Permit (11) CITY OF TIGARD MECHANICAL PERMIT
II. .., COMMUNITY DEVELOPMENT Permit#: MEC2017 00595
Date Issued: 08/09/2017
I[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S 102 BA05601
Jurisdiction: Tigard
Site address: 12531 SW GRANT AVE
Project: Ellingson Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 18
Project Description: Installation of wood/pellet stove
Contractor: OWNER Owner: ELLINGSON, LORETTA J
LORI ELLINGSON BARTON, SETH T
12531 SW GRANT AVE BARTON,JESSICA
TIGARD, OR 97223 12531 SW GRANT AVE
TIGARD, OR 97223
PHONE: 503-819-5934 PHONE: 503-819-5934
FAX:
FEES
Specifics: Description Date Amount
Wood/Pellet Stove 08/09/2017 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 08/09/2017 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/09/2017 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N. ' ation Ce ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or d. -ct questions�� to OUNC` y) in 503.232.1987 or 1.800.332.2344.
jN„,ssued By: \ / ,2ke,,, Permittee Signature: X y
Call 503.639.4175 by 7:00 a.m.for the next available inspection` ate
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
_Mechanical Permit Application FOR OFFICE USE ONLY
;J2eceived
City of Tigard 1 � ,, y: V 9 /7 (--Q4 Permit No.: ygii_ j'-a 6-Fs---
"
Date/B
1111 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960% / Date/By: Other Permit:
T 1 G ARD Inspection Line: 503.639.4175 n1', Date Ready/By: Jug: Id See Page 2 for
Internet: www.tigard-or.gov Notified Method: Supplemental Information
161
TYPE OF WORK , 0,.. }% (1 COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
�'`` 1 Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/rel?iac ,1 (g performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: 1 � *` mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
(r 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 1253 I (I (j r011A 4 AV.?. Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Tj I co t b4 p p 1d1.) coC 2 Z 3 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
P e(2Stivka .. e 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 23.32
' `"" c r Gas fir lace/insert 33.39
`DESCRIPTION or �
',4.� '', r' Flue vent for water heater or gas
/l 1=/r 7;01(* C s':- LeCCCd Pc( ( se' G If C fireplace 23.32
Log lighter(gas) 23.32
trod ‘'S.Cr" red L/ T1ill " Wood/pellet stove I 33.39 t'. /(D
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
)" gi PROPERTY'-O ,. " 3
a Other: 23.32
���- '..,,x,',.'fr�`�. ,� `�`� �� ..��> � 4�,L'�',.0 ' r ':t; " Environmental exhaust and ventilation:
Name: L 0 K' 1 i n g S b'1�1 (M LN h e e o"! J�-ibCti r Range hood/other kitchen
Address: c— i ' 4 IL /H f Clothes dr 33.39
�7J� , '� Clothes dryer exhaust _ 33.39
City/State/ZIP: For h a l� / 6 e(0 '7 L2-3 Single-duct exhaust(bathrooms,
/ toilet compartments,utility rooms) 23.32
Phone:(b3) $i g 3 Li Fax:( ) Attic/crawlspace fans 23.32
ar Jig t..- ' '' 1:::;';,i,.I , 11T ' CONTAC r PERSON ""'" ' Other: 23.32
Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional
Contact name:vS ii 4 caw))(A- /3a)y to" Furnace,etc.
Address: f z S- I —j - P a 11+ Gas heat pump
3 `/�'✓ —1 �- Wall/suspended/unit heater
City/State/ZIP: / 9f t 6 4/' (f� -7 q 2 Z Water heater
Phone:(5o3)., g`-- C) Fax::( ) Fireplace
Range
E-mail: jesc i!A Aric(✓rA.S 8cls//�� r'7^A /i. eA.-vl Barbecue
4. '" i ONTRACT Clothes dryer(gas)
Business name: enti - Other:rt
i ;., kIEi CAL PERU ' S*
Address: Subtotal ,(
City/State/ZIP: Minimum permit fee($90.00)Subtotal ,
Plan review(25%of permit fee) -bt -fit
Phone:( ) Fax:( ) State surcharge(12%of permit fee) /-/-- -/MO
CCB lic.: TOTAL PERMIT FEE /'7�"r/
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature:\s.,$;S '}(A.- / `r IGiVPIa F * Fee methodology set by Tri-County Building Industry Service Boa
Print name:( f 6
� ` Date: / /2,643 J 0)00 .8'°
1.\Building\Permits CA
_PermitApp_0400113.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
7/ T $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