Permit CITY OF TIGARD MECHANICAL PERMIT
N. COMMUNITY DEVELOPMENT
Permit#: M EC2017-00935
Date Issued: 11/27/2017
TIG R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S125DB10100
Jurisdiction: Tigard
Site address: 9600 SW SHADY PL
Project: David Crepeau Subdivision: RAZBERRY PATCH,THE Lot: 21
Project Description: Installing(1)gas line for fireplace.
Contractor: COLUMBIA HEATING&COOLING INC Owner: CREPEAU, DAVID E&MARGARET M
PO BOX 230397 9600 SW SHADY PL
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503-624-2704 PHONE:
FAX: 503-598-0270
FEES
Specifics: Description Date Amount
Fuel Piping 11/27/2017 $14.15
Type of Use: SF 12%State Surcharge-Mechanical 11/27/2017 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 11/27/2017 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.23 .1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE LSF ONE)
City of Tigard Received
g r Date/By: Aligi , Permit No.: `,
13125 SW Hall Blvd.,Tigard,OR 97223
y : S' Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 ,ov "' Date/By: Other Permit:f j1 w , 1
Inspection Line: 503.639.41751,1
"` ^' ry O
T I G A 1Z U p �, {� Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov I 1��! Notified/Method: P' Supplemental Information
;W ` TYPE OF WORK o , S� 4 COMMERCIAL FEE* SC.HI,DULE — U,E CHECKLIST
1 r Mechanical permit fees*are based on the value of the work
❑New construction 0 Addition/alteration/r G� performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: :' b mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF' CONSTRUCTION Value:$
` `�' RESIDENT/1U,EQUIPMENT/SYSTEMS FEES* .�
❑ 1-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 ANLOCATION Heating/cooling:
G `° Air conditioning 46.75
Job site address: ('
v 11 Furnace 100,000 BTU(ducts/vents) 46.75
Ci State/ZIP:
tY/ t UZ 72 Z Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: e_y 1,,,,e
Heat pump 61.06
Duct work 23.32
Cross street/directions to job site: ` Hydronic hot water system 23.32
Residential boiler(radiator or
79 -.1 .,....:-.641,-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
Lot no.: Other: 23.32
Subdivision:
z i � ��� Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
ay ' ,,, y 1 CRIPTIO " F wo , M " ry Gas fireplace/insert 33.39
/ `S Flue vent for water heater or gas
(3riii/l c Z7 i/C fI �? fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
L" 0 PROPERTY OWNER * _ .RANT w Other: 23.32
u>=a,p. . 2 t" 'x -. ' r,
Environmental exhaust and ventilation:
Name: ��J.;Z Range hood/other kitchen
Address: el/C v� J ' d othi 33.39
y �// Clothes
s ddryer exhaust 33.39
City/State/ZIP: 1 f cam " C.,)a
017 e Z Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(9)3.) �� 1 t Fax:( ) Attic/crawlspace fans 23.32
',ElAPPLICANT—1/4,, '-". ;, ;1/4'1/4„f3 CON'i`A`CT PERSON'h ' Other: 23.32
Business name: cp__ _ eta
Fuel piping:
fin%' $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 / I i ('c
Range
E-mail:
Barbecue
, CONTRACTOR*.: r1/4Clothes dryer(gas) .
Business name: Other•'
Lei 4...(,,„„k...,:� l��� C
�p MECHANICAL PERMIT ^r. '
Address: / d /�,,, 1 7 Subtotal
City/State/ZIP: --Ti' 'y l/� 5741 Minimum permit fee($90.00) it;,,,10
'� 0 Plan review(25%of permit fee)
Phone:(pp 3 ) 6,2,ii . -7� Fax:( ) State surcharge(12%of permit fee) 10..V)
CCB lic.: 74..3 �`7 CO/LI1 g- TOTAL PERMIT FEE l;U�..�
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: ,r * Fee methodology set by Tri-County Building Industry Service Board
Printname: 0,,12 Cfe t y Date: t//? -z/f 7
I:\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/022/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_PemritAPP_040113.doc 2