Permit (44) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017-00039
. DD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/18/2017
GA
t° g Parcel: 2S103DB01900
Jurisdiction: Tigard
Site address: 11495 SW VENUS CT
Project: Kephart Subdivision: GENESIS Lot: 13
Project Description: Installation of wood fireplace insert.
Contractor: TOUCAN PROPERTY INVESTMENT Owner: KEPHART, DAVID& KIMBERLY DANIEL
PO BOX 4134 11495 SW VENUS CT
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503-407-9393 PHONE: 503-403-8582
FAX: 503-640-3448
FEES
Specifics: Description Date Amount
Wood Fireplace/Insert 01/18/2017 $23.32
Type of Use: SF 12%State Surcharge-Mechanical 01/18/2017 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 01/18/2017 $66.68
Occupancy Grp:
Stories:
Fuel
Fuel Types: Solid Fuel
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utilit otification -• er. •• e rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
o direct questions to OU o' by call • 03.232.1987 or 1.800.332.2344.
ssued By: '!� i Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFF ICE CSE 0\1.\ 7 Q
Receiveyd ®�/! •/ /'�
City of Tigard / Permit No.:
■ Date/B : i
iiii . 13125 SW Hall Blvd.,Tigard,OR 97RE( VFP
CE
Plan Review
Phone: 503.718.2439 Fax: 503.598. Date/By: Other Permit:
1 I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: 10 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
JAN 18 2017
TYPE OF MT OFATIGARD) COMMERCIAL FEE* SCHEDULE.- USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ®.Addition/ ttil> dDINR ISION performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: U mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$ r4.
RESIDENTIAL EQUIPMENT/S FEES*
K1-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: C
Lf-
�l(9e7 3&) (/GKL-S Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 7 j be., Furnace 100,000+BTU(ducts/vents) 54.91
W A ZlA Heat pump 61.06
Suite/bldg./apt.no.: Project name: OQfX 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
` P `"`` Gas fireplace/insert OF WORK: � 33.39
, '
Flue vent for water heater or gas
G ,_tµg G - 2,7 1 4,M. e,'�cr fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplacinsert I 23.32
Chimney/liner/flue/vent 23 32
:.." 'F': Other: 23.32
,0 .. TY OWNER
. .. ..,x. r. � ❑ TENANT
Environmental exhaust and ventilation:
Name: atutg f /- Range hood/other kitchen
�„r equipment 33.39
Address: ails va veClothes dryer exhaust 33.39
City/State/ZIP: O� Single-duct exhaust(bathrooms,
,( toilet compartments,utility rooms) 23.32
Phone:(.S) 90Y— er1ZS,Z Fax:( ) Attic/crawlspace fans 23.32
'' C Other: 23.32
* v �,"'A1'1'I.iCANT . _ �M.CONTACT` PERSON,
Business name: `t'O� P5 Fuel piping:
1CC� $14.15 for first four;$4.03 for each additional
Contact name: 7013 V G,�. Furnace,etc.
po Lit 3y Gas heat pump
Address: Wall/suspended/unit heater
City/State/ZIP: tai& L ,,..,..%i `'49----
!7/L3 Water heater
Phone:(6o ) 5ZPr 3'427 Fax::( ) Fireplace
� Range
E-mail: Barbecue
CONNTTR,`.A,CTOR Clothes dryer(gas)
ti/ v Other:
Business name: MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00) '?Q 41°0
Plan review(25%of permit fee) -----
Phone:( ) Fax:( ) State surcharge(12%of permit fee) 10,14
CCB f587 70 TOTAL PERMIT FEE /a).S0
This permit application expires if a permit is not obtained within 180
c"' /1 days after it has been accepted as complete.
Authorized signature: ./V A * Fee methodology set by Tri-County Building Industry Service Board
Print name: ,:,, zriNiffia!--1 `
\B \ \M / "`�/�p ,�, Date: /-16C-20/7
I: uild Building 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