Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit#: MEC2013-00590
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/07/2013
Parcel: 2S103DD04600
Jurisdiction: Tigard
Site address: 10690 SW GARDEN PARK PL
Project: WARD Subdivision: GAARDE PARK Lot: 29
Project Description: Wood stove insert installation.
Contractor: REFINER'S FIRE SERVICES Owner: WARD, KAY
11944 SE MILL CT 10690 SW GARDEN PARK PL
PORTLAND,OR 97216 TIGARD,OR 97223
PHONE: 971-275-7592 PHONE:
FAX: 971-223-3232
FEES
Specifics: Description Date Amount
Wood/Pellet Stove 10/07/2013 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 10/07/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 10/07/2013 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
•
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800. 4.
)/1/Issued By: ` i _ Permittee Signature:
- /
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard ',! Received
V 13125 SW Hall Blvd.,Tigard,O:,'.,,Ir3= Plan Review
Phone: 503.718.2439 Fax: 503.':-; .1� Date/By:13 Other Permit:
T I G A R D Inspection Line: 503.639.4175 �.� Date ReadyBy: Suns: El See Page 2 for
Internet: www.tigard-or.gov Y.-:\ 063 Notified/Method: "1...1,.....6' Supplemental Information
T E OF yin Cj�� COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
R�lj° Mechanical permit fees'are based on the value of the work
❑New construction Addition/altfdfi/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
-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: t n l e 0 r��/'► r- �. (fir v-- Furnace 100,000 BTU(ducts/vents) 46.75
r `:Q/L (cc 1�� Furnace 100,000+BTU(ducts/vents) 54.91
City/State/ZIP: D ( )9ar- `O 0.--- Heat pump 61.06
Suite/bldg./apt.no.: Project name: W Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
�� Residential boiler(radiator or
hydronic) 23.32
ciq /c 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
( Flue vent for water heater or gas
n +6�l ` (( (_ bj O(Dri c,c___ fireplace 23.32
Log lighter(gas) 23.32
I Wood/pellet stove 1 33.39 33.341
Wood fireplace/insert 4--•-22332
Chimney/liner/flue/vent 23.32
lytROPERTY OWNER I ❑ TENANT Other: 23.32
�� ��jar L� Environmental exhaust and ventilation:
Name: Range hood/other kitchen
Address: I `� � A `� C '^ inc (�Dl equipment
dryer 33.39
-w �p ! 1 T' ! / Clothes d exhaust 33.39
City/State/ZIP:--1-1 Vr-sit 7 7 2 Singe- uct exaust(bathutility rooms,toilet comments, rooms) 23.32
Phone: -q _q-D ax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT I ❑ CONTACT PERSON Other: - 23.32
Fuel piping:
Business name: $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: p, �//! fv, �-,-, r(7l (-, MECHANICAL PERMIT FEES"
Address: 13 �, v V jiJ /'-' to[ / Subtotal 33 .�
l / i 6_v `A �� i'g r g ._ permit fee($90.00) 9o•06
City/State/ZIP: V ���///""" �P L Plan review(25%of permit fee)
Phone! -7 ., �7 Fax:( ) State surcharge(12%of permit fee) ho,CIO
CCB Sic.: 19( 0/4 14 TOTAL PERMIT FEE /6k)•ro
0 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized s to e: • Fee methodology set by Tri-County Building Industry Service Board
■
Print name: l� Date: a 013
I:\Building\Pennits C_PermitApp_040113.doc 4 A t' �'.11// 1 �G0461 T1'(II/02/CO EB)
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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