Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2014-00541
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2014
Parcel: 2S110AD07500
Jurisdiction: Tigard
Site address: 14905 SW 106TH AVE
Project: Geyen Subdivision: LANG HILL NO.2 Lot: 67
Project Description: Install gas fireplace insert and flue vent, Gas line to be installed by others.
Contractor: STEPHEN GEYEN Owner: GEYEN, KAROLYN JOY&STEPHEN GER
14905 SW 106TH AVE 1891 DELWOOD AVE
TIGARD, OR 97224 ROSEVILLE, MN 55113
PHONE: 612-462-2913 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 10/02/2014 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 10/02/2014 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: 12%State Surcharge-Mechanical 10/02/2014 $10.80
Stories: Minimum Fee Adjustment-Mechanical 10/02/2014 $33.29
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty odes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is jot st- ed within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow (rule •dopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y. may •b in a copy of the rules
or direct••-stions to e.k C b -ling 503.232.1987 or 1.800.332.2344.
Issu•d By: � ` ,�- Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available'j section d• -.
This permit card shall be kept in a conspicuous place on the job site until corn• et'•n of the project.
Approved plans are required on the job site at the time of each i sp ction.
Mechanical Permit Application' FOR OF`AFICE USE ONLY L �j} ff
City of Tigard Dateiv /0 /`� "+J PermicNo.: IL/ J / —�5(/
■III 13125 SW Hall Blvd.,Tigard,OR 9tiE1UED
! Phone: 503.718.2439 Fax: 503.598.196 CT 2 2014 Date/By:an Review Other Permit:
Inspection Line: 503.639.4175
T I G A R D Date Ready/By nuns ® See Page 2 for
Internet: www.tigard-or.gov CITY
��.+niFnD Notified/Method: Supplemental Information
TYPE OF
WOE'1�F P'�"�I COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction i Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
JED-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. _ ha. Total
JOB SITE INFORMATION AND LOCATION
Heating/cooling:
y9 \( �( 11-1 A Air conditioning 46.75
Job site address: / D S. S W Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 1 t 6 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 —523,,,,-11
Flue vent for water heater or gas
4511TH.,_
,--
jAS '.(."-Q pL.t CE -IN SO-7 fireplace 23.32 'G?,
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
IEC PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: 5-.110..,Q Q He—pi r£r Range hood/other kitchen
equipment 33.39
Address: J 9.9 Q c Su-.) ,(,(A ' t1/�y'vf Clothes dryer exhaust 33.39
City/State/ZIP: 1 1 c A(LI) Oa_ 97 22-V Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( (P(v 1-1,6)-2-- 2913 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:( ) Fax::( ) Fireplace ,
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: 0/1 ) ) UL Other
MECHANICAL PERMIT FEES*
Address: Subtotal _ „r6.f/
City/State/ZIP:
Minimum permit fee($90.00) 90.0e
Plan review(25%of permit fee) ----Phone:( ) Fax:( ) State surcharge(12%of permit fee) _ ID.fO
CCB lic.: TOTAL PERMIT FEE (00• UD
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: / -1 Date: 10 lz./'i
1\Buildinc •- '" i .p040113.doc 440-4617T( 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.
l:\Building\Permits\MEC_PermitApp_040I 13.doc 2