Permit (59) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017-00214
RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/27/2017
f t � g Parcel: 1S133AD11600
Jurisdiction: Tigard
Site address: 10724 SW 127TH CT
Project: Bloomfield Subdivision: AMART SUMMER LAKE NO.3 Lot: 172
Project Description: Installation of tankless water heater,gas piping for water heater and cooktop.
Contractor: VENNE PLUMBING LLC Owner: BLOOMFIELD, REBECCA ANN
15145 SW DIVISION ST 10724 SW 127TH CT
SHERWOOD, OR 97140 TIGARD, OR 97223
PHONE: 503-624-9309 PHONE:
FAX: 503-684-0940
FEES
Specifics: Description Date Amount
Water Heater 03/27/2017 $23.32
Type of Use: SF Fuel Piping 03/27/2017 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 03/27/2017 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 03/27/2017 $52.53
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y. •• .in a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
(Mb
Issued By: Permittee Signature:
G--
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE LSE O11,v
Cl of Tigard ,,.y 9; � P 7 ' ,! Received /�/ 7
u 1,: Date/By: - 417 1(0 - 1- e_�/7_o 7 ,l�
`,7 g Permit No.:
III 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review
IC Phone: 503.718.2439 Fax: 503.598.196 1 "' 2 .i ',-,, i Date/By: Other Permit:
�d„rxi f i �.l�7
1 I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juns: H See Page 2 for
Internet: www.tigard-or.gov (:,'r Notified/Method: Supplemental Information
TYPE OF*WORK COMMERCIAL FEE* SCHEDULE -USE CHECKLIST
Mechanical permit fees*are based on the value of the work
o New construction 1SLAddition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE I1VFORMATION AND LOCATION. Heating/cooling:
t , Air conditioning 46.75
Job site address: Zs.( >0.) i 2,"7 b / v'C. G� Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: -r76.4,6) 0_ 1 Z73 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: // Heat pump 61.06
LbO H fes/ rLL7� 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 j 23.32
DESCRIPTIO * WORK" v` :/ . "r,, Gas fireplace/insert 33.39
//'A� - " -: ` ",• Flue vent for water heater or gas
etk) Cs r..vS A a— = 1 —7,1,0LJ zS 5 /c fireplace 23.32
1 _ e t- ,,.,,,p, Log lighter(gas) 23.32
/�� Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
23.32
;:. 0 PROPERT t`OWNER,-."-A 'viz'' T'EN ...: v..,' Other:
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
Address: equipment 33.39
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
ANT '
APDL ANT ,; 0 ! ,„,ACT•"'ERSON ,., Other: 23.32
Business name: "-e, ,,it t 1,,t„,../
C• Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: V, ,vv,"...- Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( (i.3) S'1 41 ,C2, Fax::( ) Fireplace
E-mail: F' rww�_0ltywv . Range
y ,,,_9,,,, Barbecue
CONTRA Clothes dryer(gas)
Business name: pi, ,gr.1 L t-t•
Other:
Address: t vq 61.0 1-
MECHANICAL PERMIT FEES*.
�yb P� f l Subtotal
City/State/ZIP: , � Oa_ G Fax:( )y Minimum permit fee($90.00) 9(}•�
Plan review(25%of permit fee) ._-----'`
Phone:( )
State surcharge(12%of permit fee) /(�• (/
CCB lit.: I' � / /l t fTOTAL PERMIT FEE 1,2.d
/� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
AprAuthorized signatur-• ?C * Fee methodology set by Tri-County Building Industry Service Board
Print name: 2j Date:
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.
I:\Building\Permits\MEC_PermitApp_040113.doc 2