Permit (83) CITY OF TIGARD MECHANICAL PERMIT
1111
COMMUNITY DEVELOPMENT Permit#: MEC2017-00241
Date Issued: 04/05/2017
T[Cy R L 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S103BB04600
Jurisdiction: Tigard
Site address: 12373 SW KATHERINE ST
Project: Pham Subdivision: BROOKWAY Lot: 46
Project Description: Installation of(1)wood stove.
Contractor: OWNER Owner: NGOC PHAM
NGOC PHAM 6885 SW 144TH PL
6885 SW 144TH PL BEAVERTON, OR 97008
BEAVERTON, OR 97008
PHONE: 405-761-2725
PHONE: 405-761-2725
FAX:
FEES
Specifics: Description Date Amount
Wood/Pellet Stove 04/05/2017 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 04/05/2017 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 04/05/2017 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types: Solid Fuel
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N. • . -nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir, t questions to Ob'C b ailing 503.232.1987 or 1.800.332.2344.
Issu•d By: , / Permittee Signature: X Com----
.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE 1 SF ONI.I
City of Tigard Received '/
g k P Date/By: Ili S / Permit No.: H L 7jQe r
13125 SW Hall Blvd.,Tigard,OR 'q0 1 6+ Plan Review
Phone: 503.718.2439 Fax: 503.59: i' 1� Other Permit:
201 Date/By:
TI G A R D Inspection Line: 503.639.4175 (( Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov APR Notified/Method: Supplemental Information
TYPE OF G° Dlv�S�� COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction 0 Addition/alt ation/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT I SYSTEMS FEES*
❑ 1-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: I 13 73 5 IA) k(pi i N ER I,l; 5 Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 1-1
1 r1 C1 r J J o g g 7 223 Furnace 100,000+BTU(ducts/vents) 54.91
J P), i 1
Heat pump 61.06
t�
Suite/bldg./apt.no.: Project name: �I-1 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.: �Oth23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 123.32
DESCRIPTION 01piik9RK
Gas fireplace/insert _ 33.39
' Flue vent for water heater or gas
fireplace 23.32
01 c, l fe` W i �'�. f Log lighter(gas) 23.32
J /" Wood/pellet stove I 33.39 3-3-3cj
Wood fireplace/insert 23.32 1
Chimney/liner/flue/vent 23.32
i'ROPEIiTI'?OWNER `' Other: 23.32
. ] TENANT '<.
Environmental exhaust and ventilation:
Name: f J J G pi,,,,, (,,, .re) Range hood/other kitchen equipment 33.39
Address: 5tA, ILI/4 ti Clothes dryer exhaust 33.39
City/State/ZIP: &e,U Q t0 n 00 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(140 5 ) /4;1 17,Z S Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
Business name:
Fuel piping:
1 $14.15 for first four;$4.03 for each additional
Contact name: o dd C re 0 5 11 u s n J) Furnace,etc.
Address: ts, Gas heat pump
5 i Lig
t l /n i Wall/suspended/unit heater
City/State/ZIP: )env et to a 9., (A700i Water heater
0.405 Fax::( ) Fireplace
Range
E-mail:
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: Other:
�� gr MECHANICAL PERMIT FEES*
Address: Subtotal 3 Sl-
City/State/ZIP: Minimum permit fee($90.00) lo_ t
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) f 1 ti
CCB lic.: TOTAL PERMIT FEE A( .
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signatureAct__
F ��r7i i * Fee methodology set by Tri-County Building Industry Service Board
Print name: p t a „v I Date: zt j .1_I:\Building\Permits\MEC_Permitip040113.doc '` y'' \ 440-46171 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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