Permit CITY OF TIGARD MECHANICAL PERMIT
111
11 . COMMUNITY DEVELOPMENT Permit#: MEC2016 00320
T!GA R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/05/2016
Parcel: 2S 111 CA00500
Jurisdiction: Tigard
Site address: 9888 SW SATTLER ST
Project: Staehnke Subdivision: ALDERBROOK FARM Lot: 10
Project Description: Gas line for fireplace.
Contractor: GO DUCTS Owner: STAEHNKE, MARK D&ADINA MICHELL
253 N OLIVE ST 9888 SW SATTLER ST
YAMHILL, OR 97148 TIGARD, OR 97224
PHONE: 971-226-9504 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 05/05/2016 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 05/05/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 05/05/2016 $75.85
Occupancy Grp:
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 i OAR 952-001-0010 through OAR 952-001-1090. •u may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1*: or 1.800.332.23 /
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Issued By: ‘ Permittee Signature:
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Call 503.639.4175 by 7:00 a.m.for the next available inspection ,ate.
This permit card shall be kept in a conspicuous place on the job site until comp -tion of e project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FoR 0141(4. i. s1:oNl.)
City Of Tigard RECEIVEII Deactee,iBveyd: QP v / Permit No.: yti?f � � O
_
YL7`V-13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Inspection Line: 503.639.4175 /y 2016
�� fG?`QC)(�5--
11(,
I I(,ARI MAY U 5 2016 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
I t
iiir�3 +rbc x' l xm ,, x .;�i $ ,I,„„:„..',.. ,, "`. i,', owittf .7 ` z „77t 'r ���:
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s''*a.. r t t' x r ,, ,i.*..✓ 1 ..the '"
f a ■ • • Mechanical permit fees*are based on the value of the work
❑New construction M.4 Addition/alteration rep acement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
": g s , ,f ,}„, �, ; hVr Value $
E "!4'''' a *4 t % 1 0 d r st` '' 'u ' '';''''''. z't+. #:�... '-v; e A x : , 1 - : i r'"w ia'e t '� a hg..
.rt . � �Rt°Ma�..a'r� �e�„ ^r�r�.w�t,* '�. �, •t � S�� �r t n�£'�`
(Xt I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑ Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
' ,�t > sem, t t w( 'r;� ,ri Heating/cooling:
.. ' : Ni 3 '. x, . M „», , Air conditioning 46.75
Job site address: 9' g f.k) �,.... --`I S+4 Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: i' ol 9 7 'L 2 y Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: I Project name: Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
1..1 R& I l aGk_ >�os+ c.4- 60 �II:. Residential boiler(radiator or
hydronic)
23.32
Unit rs(fpe,not electric),
(3.c. /O S drf\c , in- all,in-duct,suspended,
etc. 46.75
Flue/vent for any of above 23.32
Other: 23.32
Subdivision: 1 Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
i f►iii N wm ' 1.V71.,
f Gas fireplace/insert
33.39
'I .-Yx, „ ," (,, ;; M,.,_ - rc, , .. , , r''; '',t fi, a Flue vent for water heater or gas
, fir lace 23.32
r Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
,,': 1 t 1 ,'*-',t,,�:. ', F3 .. '..''''''', "?!..;*V:-:.i -'- -•i,.� .' q'' ,.L .*.-_'As '-..'t'i-,1%.P` Environmental exhaust and ventilation:
Name: M I� s r att m Ic'Q. /A-of,� Oil` fa,--i Range hood/other kitchen
t l equipment 33.39
Address: S,..e._ Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
n 3 '� lmi arr ys r "3 r rt. e
lK�"az, ,., '`Mtil.:..,!";. :..4%, ,..,,,,,,�ka ?:a bi..+, : ;a. a,,r.` s-.. � oi :
Other: 23.32
Fuel piping:
Business name:-..16441rojipplilk /hi
k) Le-1,1 1,4 . $14.15 for first four;$4.03 for each additional
Contact name: ' d3-J1-(14.1"-.7 &iSS�,-VV( Furnace,etc.
Address: Gas heat pump I
5�'^^ 1 Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:66 ) y/ - $'6 1 c" I Fax: :( ) Fireplace X
E-mail: Range
_ Barbecue
x .' .o- ° =G ,��;aa t;, , ,� ) t W,, , .,..,5-..„1,,,_.,...-,i.4., , M . > � / Clothes dryer(gas)
Business name: Other
C v 0,„,Js 14 JA-L i k , oxot ' S,,, r.,,. .10 .
Address: ,5' D N O 1,i,' ST• Subtotal
City/State/ZIP: \/01yh j If A k GSM�C i 8— Minimum permit fee($90.00) V.l7V
Phone: t Plan review(25%of permit fee)
(�]/ ) 2� 6- �S LJ Fax:( ) State surcharge(12%of permit fee) i d. e)
CCB lic.: a 2 Z S/'3A to,
TOTAL PERMIT FEE)(jib,t2)
I
I/ This permit application expires if a permit is not obtained withinn 180
days after it has been accepted as complete.
Authorized signature: // * Fee methodology set by Tri-County Building Industry Service Board
Print name: "(,l, a e” Date: S/S//b
IrBuilding,Permits,MEC_PermitApp_040113,doc 440-4617T(11 02,COM'WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Family Fee Schedule:
$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_PermitApp_040 1 13.doc 2