Permit (132) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017-00571
TEGA13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/03/2017
Parcel: 2S102BC08000
Jurisdiction: Tigard
Site address: 12765 SW WATKINS AVE
Project: Kral Subdivision: 1999-007 PARTITION PLAT Lot: 1
Project Description: New wood fireplace and chimney liner.
Contractor: EMERALD OUTDOOR LIVING INC Owner: KRAL, GEORGE L&SARA
2520 SILVERTON RD NE 12765 SW WATKINS AVE
SALEM, OR 97301 TIGARD, OR 97223
PHONE: 503-370-9355 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Wood Fireplace/Insert 08/03/2017 $23.32
Type of Use: SF Chimney/Liner/FlueNent 08/03/2017 $23.32
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 08/03/2017 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 08/03/2017 $43.36
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rule adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-00 lYou mor btain a copy of the rules
or direct questions to OUNC by calling 503.232.19: _ .;44 32.2344. •
IJ,
Issued By: -. ittee Signature:
s
4 .410
Call 503.639.4175 by 7:00 a.m.for the next available inspection e.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONI..\
City of Tigard Received yr
11„, . 13125 SW Hall Blvd.,Tigard,OR 97223 ies)
Date/By: D ��+ Permit
g Plan Review t I
Phone: 503.718.2439 Fax: 503.598.196 ,,,rrrrrr
Date/By: Other Permit: _ �.
TIGARD Inspection Line: 503.639.4175i
Internet: www.tigard-or.gov Date ied/ o: See Page 2 for
201 Notified/Method:
MillSod: Supple mental Information
WC) vics10,4*
TYPE OF WORK .ex/ (ft t 1 1CJ,Q COMMERCIAL FEE* SCHEDULE USE CHECKLIST
❑New construction lL/J Addition/alteratio 0 c'T " Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
E 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory buildin
❑Multi-family building For special information use checklist.
❑Master builder 0 Other: Description
Heating/cooling:
I Qty. Ea. I Total
JOB SITE
INFORMATION AND LOCATION g/cooling:
Job site address: ) L 5w `�\t,�S _Ave_ ir conditioning 46.75
/ ti '1 Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: -71ic‘ri_cQ 0/t-, q 7 2.2_ 3 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: I 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
Subdivision: I Lot no.: Other: 23.32
Tax map/parcel no.:
Other fuel appliances:
Water heater 23.32
a DESCRIPTION OFoly9g, - ,ice, ' Gas fireplace/insert 33.39
i Flue vent for water heater or gas
' �S \'\ Y\ --4-..) Ir vGtQ EM...'cp fireplace 23.32
1_j,‘S� i f i\-v.� Lt 1'.Q Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert / 23.32 ,f-3 3:-/-
Chimney/liner/flue/vent / 23.32 ,)-73,1),
at 11" R PF 11-YaO !NER f4, I .-,r # . * ` Eii .. *. vro- Other: 23.32
` 44Environmental exhaust and ventilation:
Name:
Range hood/other kitchen
Address: equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
Phone: toilet compartments,utility rooms) 23.32
( ) Fax ( )
Attic/crawlspace fans 23.32
"° ,,.
is = �.�, � ..m a' "PERSON"' Other: 23.32
Business name: Fuel p' g:
t
1l\„2.44,,q2. s.,_.
�T �'>, �t Vt h p 1$14.15 for first four;$4.03 for each additional
Contact name: (M(t-i S
Furnace,etc.
Y Gas mpAddress: 2S 2a S' '1 v- iLm,�� nLcQ < 6-
Wall/suspended/unit
/unit heaterCity/State/ZIP: �.oL1','--,
a- .73 0 / Water heater
Phone:(,5-Q3)3 7 D_ q 35E I Fax::( ) Fireplace
E-mail: Range
Barbecue
ed 0 :11'' .CONTRACTOI " Clothes dryer(gas); - „ .r -0 '14
Business name:
.50,_ -10 �s A b 0 Other
Address: . MFCHANICP
5`' ALERI�IITSEES* _: 4- AN
Subtotal qh
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) I Fax:( )
LI
State surcharge(12%of permit fee) iQ'
CCB lie.: I—1 Ct S G TOTAL PERMIT FEE
�} n This permit application expires if a permit is not obtained within 180
Authorized sign re: Ly
l/G�(/j/j\/ days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry Service Board
Print name: Anl5 (0 I Date: ' 3 l '�
1:\BuildingWermits\ C_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