Permit (101) CITY OF TIGARD MECHANICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit#: MEC2017-00762
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/05/2017
TIGARD Parcel: 1 S134BD10200
Jurisdiction: Tigard
Site address: 10824 SW 118TH CT
Project: Robinson Subdivision: PENN LAWN ESTATES NO.2 Lot: 30
Project Description: Gas piping for range and fireplace.
Contractor: HOLMES INSTALLATION SERVICE Owner: ROBINSON, STEVEN S&MARY E
33535 NW VADIS RD 10824 SW 118TH COURT
CORNELIUS, OR 97113 TIGARD, OR 97223
PHONE: 503-647-9320 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 10/05/2017 $14.15
Type of Use: SF Minimum Fee Adjustment-Mechanical 10/05/2017 $75.85
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 10/05/2017 $10.80
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503. 2.1987 or 1.800.332.2344.
Issued By: , Permittee Signature: (//4„).-
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONE
City of Tigard Date/By: Permit No.: -
Received r / _,
III q 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C: Phone: 503.718.2439 Fax: 503.598.1960 C C 017 Date/By: Other Permit: ,, 7 y
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Suns: 10 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
IDNew construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
El Demolition Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
Multi-family ❑Master builder El Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: OC7 "IA), `/u Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: I 1.5- CV- 0 Y�/ Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Prt�ject name: 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: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
``; DESCRIPTION OF'-WO)fi�7: ` " Gas fireplace/insert 33.39
ti. `�` Flue vent for water heater or gas
7c-LCct S 1'� y 4- fireplace 23.32
�/ 1 l� 1)/4C
Log lighter(gas) 23.32
C l ,,,((pJJ""�j� Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
Al: PROPERTY. •Q R f P ❑ TE
x � ° �� :,'�' Environmental exhaust and ventilation:
Name: k- t 14 SO Range hood/other kitchen
eq� s�, l I ?--/-1.
t + - Clothes drnt 33.39
Address: ) � � h J Clothes dryer exhaust 33.39
City/State/ZIP: 1 ( 0.A .ov--e.., Single-duct exhaust(bathrooms,
�� �G y Lt " toilet compartments,utility rooms) 23.32 __
Phone:(7`+ _I o- ( ,o Fax:( ) Attic/crawlspace fans 23.32
ve p r ' . ®t s RSON Other: 23.32
Business name: .'�'r�4i- /� �f.y,- Fuel piping:
�Glti $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
3t ,
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
,CONTRA(TOR ...i-. , „,_,um Clothes dryer(gas)
Busin �� 4/ S Other:
e A '113ECHANICAL PERMIT FEES* T
Address: S W 1v W V^b 1 C I Subtotal
City/State/ZIP: l IQ tA,eo l (vR 0•y'J- 9'4-7
'�Il 3 Minimum permit fee($90.00)
�j Plan review(25%of permit fee)
Phone:` O_ 01.6 7 _7 c 7 Li Fax:( ) State surcharge(12%of permit fee)
CCB lic.: /( 0.1--1.( 47 3 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
p„w:0_1:Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: th (,, j `."v Date: S
I:\Building\Permits\MEC_PermitA p 040t13.doc 440-4617T(11/02 OM/WEBf
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 fust$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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