Permit CITY OF TIGARD MECHANICAL PERMIT
4
COMMUNITY DEVELOPMENT Permit#: MEC2016-00049
13125 SW Hall Blvd.,Tigard OR 97223 503 718 2439 Date Issued: 01/21/2016Parcel: 2S115AA09000
Jurisdiction: Tigard
Site address: 10727 SW TITAN LN
Project: McDonald Subdivision: BERKLEY ESTATES Lot: 22
Project Description: Install gas fireplace insert,flue vent 8 gas line.
Contractor: MICHAEL SHAWN CALHOUN Owner: MACDONALD, MARILYN C
4985 SE WILLOW ST SPEEDIE,WILLIAM JOSEPH
PORTLAND, OR 97222 10727 SW TITAN LN
TIGARD, OR 97224
PHONE: 503-704-2983 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 01/21/2016 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 01/21/2016 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel Piping 01/21/2016 $14.15
Stories:
12%State Surcharge-Mechanical 01/21/2016 $10.80
Minimum Fee Adjustment-Mechanical 01/21/2016 $19.14
Fuel
Fuel Types: Natural Gas
Gas Pressure.
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Stale of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No"" Center. Those rules are set lorth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir questions to C by calling 503.232.1987 or 1.800.332.2344. (� � /'1�, //
Iss ed By: Permittee Signature: 1i C—" `-�
Call 503.639,4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application
City of Tigard RECEIVEP Received / )' /� PermitN..: H�t�f6_
13125 SW Hall Blvd.,Tigard,OR 97223 Dxroitly. O'r
Plan Review
Phone: 503.7182439 Fax 5(13.598.1960 Date By: Other Penna:
Inspection Line: 503.639.4175 Inn' q 1'
V 2 1 D Date Ready
tho Jwu. ® See Page 2 for
Internet: www.liganl-or.gov NotifiedMethod: Supplememal Information
TYPE ' COMII�RCW. FE�CSCR4ilU,. >_.USE
Mechanical permit fees'are based on the value of the work
❑ New construction ❑ Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition Other: mechanical materials,quipment,labor,overhead,and profit.
Value:S
", CATECIIRY'OF CONSTRUCTION RESIDENTIAL EQUIPMENT f$VSTEM$.FBW i
JZI-and2-familydwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family ❑ Master builder ❑Other: Dcv.mption Qty. I Ea. Total
'JOB SITE INFORMATION.AND-LOCATION Heatin coolin :
- ' • Air conditioning4(.75
Job site address: i on Z"L--1 5-w, \ In L N s Furnace 100.000 BTU(ducts vents) 46.75
City/State/ZIP: Furnace 100,000+BTU(ducts rents) 54.91
Heat pump 6L06
Suite/bldg./apt.no.: Project name: Ductwork 23.32
Cross street/directions to job site: H dronic hot waters stem 23.32
Residential boiler(radiator or
h dronic) 23.32
Unit healers(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue,veal for any of above 23.32
Subdivision: Lot no.,
Other 23.32
Other fuelappliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water healer or gas
6 A \ r 7
fireplace 23.32
�� Lis lighter( as) 23.32
f ` Wood, elletstove 33.39
Wood lire lace/insen 23.32
Chimne ,liner/flue vent 23.32
Other: 23.32
PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:
Name: t L Range hood/other kitchen
D c2 equipment 1 33.39
Address: Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms.
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawls ace tans 23.32
` 11j"PPLICANTOL
CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
` :SIN%V✓Vi, C I ix.0V
$14.15 for first four;54.03 for each additional
Contact name: b Furnace,etc.
Address: Gas heal um
Wall'sus ended'unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( )
Fireplace
Range
E-mail:
Barbecue
, CQNTRACI'OR Clothes dryer( as)
Business name: In C 0 U h Other
�Gi I. ) MECBANICALPERMF!'l
Address: +EESa
"1 W� S Subtotal
City/State/ZIP: O!"t'1b(L -) Z Minimum permit Ice(590.00) Q.
Plan review(25%ofpermit fee)
Phone: Tal �(�
O Shoe surcharge(12°0 of permit fee) 70-_it)
CCB he.: 6 ( 9 6 /7 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within Igo
days after it has been accepted m complete.
Authorized signature: • [cc methodology set by Tri-County Building Industry Service Board
Print name: �'Y""'l� Date: 'L /1� ,�.a�ia� '4157-1-0
1'.Building4ermieu ML(' PermiN Wl11I d,Jor 440. ,1"/ h " ""F- cs�
OP T111 �d'O WGaI per � �/�'
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-F mily 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_PcrmitApp_040113.d,,c 2