Permit (9) CITY OF TIGARD74
MECHANICAL PERMIT
2 `' COMMUNITY DEVELOPMENT MECHANICAL
MEC2016 00635
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/01/2016
Parcel: 2S 104 BC07900
Jurisdiction: Tigard
Site address: 14125 SW MITCHELL CT
Project: Hindman Subdivision: HILLSHIRE CREST Lot: 1
Project Description: Move gas line for cooktop
Contractor: TRUE BLUE PLUMBING LLC Owner: HINDMAN,GAVIN D
3300 NW 185TH AVE#311 14125 SW MITCHELL CT
PORTLAND, OR 97229 TIGARD, OR 97223
PHONE: 503-747-9989 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 09/01/2016 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 09/01/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 09/01/2016 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct q :< .• • OUNC by calling 503.232.1987 or 1.800.332.2344. ///
Issue,; By: j i / � Permittee Signature: //
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applicata ii FOR OFFICE CSE()NEN
1 Received 9�
City of Tigard Date/By: `�� (// / Permit No.:He �� QD 3
III13125 SW Hall Blvd.,Tigard,OR 972,if. ' !- ! < , Plan Review L
Ill Phone: 503.718.2439 Fax: 503.598.1960Date/By: Other Permit:
T 1 G A R D Inspection Line: 503.639.4175 # Date Ready/By: Juris: 61 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
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TYPE OF WORK COMMERCIAL FEE* SCHEDULE— USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
,"ll-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:
Air conditioning 46.75
Job site address: l LI ( 2,.„5--- S(A) /14 „lac(( L+. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: �`r U`o�� OK 7 Furnace 100,000+BTU(ducts/vents) 54.91
/, �n`.
/44 B M R N 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
MoU& C5D c rol- &-fir e fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
❑ PROPERTV OWNER , 0 TENANT Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: 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
APPLICANT 0 CONTACT PERSON Other: 23.32
Fuel piping:
Business name: -rt t,( /V 4'(� -F7' fit Vvjt j,trt . $14.15 for first four;$4.03 for each additional
Contact name: YSe,i1 vt!- V Furnace,etc.
Address: 3 '
�_ � i S_ jd /4 u e #3i( Gas heat pump
} Wall/suspended/unit heater
City/State/ZIP: -pZx ci'(at / �� `"/ 7.2:2--} Water heater
Phone:(3 ) �7-l /3 , g 3' Fax::( ) Fireplace
t.. Range /
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name:
4 R AI MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00) 4511'`,/l•D' I
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) 1,-, ,,0
CCB lie.: 1 97 29 0TOTAL PERMIT FEE /pp.$>]
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
,,ee•
Authorized Signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: "�a gcl -1.--4 C,;+i.)I.'/ Date: 9'— 1 (C
I:\Building\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:
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.
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