Permit CITY OF TIGARD MECHANICAL PERMIT
' s COMMUNITY DEVELOPMENT Permit#: MEC2014-00243
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/21/2014
T[GAR.O Parcel: 2S110DD10300
Jurisdiction: Tigard
Site address: 15705 SW HIGHLAND CT
Project: Mikels Subdivision: SUMMERFIELD NO.6 Lot: 319
Project Description: Installation of gas line for new range.
Contractor: COMPLETE HEATING&COOLING Owner: GEORGE MIKELS
18310 SW BENFIELD AVE 15705 SW HIGHLAND CT
LAKE OSWEGO,OR 97035 TIGARD,OR 97224
PHONE: 503-332-4514 PHONE:
FAX: 775-628-1630
FEES
Specifics: Description Date Amount
Fuel Piping 05/21/2014 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 05/21/2014 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 05/21/2014 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you t, follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-00:1. You may obtain a copy of the rules
or dire uestions to UNC by calling 503.232.1987 or 1.800.332.2344.
I /
Is ed By: Permittee Signature:
At.-Call 503.639.4175 by 7:00 a.m.for the next available inspec f e.
This permit card shall be kept in a conspicuous place on the job site until • ion of ••eject.
Approved plans are required on the job site at the time of each ction.
Mechanical Permit Applicatty�l► EIVEP FOR OFFICE USE ONLY
City of Tigard Date/By: jj�r ��%/ Permit No.: // 9 / ���
Er
�
13125 SW Hall Blvd.,Tigard,OR 97223
Ia�4Y 21 2014 Plan Review
Phone: 503.718.2439 Fax: 503.598.1 Received
Date/By: Other Permit:
T I G A R I) Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE ittfitatit6VVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑ Master builder ❑Other: Description I Qty. Ea. j Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: /s r)e/ v , w w,GN q C.---]` Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: IT)/4P--4 Furnace 100,000+BTU(ducts/vents) 54.91 ,
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 33.39
Flue vent for water heater or gas
K z"igh 9 f V 2/4r"QL�` V,Q_p, fireplace 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 I ❑ 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
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:( ) I Fax: :( ) Fireplace
Range % /
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:CoC Pa icyy ` , aJA J , Coe ie Other. *
6 /t-'I � MECHANICAL PERMIT FEES*
1 : (C) 636.1A/Pi f 6/ �((3 _ Subtotal
City/State/ZIP: / �1 JC, tDs v /`1�"c & ? 7 0 3� Minimum permit fee($90.00)
Cf t I �'IJ i-iii Plan review(25%of permit fee)
Phone:(S' ) 3 C1 :✓/ > 1 Fax:(SO j S3 1/4/S`'./V State surcharge(12%of permit fee)
CCB lic.: b ( / TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: *iiirpr... / * Fee methodology set by Tri-County Building Industry Service Board
Print name' 1 .1/ if Date:,S"
1.\Building\Permits\MEC_P pp_040I 13.doc ..I '•ITT I1/02/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\Permits\MEC_PermitApp_040I 13.doc 2