Permit f- CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2015 00796
j t 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/23/2015
T1GARi
Parcel: 2S103BB03400
Jurisdiction: Tigard
Site address: 12505 SW KAREN ST
Project: Harshfield Subdivision: BROOKWAY Lot: 34
Project Description: Installation of gas insert and gas piping.
Contractor: RICK STICKA LLC Owner: HARSHFIELD, RUTH A
686 S 25TH CT 12505 SW KAREN ST
CORNELIUS, OR 97113 TIGARD, OR 97223
PHONE: 503-680-1046 PHONE: 503-704-2724
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 11/23/2015 $33.39
Type of Use: SF Fuel Piping 11/23/2015 $14 15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 11/23/2015 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 11/23/2015 $42 46
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notific, -• enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct•.estions to O.NC by calling 503.232.1987 or 1.800.332.2344.
Issued : : / 7 Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Mechanical Permit Application FOR OFFICE USE ONLY •
Received _ ��
City of Tigard Permit No.: -cO
1111 p CcIV Date/13y: ..i ��S
a 13125 SW Hall Blvd.,Tigard,OR 97 Plan Review
Phone: 503.718.2439 Fax: 503.598.19 Datc/I3y: Other Permit:
Inspection Linc: 503.639.4175
Date Ready/I3 ; Juris: See Page 2 fur
TIGARD g NOV 2 3 2015 ' is: ElInternet: www.ti ard-or.'ov Notified/Method: Supplemental Information
CITY Oc Tr(>ngt�
e..nr sc s COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
TY 0AV;'kRit!ilesi1'; ondl 9f'Ni
Mechanical permit fees*are based on the value of the work
❑ New construction ddition/alteration/replacement performed. Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
1-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist.
0 Multi-family ❑ Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
) �/
Air conditioning 46.75
Job site address:
ja U/ ,ek Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: el7(;Aele41 CR.. q V,?-3 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
Other: 23.32
Subdivision: Lot no.:
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
64S (/18e/-7 w�77.4- 6-1. fireplace 23.32 .
P' Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/Ilue/vent 23.32
PROPERTY OWNEROther: 23.32
0 TENANT
Environmental exhaust and ventilation:
Name: ?JAW/ / /,,;�eLD Range hood/other kitchen
Address: j���s� Kms/e" S/
equipment 33.39
� Clothes
dryer exhaust 33.39
City/State/ZIP: --r; G&‘,_,,--6 ,e/` /q 1 ��3 Single-duct exhaust(bathrooms.
l rt
toilet compartments,utility rooms) 23.32
Phone:( ---- � ) P-200 c 01ca4/ Attic/crawlspace fans 23.32
[APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: ,cLS G _ Z-1—C_..-
Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: R}-cK .....c, , C _ Furnace.etc.
86 J� GT Gas heat pump
Address: Wall/suspended/unit heater
City/State/ZIP: C� t'*t 612-e?,t1 3 Water heater
Phone:((q 60-0-/c),-/ 6, Fax: :( ) Fireplace I •
Range
E-mail:
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: ��-�/� /�� LL C_ Other:
G'--z `� MECHANICAL PERMIT FEES*
oOAddress: 4 s,/ t2,C-` t-C 77 Subtotal
City/State/ZIP: ar ilk; elr--- /3)113Minimum permit fee($90.00) %eV)
l Plan review(25%of permit fee)
Phone:(.93 ����
R / Fax:( )
T1� fo State surcharge(12%of permit fee) /D.�f�,lC'�
CCB lic.: / C.:I TOTAL PERMIT FEE RV•$i'�
ele This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signat • * Fee methodology ser by"17i-County Building Industry Service Board
Print name: �r�ri�L, �Tr� c_4(_4,.___ Date: `/ �3l
I:\Buildine\Permits\MEC t'erm itApp_PIOt 13.doc 044(0 46171'(I J_/COMIWEB)
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\M EC_PermitApp_040 113.doc 2
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12505 SW KAREN ST, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2015-00796
David Young
25 psi, 15 min.
Note: seal gas line penetration in fireplace chase.
Violation Summary:
Inspector Contractor