Permit '1,4 , OF TIGARD MECHANICAL PERMIT
'' COMMUNITY DEVELOPMENT Permit#: MEC2017-00073
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 01/30/2017
TI[ F41?i7 9
Parcel: 2S114BA14700
Jurisdiction: Tigard
Site address: 9500 SW MARTHA ST
Project: Brown Subdivision: COPPER CREEK STAGE 4 Lot: 112
Project Description: Installation of gas piping for gas log set.
Contractor: HOLMES INSTALLATION SERVICE Owner: BROWN, BARBARA J
33535 NW VADIS RD 9500 SW MARTHA ST
CORNELIUS, OR 97113 TIGARD, OR 97224
PHONE: 503-647-9320 PHONE: 503-624-9448
FAX:
FEES
Specifics:, Description Date Amount
Other,Fuel Appliances 01/30/2017 $23.32
Type of Use: SF Fuel Piping 01/30/2017 $14.15
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 01/30/2017 $52.53
Occupancy Grp: 12%State Surcharge-Mechanical 01/30/2017 $10.80
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issua work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
ility Notification .-nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to O ' .y c. '-. 03.232.1987 or 1.800.332.2344.
Issued By: . , I Permittee Signature:
/4.-: (. --- r IL/r-itrv66-..4j/
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE LSL O1L1
City of Tigard Received / �A �� • ,, ��►yy�7
Date/By: ` vV ArmidI ��iia Permit No.:1,/ / 7 e2Z2)
13125 SW Hall Blvd.,Tigard,OR 97223 ,, l` /
II Phone: Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 l' a PlanDatey:
'T I G A R D Inspection Line: 503.639.4175 ,P _ Date Read/B Iuris:
Internet: Line:www.tigard-or.gov Ready/By: Supplemental See Page 2 nr
'��'�( Notified/Method: Information
��N
':E OF WORK ii,11,, COMMERCIAL.FEE* SCHEDULE - USECHECKJAST
4 1,4- Mechanical permit fees*are based on the value of the work
❑New construction I: Addition/alteratiV\� r performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition • Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION.;
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
Multi-family 1=1 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
( C--�,r O LAI
' 1,s^ G/1 n S,.-� Air conditioning 46.75
Job site address: "7 v v /V` t?�I(J, 7 )
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 1 \c c{/ L Ove_ 9 -7 a.L Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: 7 Project name: Heat pump 61.06
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
Oth
Subdivision: Lot no.: er' 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
- DESCRIPTIO$ OF"WitK `"7 4444: '"'4 Gas fireplace/insert 33.39
�` a .. /. f-y /"" ,�_ Flue vent for water heater or gas
-1 'TsC I k, 5 O n(,4 / ("v A U- LJ�n ). I fireplace 23.32
1 -�J Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/ t 23.32
23.32
ROPERTY;q,*, E., ', !: : � 7t.
tis
� Enviro Im ntal exhaus d ventilation:
Name: 01„t J A-f j4 yovv Range hood/other kitchen
equipment 33.39Address:(t 5---QJ S v -/ /- $ .)
Clothes dryer exhaust 33.39
City/State/ZIP: ( p. O�._ q 7 L 1 Single-duct exhaust(bathrooms,
�/ toilet compartments,utility rooms) 23.32
Phone: �l r 7 r^ � Fax:( ) Attic/crawlspace fans 23.32
APPLICANT h . ❑ CONTACT' PERSON `' a Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail:
Barbecue
CONTRACTOR Clothes dryer(gas)
Business na Ll/v1V�!-9 —.i-52 - L 1 ( Other:
Address 3S Sc JV ZAJ a1 1✓ I 1 � MECHANICAL PERMIT FEES*
.n Subtotal
City/State/ZIP: Co A o c.._\k s 0 v-e.. 1 7 l/3 Minimum permit fee($90.00)
Phone:; )OZt, 7, 7 5-7 Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lic.: C° 67._ 1 7 3 TOTAL PERMIT FEE /GV.
g
This permit applicationsit hasrbs if a permit is not obtained within 180
days after it been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
I
Print name: gA-y ( 4,N pc*1� Date:1� )
I:\Building\Permits\MEC P tApp_1040113.doc 40-4617T 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\Pennits\MEC_PermitApp_040113.doc 2