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Permit CITY OF TIGARD MECHANICAL PERMIT ;1114 '''' COMMUNITY DEVELOPMENT Permit#: MEC2016-00612 T FGA D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/22/2016 , Parcel: 1 S 134ACO2637 Jurisdiction: Tigard Site address: 11045 SW COTTONWOOD LN Project: MISK Subdivision: ENGLEWOOD NO.3 Lot: 194 Project Description: Gas piping for range. Contractor: AGAPE GASWORKS LLC Owner: MISK, RONALD 8940 SE CLINTON ST 11045 SW COTTONWOOD LN PORTLAND, OR 97266 TIGARD, OR 97223 PHONE: 503-570-9722 PHONE: FAX: 503-775-1007 FEES Specifics: Description Date Amount Fuel Piping 08/22/2016 $14.15 Type of Use: SF 12%State Surcharge-Mechanical 08/22/2016 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/22/2016 $75.85 Occupancy Grp: Stories: Fuel Fuel Types: Gas Pressure: Total $100.80 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not st. ed withi 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you follow the rule adopted y the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-4.:0. You m.- obtain a opy of the rules or dir- .uestio o OUN by calling 503.232.1987 or 1.800.332.2344. Iss d By: / Permittee Signature: 11 -- Cr- 14A--6—LY � irk Call 503.639.4175 by 7:00 a.m.for the next available inspe •. ..te. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE USE O\L1' City of Tigard Received 'f/llf ? Date/B (g" ,7(} kg Permit No.: _ L t /' l I/ . 13125 SW Hall Blvd.,Tigard,OR 97223 , 'i "'n y" t ■ Phone: 503.718.2439 Fax: 503.598. C'#.0'41,‘ ; a It '1 y. DPlate/Byn : Review ,., '°` Date/By: Other Permit: Ti G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for Internet: www.tigard-or.gov % r';i�f Notified/Method: 7.- -(.1.2 Supplemental Information IW TYPE OF WORK COMMERCIAL FEE* SCHEDULE- USE Ctll✓CKLIST y, flE 14 �t t • Mechanical CIA' fees*are based on the value of the work o New construction .,[1,�lddition/alteratioili epl em�e x ' '; • 't` performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: �"k n` \ mechanical materials,equipment, labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES Z and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND-LOCATION Heating/cooling: Job site address: / J C Li b 5- J n Air conditioning 46.75 t' (,_>j(,7 Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 7i C-- ej ©`i Furnace 100,000+BTU(ducts/vents) Heat pump 54.91 Suite/bldg./apt.no.: Project name: 1"`i,( 61.06 W l 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 -,.. m °.. �: � .E ,p �t Flue vent for water heater or gas jszs+ .. c-k DESCRIPTION c`('`'� I 1 'Q 1 ��V fireplace 23.32 (`(�i.L.l 1 J L� FG.r t,..i `�l5 '�"-('ft's Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 "..PROPERTY OWNER 4: r 0'TENANT, Other: 23.32 ` Environmental exhaust and ventilation: Name: To riN. Range hood/other kitchen Address: 1 l G(f - 5j � �'� �` equipment 33.39 `t dC` %(rJ\ Lir\ Clothes dryer exhaust 33.39 City/State/ZIP: `,,,—)ot A 6 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 n•. „� APPLICANT '' 0 CONTACT PERSON Other: 23.32 Business name: Fuel piping: '� �"� � '`k� ��� Lf� "`—� $14.15 for first four;$4.03 for each additional Contact name: +✓ 1'r`1 k__i_t 1(, .ft1 Q 0\- Furnace,etc. Address: i--r-6"--- s iv_ sO 11,,,i-__ Gas heat pump t Wall/suspended/unit heater City/State/ZIP:TG`r k r i 6 (-31 I Water heater Phone:( bi) 3---)0__ q-) 9..,. Fax::( ) Fireplace Range f /ii, E-mail: °t Ls fc, � c,V\•� lt. ( ^ Barbecue V � CONTACTOR Clothes dryer(gas) Business name: „,r /" Other: ( �'�J�,� LLC___ " MECHANICAL PERMIT FEES* Address: + ' d tom« Subtotal f LJ t T City/State/ZIP: -4V J Minimum permit fee($90.00) 1 D. q ) ^� - Plan review(25%of permit fee) Phone:(�l 1)1) .�lb—I-7 aa... Fa ( ) State surcharge(12%of permit fee) i/U .a CCB lic.: + M 98 i TOTAL PERMIT FEE i i 00D v �-y�/ This permit application expires if a permit is not obtained within 180 mes w-Likc Ker,b-" days atter it has been accepted as complete. Authorized '_ re: * Fee methodology set by Tri-County Building Industry Service Board Prin n... /�s� Date: . - r I:\Building\Permits\MEC_PernutApp_040113.doc 440-4617T(11/02/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. I:\Building\Permits\MEC_PermitApp_040113.doc 2