Permit OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00568
13125 SW Hall Blvd., Tigard OR :97223 503.639.4171 Date Issued: 10/27/2009
Parcel: 2S114BB02700
Jurisdiction: Tigard
Site address: 16365 SW GREENLAND DR
Subdivision: Lot: 0
Project: , Bartocci
Project Description: Install pellet insert.
Owner: FEES
BARTOCCI, KENNETH A & JENNIFER A Description Date Amount
16365 SW GREENLAND DR
TIGARD, OR 97224 Wood /Pellet Stove 10/27/2009 $33.39
12% State Surcharge - Mechanical 10/27/2009 $10.80
PHONE: Minimum Fee Adjustment Mechanical 10/27/2009 $56.61
Contractor:
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
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 OARi952- 001 -0010 through OAR 952 - 001 - 0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: `S $� _ j ( ie Perm ittee.Signature. �b�.�.�.
Call 503 :639.4175 by 7:00 a.m. for a n:inspection; that business day.
This permit card shall be kept in a conspicuous place on the job until completion of the project.
Approved plans are required on the job site at time of each inspection.
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lVleehanical Permit.Application 1 1�„ ,` a�� w h, k oRo °FF use o? �v _ 16`..V �,4�, I ,
City Of Tigard D E iew Permit No 5 Sligard OR 97223 CEIVE�
Phone: 503.639.4171 Fax: 503.598 :1960 Date/By:.
ther Permit:
Ins ection.Line: 503.639.4175 ..
T I G A R D: p OCT O C T •
2 7 2009 Date eBy: ' S See Page 2 for
.. , i Internet: www.tigard Notified/Method: Supplementallnformation
CITY OF TIGARD
TYPE'-'9F ,wPifitlILDING DIVISION . -`; , COMMERCI'A'Lr"FEE *` SCI EDULEb ; USE CHECKLIST
El New'construction i Addition/alteration /replacement Mechanical permit fees* are 'based'on °the value of flie'work
performed. Indicate the value (rounded to the nearest dollar) ofiall.
❑ Demolition . iOther: mechanical materials, equipment, labor, overhead, and profit.
_ _ Value $
' • .. 'CATEGORY OF, CONSTRUCTION
• -RESIDENTIAL EQUIPMENT / SYSTEMSiFEES*
►:(1- and,2-family dwelling El Commercialindustrial 111 Accessory building
For special. information use checklist:
❑ Multi-family ❑ Master builder ❑ Other: Description Qty. Ea. Total
•• ',JOB;' SITE INFORMATION`;AND,)L y : Heating/cooling
Job site address: 2 ` n CJ t< � i -D� Air conditioning
:J l .�/ (requires site plan showing placement) 46.75
'
11 ^, � ex (:)9..., °\1 • Furnace 100,000 BTU (ducts /vents) 46.75
v J
n _ t er • Furnace 100,000+ BTU (ducts /vents) -' • 54.91
Suite/bidg /apt. no.: Project name: XTVI �A Heat pump 61.06
Cross street/directions to job site: Duct work 23.32 ,
�� n , 1 Hydronic hot water system 23.32 •
Gi .�V�l� / � Y �eNl 1 AY Dv 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
Tax map /parcel no.: Other fuel appliances
' f Water heater 23.32
�
DESCRIPTION 10E' WORKQ • _ , w:, ��
Gas fireplace 33.39
Flue vent for water heater or gas
(\ ` _ ` l \ e - S � `n ` ne -vV- fireplace 23.32
`-,�O:.V\ T if�t] -�Ci Log lighter (gas) 23.32
_ Wood/pellet stove 1 33.39
Wood fireplace /insert 23.32
J , . , ,, , . F. ,, ,: Chimney/liner/flue/vent 23.32. ■ PROPERTY :OWNER il T ENANT
Other: 23.32
Name: \ e •r,i' ' }• -KPX, $0..X-4-be i Environmental exhaust and ventilation
Cj� � Range hood /other kitchen
Address:
\`.Q - LQ l7Y e�" �� Dv equipment 33.39
City /State /ZIP: - 45,,i,e-d, bp,_ on 2-?-4 Clothes dryer exhaust 33.39
f.n Single -duct exhaust (bathrooms,
Phone: ( ' '7 t Fax: ( ) toilet compartments, utility rooms) 23.32
APPLICANT : .a + ,' fl '' „CONTACT PERSON{ `. , ' Attic/crawlspace fans 23.32
Other: 23.32
Business name:
Fuel piping
Contacfname:, c(' . (°5' 42A-' ((�..... L $14.15 for first;four; $4.03 for each?additional -
c
Address: (J Furnace, etc.
� � Gas heat pump
City /State /ZIP: `�” `�` p a ✓ Wall /suspended/unit heater
-Phone: ( ) Fax: : ( ) Water heater
Fireplace
E s' � 4 '�X
E-mail: \O, b 3( (� 1 74:3 (Le - Range
. ,' •.CONTRACTOR°: s e :,,:'::r:
,� .. ' -' Barbecue
Business name: N.,1 Clothes dryer (gas)
Other::
Address: ; i11ECHANICALPERMIT •FEES *
;City /State /ZIP: Subtotal
Minimum permit fee ($90.00)
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee)
TOTAL PERMIT FEE 100 , 80
This permit application expires if a permit is not obtained within 180
Authorized signature:
A. d ays a it has been accepted as complete.
�
Print name: �l l A. .. Date: 1C.) a 1 I On * Fee methodology set by Tri- County Building Industry Service Board
I:\Building\Permits\MEC- PermitApp.doc 10/01/09 440 -4617T (11/02 /COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi- Family Fee Schedule:
Total Valuat><on °Permit Feei__
$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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