Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017-00712
i Co'A D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/18/2017
T-
Parcel: 1 S 133DC05700
Jurisdiction: Tigard
Site address: 13475 SW BRITTANY DR
Project: CUNNINGHAM Subdivision: BRITTANY SQUARE NO.1 Lot: 15
Project Description: Replacement wood stove insert.
Contractor: REFINER'S FIRE SERVICES Owner: CUNNINGHAM, GREGORY&TERESA J
19105 S LYONS RD 13475 SW BRITTANY DR
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 971-275-7592 PHONE:
FAX: 971-223-3232
FEES
Specifics: Description Date Amount
Wood/Pellet Stove 09/18/2017 $33.39
Type of Use: SF Chimney/Liner/FlueNent 09/18/2017 $23.32
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 09/18/2017 $33.29
Occupancy Grp: 12%State Surcharge-Mechanical 09/18/2017 $10.80
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes ,nd all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started in 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules a...ted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. o. -in a copy of the rules
or direct questions to OUNC by calling 503.2%.1987 or 1.800.332.2344.
Issued By: / Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
Cl of TI and Received Permit No.:
IN `.f g Date/By: G� I 7 ',„ „..,,
_
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598 Plan Review
EC1 Other Permit:
i Date/By:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: J ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: 7-. .d. Supplemental Information
SEP 1 8 2017
OFrift COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
OF
n0ARD Mechanical permit fees*are based on the value of the work
❑New construction constructionraiX••<.-kfition/StIftsigtItilSehil `i , performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
and 2-family dwelling El Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: t'b”f.5 d/'f 4-6-‘4,-&1_ j7 jL Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: ----'
V� 0�a,,� Ot 22-"t› 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: t 3 S + 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`WOR* - s .,-;.1.41,,7Gas fireplace/insert 33.39
x'
Flue vent for water heater or gas
?e.v(.li�`.Q 6,.2.4-0A-A- LtiCOJ-- LdJ‘e -'T fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove . 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 0 23.32
.. Other: 23.32
ral OPERTY OWNER _ ..' wv
Environmental exhaust and ventilation:
Name: .-i.p a Range hood/other kitchen
equipment 33.39
Address: 1y4 1r? �:.J -' t _ _ . 'L Clothes dryer exhaust . 33.39
City/State/ZIP: . �� -- ` �`1 Vi---5 Single-duct exhaust(bathrooms,
\-� .— toilet compartments,utility rooms) 23.32
Phone:( 9 . 13 •5'� Fax:( ) Attic/crawlspace fans 23.32
' ` `ACT',PERSON F -'t Other: 23.32
`� APPLICANT: ; ;,� � . s
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Gas heat pump
Address:
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
;} ' t „*- : CONTRA O Y. mit
: ,t x1� Clothes dryer(gas)
Other:
Business name: ` .ec► _ `,),i C.Q j%Ik #ANI L PE ti l T *.
•
Address: zo Li 3 5 C'I e 1 J Q1 12L( Subtotal
Minimum permit fee($90.00)
City/State/ZIP: ��� '�' 1 , �j(z 705 Plan review(25%of permit fee)
Phone:(C t) a - I : 34 T�\ Fax:( ) State surcharge(12%of permit fee)
CCB lic.:` p k l TOTAL PERMIT FEE df„_1'
This permit application expires if a permit is not obtained within 180
i' days after it has been accepted as complete.
Authorized signature: '� * Fee methodology set by Tri-County Building Industry Service Board
Print name: e,,.,,c,Qs> j,` '�N Mi►t�t„n., Date: cAl Vis-\11
I:\Buildmg\Permits\MEC_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\Pennits\MEC_PermitApp_040113.doc 2
CITY OF TIGARD MECHANICAL PERMIT
IN ..- . COMMUNITY DEVELOPMENT Permit#: MEC2017-00712
"',GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/18/2017
Parcel: 1 S 133DC05700
Jurisdiction: Tigard
Site address: 13475 SW BRITTANY DR
Project: CUNNINGHAM Subdivision: BRITTANY SQUARE NO.1 Lot: 15
Project Description: Replacement wood stove insert.
Contractor: REFINER'S FIRE SERVICES Owner: CUNNINGHAM, GREGORY&TERESA J
19105 S LYONS RD 13475 SW BRITTANY DR
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 971-275-7592 PHONE:
FAX: 971-223-3232
FEES
Specifics: Description Date Amount
Wood/Pellet Stove 09/18/2017 $33.39
Type of Use: SF Chimney/Liner/Flue/Vent 09/18/2017 $23.32
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 09/18/2017 $33.29
Occupancy Grp: 12%State Surcharge-Mechanical 09/18/2017 $10.80
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started .• in 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules a...ted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. . o. -in a copy of the rules
or direct questions to OUNC by calling503.2 .1987 or 1.800.332.2344.
Issued By: Permittee Signature: VAIIIIIIIkb
/,/,,,,4
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
Date/By: Permit No.: 77
13125 SW Hall Blvd.,Tigard,OR 97223 � � 'Q,l�'�
.1111 i Phone: 503.718.2439 Fax: 503.59 8 "AJ I
Date/By:
Line: Plan Review Other Permit:
T I G A R D Inspection 503.639.4175 Date Ready/By: funs:
Internet: www.tigard-or.gov See Page 2l for
SEPy )�}{/ Notified/Method: 7.- .6r. Supplemental Information
1 8 201 t V
TYP
OF COMMERCIAL FEE* SCHEDULE USE CHECKLIST
A dr' ° OF II ARD Mechanical permit fees*are based on the value of the work
El New construction ddition/�r [25INROM S10 r( performed.Indicate the value(rounded to the nearest dollar)of all
mechanical materials,equipment,labor,overhead,and profit.
El Demolition ❑Other:
Value:$ -�—,
CATEGORY OF CONSTRUCTION !�-
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description P Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
t d'� 5Air conditioning 46.75
Job site address: �JcC ��
�t i ( 4-�G'v�-M ..P11.- Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: ---7: �[v` OR- Ol X122 > Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name:S Heat pump 61.06
Duct work 23.32
Cross street/directions to job site: t 3 '5 #t.- 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
� DESCRIP�'IOIY O ',�°VVO� r �y . .� Gas fireplace/insert 33.39
.- .° Flue vent for water heater or gas
i,e-c)t (LQ 6,2.4.04.- . wood, 5.ko,h, ,i---C fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove . 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 1*{ 23.32
, w. 1DPEIireow. R4- ' vli 1 n vim, Other: 23.32
. w ,,
Environmental exhaust and ventilation:
Name: �' C ��1-^- Range hood/other kitchen
I equipment 33.39
Address: 13 1 e_):.3 � Clothes dryer exhaust 33.39
City/State/ZIP: ---\--A . e_t� 6f,- Ct 1,L.L...5 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone: ?)) ,
( 13 Z— Fax ( ) Attic/crawlspace fans 23.32
�;: tN' k Other: 23.32
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
Range
E-mail:
Barbecue
. ,nM.. ;;�
CONTRACTORr R , Clothes dryer(gas)
Business name: �,� ^ `p Other:
ei-t .l �e �J M'� Ce ,9 - i iicilA ICxL P' RMI?FE *' `%
Address: 2)LA 3"'j
5 GI e i �,r 26` Subtotal
City/State/ZIP: d ,sc..—I C,' .,t 6 2 q10 4 5 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:
a� A3 ( ) State surcharge(12%of permit fee)
CCB lic.: C p t.Akt.k TOTAL PERMIT FEE 0,._.P
This permit application expires if a permit is not obtained within 180
OMdays after it has been accepted as complete.
Authorized signature: "��' * Fee methodology set by Tri-County Building Industry Service Board
Print name: C-�(` (N p "', 6 Date: cil \Vic1 11
I.\Building\Permits\MEC_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