Permit CITY OF TIGARDIN MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2017-00798
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/12/2017
T f '' ' g Parcel: 2S112CA03700
Jurisdiction: Tigard
Site address: 15540 SW 79TH AVE
Project: Brooks Subdivision: DURHAM ACRES Lot: 19
Project Description: Replacing wood stove with gas stove and installing gas piping.
Contractor: WHITTINGTON&SONS PLUMBING COMPANY Owner: BROOKS FAMILY TRUST
6375 SW CHERRYHILL DR BY WALTER J BROOKS TR
BEAVERTON, OR 97008 15540 SW 79TH AVE
TIGARD, OR 97224
PHONE: 503-536-5910 PHONE:
FAX: 503-648-0617
FEES
Specifics: Description Date Amount
Other,Fuel Appliances 10/12/2017 $23.32
Type of Use: SF Fuel Piping 10/12/2017 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 10/12/2017 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 10/12/2017 $52.53
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 1-ZOr I/ / ? Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONE\
City of Tigard RE !\f Q eived e�
.ate/By: ` I PermitNo.:
II " 13125 SW Hall Blvd.,Tigard,OR 97223 �/ 6,,A.
7 1
1
Phone: 503.718.2439 Fax: 503.598.1960 2017 Plan Review C OCTT Date/By: Other Permit:
Ti G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov CUP(OF I tGAR 1 Notified/Method: Supplemental Information
BUILDING DlVlSI 1
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
0 New construction N'Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
Ign-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: I S S 1-1 0 5 w Air conditioning 46.75
� � Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: PO4,41 U ri tP I 0(L.. q I-2_7_9 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: 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
5 '71111 I s ) L/ DL(9 St' 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
.,, .;% Etil.' PTION 0k' WORKr Gast eplawa'nert $�Gk/C� 33.39
1 "" '' ,. Flue vent for water heater or gas
12, 1 i f ‘` �6 S (c✓I e- A!t- S fv t/L' fireplace 23.32
Log lighter(gas) 23.32 X
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
v' t
Other:
Z; P ERT'' O ,z. vR x. TENANT' t s. : r 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
Address: equipment 33.39
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
... ' jar,qtat k `..t , ` ,/71.,* ,aC NTA ON" Other: 23.32
Business name: i7"11l 1'•1-t vlc)}p V $ ..90 0 c pi a of&W1` m P a i1 Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: 11/1 e f 0 i ft in G h2P1 Furnace,etc.
! Gas heat pump
Address: /S z. so 11l�✓it i)t i t 44. . Iga tit %,t r 0 Wall/suspended/unit heater
City/State/ZIP:✓ Bo IP 4/1'124 l ti( 0V Water heater
Phone:(S03) 530 S9(0 Fax::( ) Fiyalflace 97 a i C I
E-mail:,1110 vl be, e i't) 6 )-C(vu D.(.O:`vl Range
time
1 Barbecue
.'
<; r. CTOR Clothes
' :: ��k dryer(gas)
Business name: W $ Sr - Other:
(.03. --s-- j� f Y ,mEcrome "ipilTFETES*
Address:
� J ate,rd i(')i �f C(4 . Subtotal
City/State/ZIP: ' s J e&t nt 0 4_ el Qot)? Minimum permit fee($90.00)
Phone:(S iD3) 336 S9(0 Fax:(�'0,$) to q (i 0 Plan surchargerev (25%of permit fee)
'J State (12%of permit fee)
CCB lie.: 20 ,7 L q /7/7 / TOTAL PERMIT FEE
W7/7(177! This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: 1, � , * Fee methodology set by Tri-County Building Industry Service Board
Print name:( l wH ' n3(1..fp . Date: 10 ('Z III-
I:\Building\Permits\MEC_PennitApp_040113.doc
440-4617T(1 I/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.
1:\Building\Permits\MEC_PermitAPP_040113.doc 2