Permit (10) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017-00725
Date Issued: 09/21/2017
T eea# t. 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S1116D01514
Jurisdiction: Tigard
Site address: 14950 SW 100TH AVE
Project: KEAST Subdivision: ALDERBROOK FARM Lot: 6
Project Description: Wood stove installation and venting.
Contractor: R&D INSTALLATIONS Owner: KEAST, RICHARD&ERIN
5246 SE 62ND 14950 SW 100TH AVE
PORTLAND, OR 97206 TIGARD, OR 97224
PHONE: 503-774-7142 PHONE:
FAX: 503-774-7142
FEES
Description Date Amount
Specifics:
Wood Fireplace/Insert 09/21/2017 $23.32
Type of Use: SF
Chimney/Liner/FlueNent 09/21/2017 $23.32
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 09/21/2017 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 09/21/2017 $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 rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1 '60.$32,234_4 �`�/�
Issued By: •. :-Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application r4 Y, 3 ' FOR OFFICE USE ONLI
iltV,,,ti
4f 'eceived
City of Tigard ''.� Date/By: — Permit No.:J ..'�Y ._ lt13125 SW Hall Blvd.,Tigard,OR 97223 IN
Plan Review
tI Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Date/By:
T 1 G A R D Inspection Line: 503.639.4175
�� N Date Ready/Bed/metho See Pagefor
Internet: www.tigard-or.gov i, ,.]Ii [ified/Method: Supplemental Information
TYPE OF WORK .' �- DIV iSKII COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
New construction t Mechanical permit fees*are based on the value of the work
❑Addition/alteratio acement performed.Indicate the value(rounded to the nearest dollar)of all
L Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
?4:1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
f� + S r O Air conditioning0 ,046.75
Job site address: !lJ S � Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 77y t!/ CJ,e.- Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: y....e�C '. Duct work 23.32
Cross street/directions to job site: �7-r, 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 23.32
,\ : DESCRIPTION OF RK Gas fireplace/insert 33.39
`` Flue vent for water heater or gas
Q
.L 1 (..)•.3 CO
�' flL � fireplace 23.32
t' U`L CT �ii111���"""'��� Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 1 23.323-37
Chimney/liner/flue/vent J 23.32 2-3,9
0 t` gi 'ERTY �,.. ''Z ', ' Other: 23.32
ENANT
Environmental exhaust and ventilation:
Name: 01" '1 4- Et,t S- Range hood/other kitchen
equipment 33.39
Address:
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
a ( AP.w ANT iiia i COI ACT e Other: 23.32
I
Business name: / Fuel piping:
S G -..,5 $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
- Range
E-mail:
Barbecue
4,1 O OR ,:. Clothes dryer(gas)
� � x
Business name:
I D 4-144 /4- S
MECHAVICAIPERMT F°
*
Address: ,s . 2� Subtotal
City/State/ZIP: qCL a- 9
Minimum permit fee($90.00)
t Plan review(25%of permit fee)
Phone:(5(3 77C/-7/C(� Fax:( — State surcharge(12%of permit fee)
CCB lic.: sg 9,S TOTAL PERMIT FEE la-by
This permit application expires if a permit is not obtained within 180
_.----- days after it has been accepted as complete.
Authorized signator . ,/// * Fee methodology set by Tri-County Building Industry Service Board
Print name: 4 L ( n . ''-2/17
I:\Building\Permits\MEC_PermittApp_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
CITY OF TIGARD MECHANICAL PERMIT
:11111 82: COMMUNITY DEVELOPMENT Permit#: MEC2017-00725
Date Issued: 09/21/2017
T f GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S111BD01514
Jurisdiction: Tigard
Site address: 14950 SW 100TH AVE
Project: KEAST Subdivision: ALDERBROOK FARM Lot: 6
Project Description: Wood stove installation and venting.
Contractor: R&D INSTALLATIONS Owner: KEAST, RICHARD&ERIN
5246 SE 62ND 14950 SW 100TH AVE
PORTLAND, OR 97206 TIGARD, OR 97224
PHONE: 503-774-7142 PHONE:
FAX: 503-774-7142
FEES
Specifics: Description Date Amount
Wood Fireplace/Insert 09/21/2017 $23.32
Type of Use: SF Chimney/Liner/FlueNent 09/21/2017 $23.32
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 09/21/2017 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 09/21/2017 $43.36
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 orr1.332234 .
Issued B � > itte4.Signature: /,--"\-
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application y
,-r�, t 9 r, FOR OFFICE USG ONLY
City of Tigard �"'� R, f r.,eceived
w p � " Date/By: " l 1//7 Permit No.: 1 N
13125 SW Hall Blvd.,Tigard,OR 97223 r
Ill Plan Review
Phone: 503.718.2439 Fax: 503.598.1960Other Permit.
Inspection Line: 503.639.4175 , c)\-1 Date/By:
T I G A R D I , Ready/By:Date
Internet: www.tigard-or.gov �F See Page 2 for
k 4, I�Qtified/Method: SupplementalIffl
Information
''if'
3 ik.ti4 P
1 „`r. o l ,,,� COMMERCIAL FEE* SCHEDULE USE CHECKLIST
TYPE OF WORK 1�1 I
}Z j eme Mechanical permit fees*are based on the value of the work
ew construction ❑Addition/alteratiojilacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
-and 2-family dwelling 0 Commercial/industrial ❑Accessory building
0 Multi-family ❑Master builder CI Other: DescripFor special information use checklist.tion Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Vf — 5 CJ (OC)-4-
� Air conditioning0 ,046.75
Job site address: S D Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 77Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: �L„e 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: Other: 23.32
Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF` RK - Gas fireplace/insert 33.39
,r. Flue vent for water heater or gas
t s 19'LA ( (..)•... CO fireplace 23.32
vse Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 1 23.32 ;337
Chimney/liner/flue/vent J 23.32 -3,33
Other: 23.32
PR. , 'RTY OWNER t'TE A ii
Environmental exhaust and ventilation:
Name: 1, ,j._ Et(. Range hood/other kitchen
equipment 33.39
Address:
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
D PL 0 , t Other: 23.32
am^e^ b Fuel piping:
Business : j
name / - S
$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
Range
E-mail:
Barbecue
ONTRA 'TOR�= .''
�_ ,� _ '� �� k Clothes dryer(gas)
Business name: D Other:
Address: J LV 6 5i co ZR 11IECHAIVICAL PFEES .
�n �a Subtotal
City/State/ZIP: P 44 s C , Minimum permit fee($90.00)
t
Plan review(25%of permit fee)
Phone:(50`31 �/�� Fax;( in-- State surcharge(12%of permit fee)
CCB lic.: Y9,5o�.� 7c' TOTAL PERMIT FEE i -S-7")
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signatur ///: * Fee methodology set by Tri-County Building Industry Service Board
Print name: 0l ( fl l9t: ----.2i--/7
I:\Building\Permits\MEC_PermitApp_'"' 11110040113.doc JJ� 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\Pennits\MEC_PermitApp_040113.doc 2