ROGER S
2520 SILVERTON RD NE 10668 SW KENT ST
SALEM, OR 97301 TIGARD,OR 97224
PHONE: 503-370-9355 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 09/25/2013 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 09/25/2013 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: 12%State Surcharge-Mechanical 09/25/2013 $10.80
Stories: Minimum Fee Adjustment-Mechanical 09/25/2013 $33.29
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No' ion -- -r. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y• may obtain a copy of the rules
or dir-• questions to OUN •y calling 503.232.1987 or 1.800.332.2344.
lss ed By: i Permittee Signature:
—— r r
Call 503.639.4175 by 7:00 a.m.for the next available inspection
This permit card shall be kept in a conspicuous place on the job site until comp etion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE uSl,ONLY
RECEIVED Received /qy�G�/
III City of Tigard Date/By: ® Permit No.: / /G,4 / 05-A•
° 13125 SW Hall Blvd.,Tigard, 9722 Plan Review
C ' Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
P I G A R D Inspection Line: 503.639.4175 , ,) 5 't Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OFTIGARD
TYPE OF �'A INr COMMERCIAL,FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
,®,1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: I 0 to� .8 5' ) (,Q.,,t Si S _ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: TI (n0.yr 97 Z Lf Furnace 100,000+BTU(ducts/vents) 54.91
J 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
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 '1 33.39
_ Flue vent for water heater or gas
.--I-V\.,SrEX- \ Ce`-rj F a. .. �) ac_x_ Tv„S.Q.rT fireplace 1 • 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
-APPLICANT ❑ CONTACT PERSON Other: 23.32
� � Fuel piping:
Business name: 6.,,,,,24,-.0,..11Q 171 oo r Li V 1 1^0v $14.15 for first four;$4.03 for each additional
Contact name: Ck(-;S CA.,4eQ Furnace,etc. /
Address: 25 co 5 t ) vt°t`Z)Y-. �6 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: •5,ti 7730 I Water heater
Phone:(503) 3 70_R 35,5- Fax: :( ) Fireplace
Range
E-mail:
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: 'E c�� D1�CtQQ)O r^ Li'V t Other: *
n n ^/ MECHANICAL PERMIT FEES*
25 Zo 5 t 1 ire1L.-'tom.-. r) c9 6 Y E Subtotal qe•„,...
City/State/ZIP: .SG-l_12, — .. 9 -73 C. / - Minimum permit fee($90.00) .---
Phone:(.503) 370—C 35 S Fax:( )
Plan ch review ge(25%of permit fee)
f State surcharge(12/o of permit fee) 1p.S'U
CCB lic.: I.cj 57, 9 /043 TOTAL PERMIT FEE /Lb• ire,
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: CI,Nr i s tek Date: ,-25---../ 3
I\Building\Permits MEC_PermiiApp_040113.doc 440-4617T(I I/02JCOM/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.
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