Permit (2) •
CITY OF TIGARD MECHANICAL PERMIT
r COMMUNITY DEVELOPMENT Permit #: MEC2013 -00191
13125 S W Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/09/2013
T I c; r1 R. C) 9 Parcel: 2S 102DC06800
Jurisdiction: TIGARD
Site address: 13788 SW 90TH AVE
Project: Beckett Subdivision: EDGEWOOD Lot: 11
Project Description: Installation of gas insert and associated gas piping
Contractor: RICK STICKA LLC Owner: GERTZ CONSTRUCTION CO INC
686 S 25TH CT 19200 SW 46TH AVE
CORNELIUS, OR 97113 TUALATIN, OR 97062
PHONE: 503 - 680 -1046 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 04 /09/2013 $33.39
Type of Use: SF Fuel Piping 04 /09/2013 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 04/09 /2013 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 04 /09/2013 $42.46
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 N. • . on - - -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or di t questions to OU b lin. 503.232.1987 or 1.800.332.2344.
Is ed 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 App FOR OFFICE USE ONLY
LL
City of Tigard 9 EtEI Date/By: / 3 Permit No.: L e.-,../0/ 3 - O� l / M
13125 SW Hall Blvd., Tigard, R Plan Review
Phone: 503.718.2439 Fax: 503.59IR0 O 2 Received
2013 Date/By: Other Permit:
TI G A R D Inspection Line: 503.639 e7 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: .- t ( Supplemental Information
CITY OFTIGARD 1
. ^1•;' - lit v411i ► i t COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction IP • ddition/alteration /replacement 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*
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: I ? - jq S W I 04 Jv e. Furnace 100,000 BTU (ducts/vents) 46.75
City/State/ZIP: - i gaud - O(L, q - 23 Furnace 100,000+ BTU (ducts/vents) 54.91
B
b1 Heat pump 61.06
Suite/bldg. /apt. no.: Project name: + i - 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 WORK Gas fireplace/insert t 33.39
Flue vent for water heater or gas
6 4s / ft 5 44-7 ?-4._ `( W i p L 6-4 ?, ed o� fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney/liner /flue /vent 23.32
ROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: `E raM 40A( 't cie e 77— Range hood/other kitchen
equipment 33.39
Address: /3 7 S e.i.,) ei 0 rze .44,te Clothes dryer exhaust 33.39
City /State /ZIP: Ga Qe_ Single -duct exhaust (bathrooms,
( toilet compartments, utility rooms) 23.32
Phone: ( ) Fax: ( ) Attic /crawlspace fans 23.32
PPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: �y/� _ Fuel piping:
C-l` l l Cam— L L $14.15 for first four; $4.03 for each additional
Contact name: R? UL f Furnace, etc.
Address: l � , . , ---r -2 Gas heat pump
�T • Wall/suspended/unit heater
City/State /ZIP: 1 �yeL f �2 9 )71/3 Water heater
Phone: (sZj3) 6 8o - ti 6, Fax: : ( )
Fireplace
Range
E -mail: r1 "C/ - !7i C /CC` aa 6 ) , [.Om Barbecue
CONTRACTOR Clothes dryer (gas)
Business name: - // k Other:
% CJ� . / / C lC L L C— MECHANICAL PERMIT FEES*
Address: 4 k6 S'' ,-9-..S-1.
- Subtotal
City /State /ZIP: ,8_ L / a - ' o 2 Minimum permit fee ($90.00)
p; �� Plan review (25% of permit fee)
Phone: (V) ) t1�r� ._ ') // a Fax: ( ) State surcharge (12% of permit fee)
CCB lic.: / q d s --q TOTAL PERMIT FEE /eV . F
7 This permit application expires if a permit is not obtained within 180
/ �/ days after it has been accepted as complete.
Authorized signature: __ �� " Fee methodology set by Tri -County Building Industry Service Board
Print name: 7.?/1/4C-1 G <77\C t c-___ Date: C/_ 9 _ / 3
I \ Building\ Permits\MEC_PermitApp_040113.doc 440- 4 (I 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.
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