Permit CITY OF TIGARD MECHANICAL PERMIT
111 • COMMUNITY DEVELOPMENT Permit#: MEC2019-00101
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/20/2019
T I`"�i`�� g Parcel: 2S103DB04800
Jurisdiction: Tigard
Site address: 11155 SW NOVARE PL
Project: Miller Subdivision: GENESIS NO.2 Lot: 46
Project Description: Replacing gas fireplace with updated insert.
Contractor: OWNER Owner: MILLER FAMILY TRUST
DARYL MILLER BY MILLER, DARYL R&DEBORAH H TRS
11155 SW NOVARE 7 VIA ARRIBO
TIGARD, OR 97223 RANCHO SANTA MARGARI, CA 92688
PHONE: 949-939-2070 PHONE: 949-939-2070
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 02/20/2019 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 02/20/2019 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 02/20/2019 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. c�—,�� ,/'�,
Issued By:70, 4� ! . /./e.......&{ .."
/7 Permittee Signature: �1.J� . +`
. 1 JCS
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application 1: .-7 FOR OFFICE USE ONLY
City of Tigard FEBA •Date/By: �(
ay
IIII13125 SW Hall Blvd.,Tigard,OR 97223 E 019 Review �V [` ��r� -
_ 2 C U!.7 Plan Review /
Phone: 503.718.2439 Fax: 503.598.1960Date/By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov ° ,,__ K siotified/Method: Supplemental Information
TYPE OF WORK d O1SIM :ERCIA FEE* SCHEDULE- USE CHECKLIST
.x.. rte. - ,- z .... ,
Mechanical permit fees*are based on the value of the work
❑New construction ;®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,andprofit.
Value:$ 15 0 0
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
;31-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 ,x Heating/cooling:
3. .v
Air conditioning 46.75
Job site address: t 1 1 5 5 S (J v it is c--... 0 L_ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: —T.% c-;1 t2 U il)-- G 7 Z'z 3 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: G ,.1 FS 1 c, L__ ---I t Hydronic hot water system 23.32
Residential boiler(radiator or
1\2'C)v ci r -e_. e L 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
9 ,i)E�CRIDTION '+rwo*! Gas fireplace/insert ) 33.39
Flue vent for water heater or gas
-C. IRC o‘ a C(c i c'f i) V e l A-c.C4 c"�G:$ _fireplace 23.32
Log lighter(gas) 23.32
C 1 ,'< r7 \ Cx c‹, w ,4-�--, t✓ a c›,--\--�. Wood/pellet stove 33.39
l tM S c_--4- Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Rf� Tl t ,' G.a ''i Other: 23.32
�}`h a*:?.. 0 NAM T ..
°•��^� x - 7 r• •, -• '.# Environmental exhaust and ventilation:
Name: '--- o.,-- t r , irs-1 ; i '--e t--- Range hood/other kitchen
Address: 11 ( S S S WN G U j. L... equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: —r i Single-duct exhaust(bathrooms,
ty � '� Z 3 toilet compartments,utility rooms) 23.32
Phone:(91 C1 3 cl -?.-C.)--T 0 Fax:( ) Attic/crawlspace fans 23.32
e. . V. 0 CONTACT POa
N ' Other: 23.32
v
Fuel piping:
Business name:
^ $14.15 for first four;$4.03 for each additional
Contact name: l (A S (:\63 CD.-6 Furnace,etc.
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: a 1,(r \ -v" L) Cs , 8 v Barbecue
* CONTRACTOR: Clothes dryer(gas)
Other:
Business name: ' MECHANICAL PERMIT PI S* A' Y'
Address: .t
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( State surcharge(12%of permit fee)
CCB lic.: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
( days after it has been accepted as complete.
Authorized signature: `� , '%V t�C� * Fee methodology set by Tri-County Building Industry Service Board
Print name: `l l Y L , .'ti i �.CC,-2 Date: Q Z- ZO ‘`t
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-FamilT Fee Schedule:
Tott 1 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