Permit CITY OF TIGARD MECHANICAL PERMIT
' ' COMMUNITY DEVELOPMENT Permit#: MEC2019-00417
T Fc AR F) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/20/2019
Parcel: 25111 CA04100
Jurisdiction: Tigard
Site address: 9760 SW LAKESIDE DR
Project: SIMRELL Subdivision: SUMMERFIELD NO.12 Lot: 661
Project Description: Adding(1)range hood for electric range,(1)bathroom exhaust fan,and(1)gas line to new gas fieplace
Contractor: RICK STICKA LLC Owner: SIMRELL, MICHAEL L&MELODY J
16344 BIG BUCK LN 9760 SW LAKESIDE DR
BEND, OR 97707 TIGARD, OR 97224
PHONE: 503-680-1046 PHONE: 503-453-0206
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 06/20/2019 $33.39
Type of Use: SF Range Hood/Other Kitchen 06/20/2019 $33.39
Class of Work: ALT Type of Const: Single Duct Exhaust(Bathrooms,Toilet, 06/20/2019 $23.32
Occupancy Grp: Utility Rooms)
Stories: Fuel Piping 06/20/2019 $14.15
12%State Surcharge-Mechanical 06/20/2019 $12.51
Fuel
Fuel Types:
Gas Pressure:
Total $116.76
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You m.y obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 0 1.800.332.2344. r /
i
Issued By: _______„...47"
/I/2 Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applicatiri� FOR OFFICE t'SI,O\I.\
City of Tigard Received / `
F 74 ' �0
135
13125 SW Hall Blvd.,Tigard,OR 97223 i z;, : Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 ` ' .0 E1 Date/By: Other Permit:
I 16 A R D Inspection Line: 503.639.4175 i Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
.. ,.. .: .
CO CIAI FEES St Ii1 UUL USEK. „
` MMER r F
Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demoli ' n 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION y RESIDENTIAL 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 Am INFORMATION LOCATIONHeating/cooling:
. .. Air conditioning 46.75
Job site address: // { /J /�
1Q S � �f i' -t�S%/7 Ate— k f�C_ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: --77 6 e7,6 (> t�� 6 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: 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 33.39
` x53 ; x...
,1� t Flue vent for water heater or gas
IPS- L/ AZQ 76 t/ /' ./L-4e fireplace 23.32
Log lighter(gas) 23.32,/ CC)4
/ Wood/pellet stove 33.39
/5/ (11 EX L'J-''r?,�-�j F-4 Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
' PROPER*`-OWNER -1` '. TENANT;- Other: 23.32
' ..i. r. Environmental exhaust and ventilation:
Name: / e „s--i FYI r--� 1( Range hood/other kitchen 1-7 1
_c mn equipment 33.39
Address: 9' 60 � L-/ >4 I)� S � _ Clothes
dryer exhaust 33.39
'------77
�
City/State/ZIP: / / 6 a/)--4 C3(�'- 12:�1 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) i C,,QC.J 'CONT,�AG�'Fax:( ) Attic/crawlspace fans 23.32
x' APPLICANT PERSONOther: 23.32
Business name: Fuel piping:
/ ))�� s?7-6!e/` 1.-6_C__ $14.15 for first four;$4.03 for each additional
Contact name: i Cid• c i/`C:/< , Furnace,etc.
Address: / 3 'J (_� is C,� Gas heas pump
/ cE1 l �? / � �-� Wall/suspended/unit heater
City/State/ZIP: iJ . /'O� 17 ( +2 Water heater
Phone:O$) 6F. /AA
G/C./, Fax::( ) Fireplace 1
1 1�' Range
E-mail: r-/ _, S%/C-/(- - L-if-a--/L. r C 2vM Barbecue
'CONTRACTOR. Clothes dryer(gas)
Business name:
1Other:
�� TTC L L _ MECHANICAL PERMIT FEES*
Address: / Z ‘/C J'? / 6 , L.( _ Subtotal
City/State/ZIP: 3 fz>/,,,/_( / ' 2 2 07 Minimum permit fee($90.00)
Phone:( (�//���yJ i Fes: Plan review(25%of permit fee)
5 T�(J_,,,e16
l� ( ) State surcharge(12%of permit fee)
CCB lic.: ) q 6 5"c TOTAL PERMIT FEE
G 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: 2k57-/- __ Date: 6 ) -/
ci
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-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_PermitApp_040113.doc 2