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Permit (28) CITY OF TIGARD MECHANICAL PERMIT Permit#: MEC2017-00281 • COMMUNITY DEVELOPMENT Date Issued: 04/25/2017 --[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 25111 DD05200 Jurisdiction: Tigard Site address: 15855 SW STRATFORD LOOP A Project: Skjelstad Subdivision: STRATFORD Lot: 6 Project Description: Installation of gas stove,venting and gas line. Contractor: OWNER Owner: SKJELSTAD, GARRETT ARIC SKJELSTAD SKJELSTAD, ARIC C&MELODY E 15855 SW STRATFORD LP 15855 SW STRATFORD LOOP STE A TIGARD, OR 97224 TIGARD, OR 97224 PHONE: 541-743-3232 PHONE: 541-743-3232 FAX: FEES Specifics: Description Date Amount Gas Fireplace 04/25/2017 $33.39 Type of Use: SF Flue Vent for Water Heater or Gas 04/25/2017 $23.32 Class of Work: ALT Type of Const: Fireplace Occupancy Grp: Fuel Piping 04/25/2017 $14.15 12%State Surcharge-Mechanical 04/25/2017 $10.80 Stories: Minimum Fee Adjustment-Mechanical 04/25/2017 $19.14 Fuel Fuel Types: Natural Gas Gas Pressure: Total $100.80 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not sta -d within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules /dopted by the Oregon Utility • Ica io --nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. ou may oblin a copy of the rules or di--ct questions to 0 C by .fling 503.232.1987 or 1.800.332.2344. 411Wik Iss 'ed By: k / Permittee Signature: ^_ 1111 Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE ISE OM.V City of Tigard Received �� n Date/By: ja Permit No.: /�y' gd 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review 11 s Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees*are based on the value of the work 0 New construction X Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRiJCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 12 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: ��S.cc $(,,J S7 6Z.47F1Z © 0 i-p -.0771 Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 7 ,/4 f O 6 CZ (, )-it Furnace 100,000+BTU(ducts/vents) 54.91 / Heat pump 61.06 Suite/bldg./apt.no.: A Project name: /4.„...-3—E_L 6 r'A- ) Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 " Residential boiler(radiator or 5(i.../ A O " S .I RT /Cl Z 0 hydropic) 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 23.32 ' DESCRIPTION-:OF F,:WORK`- Gas fireplace/insert 1 33.39 �1 Flue vent for water heater or gas 1 1 1134a=ri4-?L� OA /f 6 /L7— . fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 PROPERTY OWN R � 23.32 .. ❑ TNANT' Environmental exhaust and ventilation: Name: Q rz 1 L 5 Je ,- 0 Range hood/other kitchen equipment 33.39 Address:r//c q S 7`12.+4-7-1-6z Q ll� Clothes dryer exhaust 33.39 City/State/ZIP: 17( .'-►z D U(Z y> 1a. Single-duct exhaust(bathrooms, cT toilet compartments,utility rooms) 23.32 Phone:(5-11/) 7/.f.3 3 3 Fax:( ) Attic/crawlspace fans 23.32 0'APPLICAN'T �,;. ❑ CONTACT PARSON '` Other: 23.32` � .t 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 f Range E-mail: Barbecue CONTRACTOR Clothes dryer(gas) Business name: d tc)1) E Other: MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) qD.ee Plan review(25%of permit fee) e Phone:( ) Fax:( ) State surcharge(12%of permit fee) ,0.it CCB lie.: / TOTAL PERMIT FEE /%1. 90 ' ' This permit application expires if a permit is not obtained within 180 Vdays after it has been accepted as complete. Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board Print name: /4 21 ( 5 i-_--7-e L,st -0 Date: II-c)r_aQr? I:A Building\Permits AMEC_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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