Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2014-00406
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/04/2014
Parcel: 2S103BB07500
Jurisdiction: Tigard
Site address: 12512 SW 123RD AVE
Project: Wylder Subdivision: LAKE TERRACE Lot: 3
Project Description: Installation of outdoor fireplace and gas piping for fireplace and barbecue.
Contractor: SHEPARD BROTHERS MANAGEMENT LLC Owner: WYLDER, RICHARD D
2830 NW 29TH 12512 SW 123RD AVE
PORTLAND, OR 97210 TIGARD, OR 97223
PHONE: 360-772-0355 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 08/04/2014 $33.39
Type of Use: SF Fuel Piping 08/04/2014 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 08/04/2014 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 08/04/2014 $42.46
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0091 You ma obtain a copy of the rules
or direct ions to OU • by c. ing 503.232.1987 or 1.800.332.2344.
Issued y: / Permittee Signature: 4■
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit A li FOR OFFICE USE ONLY'
ill City of Tigard EIVEh Date/ y:i �1 Permit N0.: /�/I �In/ r 04016
-r 13125 SW Hall Blvd.,Tigard,OR 97223 Dateii3y: J 7 / ►/ ` �r
Plan Review
Phone: 503.7182439 Fax: 503.598.169 1 Date/By: Other Permit
TI G n R n Inspection Line: 503.639.4175 AUG 4 201 4 Date Ready/By:
turfs. ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OFTIGARD
TYPIRMI$ DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction 2 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*
„12] I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family ❑Master builder ❑Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 1 Z (Z 5(A_, I Z 3 " Furnace 100,000 BTU(ducts/vents) 46.75 _
City/State/ZIP: G' ‘,.,--k Die q 7 Z- 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: �� 12 3 - 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 I 33.39 `T
A Flue vent for water heater or gas
4-4.4 e■,,"-e s /3 Q 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 ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name:
?..14-1^.- r.�vwc)-1 Range hood/other kitchen
equipment 33.39
Address: I'Z S- Z -S40 1Z-3 Clothes dryer exhaust 33.39
City/State/ZIP: 1-60„.4, b q-72.2.--S 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: �� QQ �{ Fuel piping:
SLw"Y" ' "`^.4 Th�'t^�' - $14.15 for first four;$4.03 for each additional
Contact name: A ; c 0..4 Furnace,etc.
Gas heat pump
Address: t 30 12(A_� ? /su
Wall/suspended/unit heater
City/State/ZIP: ,eol'k.,,a._..e.0 dt2 t.'l 72 )U Water heater
Phone:( >) 7 7 2_ 6)s-S- Fax::( ) Fireplace
Range _
E-mail: J r' � r , 4n,1"- Barbecue `I )Nil 5
"`Y CONTRACTOR Clothes dryer(gas)
Other: 0uP06/ AedateE, f
Business name: SQ4-..-..4_ to &N---P MECHANICAL PERMIT FEES*
Address: Subtotal 4/ -), „c-1
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: i 8(6 2,0 S q y TOTAL PERMIT FEE /)O.
This permit application expires if a permit is not obtained within 180
0 days after it has been accepted as complete.
Authorized signature:gn ��•� • Fee methodology set by Tri-County Building Industry Service Board
Print name: A S zsa I Date: $1L'/)Li
1:\Building\Permits\MEC_PmnitApp_0401 t3.doe 440-4617T(t lrovcoM/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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