Permit CITY OF TIGARD MECHANICAL PERMIT
- COMMUNITY DEVELOPMENT Permit#: MEC2014-00469
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/27/2014
Parcel: 2S1 11 CA12400
Jurisdiction: Tigard
Site address: 9724 SW OAKS LN
Project: Holt Subdivision: SATTLER PARK Lot: 9
Project Description: Gas fireplace insert with gas piping.
Contractor: RICK STICKA LLC Owner: HOLT, MATTHEW
686 S 25TH CT 9724 SW OAKS LN
CORNELIUS, OR 97113 TIGARD, OR 97224
PHONE: 503-680-1046 PHONE
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 08/27/2014 $33.39
Type of Use: SF Fuel Piping 08/27/2014 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 08/27/2014 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 08/27/2014 $42.46
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100 80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance. or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-00 You may ain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: —
�L/JLIL.��'7
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR 01.F1( 1: I SF 0\I.1
Received
City of Tigard ��
Date/By: in Permit No.:At ,r/ - • -
• 13125 SW Hall Blvd.,Tigard,OR 97
Phone: 503.718.2439 Fax: 503. Plan Review
�� DateBy: Other Permit:
I I t■A It I Inspection Line: 503.639.417 1% Date Ready/Fly: ® See Page 2 for
Internet: www.tigard-or.gov �9 O \ Notified/Method: r Supplemental Information
, , Ct -
T OF WO COMMERCIAL FEE* SCHEDULE USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction Addition/altera sy"ement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: . mechanical materials,equipment,labor,overhead,and profit.
Value:$
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 I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
^ Air conditioning 46.75
Job site address: h!A� S(,J OA ,�cs tx
t Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: -'/6 card De__ Furnace 100,000+BTU(ducts/vents) 54.91 _
Heat pump 61.06
Suite/bldg./apt.no.: Project name: th 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 33.34
Flue vent for water heater or gas
C j•ior7 1, 101- 643 00.e For fireplace 23.32
Log (gas) 33.39`i.A 4/ 'GE 4 �� ^ sros Wood/pellet stove
33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32 _
PROPERTY OWNER El TENANT Environmental exhaust and ventilation:
Name: MA-7774e14) NO r Range hood/other kitchen
Address: 9 ad./ S W O 4/ S (_k Clothes dryer 33.39
/ / Clothes dryer exhaust 33.39
City/State/ZIP: ! ' G a4-4 , 0 le-- q Single-duct exhaust(bathrooms,
1 toilet compartments,utility rooms) . 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
14°APPLICANT ❑ CONTACT PERSON Other: 23.32
Business nam i S7r1 C & L.L. Fuel piping:
514.15 for first four;54.03 for each additional
Contact name: I C r STj`cfr..g- Furnace,etc.
Address: 6 36 % , C71-5-135 7-) Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: C.Vrit4Z--ilkage 0 /7 113 Water heater
Phone:(Sal tgo - 10 jf e, Fax: :( ) Fireplace L / f•ir
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer��O e
Business name: S'T7r�cX� LLL Other: r
, MECHANICAL PERMIT FEES*
J
Address: L7 - Subtotal i{"7,j h
City/State/ZIP: CvrA,e_£t� e o,C._ 171r5 Minimum permit fee($90.00) /0.V,
Phone:(�f3) tD D�- f £6 Fax:( ) Plan review(25%of permit fee) --
State surcharge(12%of permit fee) (b_,r,
CCB tic.: 1 4 Q a 9 ii 11/(4, TOTAL PERMIT FEE ice-gb
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: Tce C. (. ST t C Ka._ Date: QUA..
1:\Building�Permils\MEC_PermitApp_040113.doe 440-4617T(11/02/ ES)
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 * ' i�, '� ■ i 4, 2• �t#1
fraction thereof,to and including
$50,000.00. Si 1• NA C
$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.
3%-t''2. CA'-tom� 4►.
tit
v11'O\ ^:AQ rtiZ
arAn-5 .1
r-., A- y c
• C • ev:cL
1 C 1 ti'f
I:\Building\Permits\MEC PermitApp_040113.doc
L