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Permit CITY OF TIGARD MECHANICAL PERMIT C OMMUNITY DEVELOPMENT P ermit #: MEC2009 -00676 4j GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/23/2009 Parcel: 2S103DC00813 Jurisdiction: Tigard Site address: 11205 SW GAARDE ST Subdivision: Lot: 0 Project: Anderson Project Description: Installation of wood fireplace insert. Owner: FEES ANDERSON, BRUCE Description Date Amount 11205 SW GAARDE ST Wood Fireplace /Insert 12/23/2009 $23.32 TIGARD, OR 97223 12% State Surcharge - Mechanical 12/23/2009 $10.80 PHONE: 503- 639 -0013 Minimum Fee Adjustment - Mechanical 12/23/2009 $66.68 Contractor: ADVANTAGE CONSTRUCTION & MAINTENANCE INC PO BOX 756 PHONE: 541 - 318 -7809 FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: Solid Fuel 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, • ' ,,. ' - suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rul- .:opted . the Oregon Utility •tification Center. •se rule .re set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. Yo ay obtain . opy of t es or di -ct questions to OUNC by - ing 54 •. 46.6699 or 1.800.332.2344. Iss ed By: , ? Permittee Sign • :> i ► Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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 L g - ,{{ f ��i ` 4 r l Olz 1 ONi,Y � ” fa - . City of Tigard Date/By: / - i t s U "' r Permit No.: eer9 —p0 i7 I N " 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: I I C A D Inspection Line: 503.639.4175 Date Ready /By: Jur' Page www.ti and -or. ov S See Pa t t for g g Notified/Method: �� Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST 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 ❑ Demolition ® Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION " . • Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* Vi 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling / , q C Air conditioning Job site address: I 1 Z © 5 S �l , c 01 7 - ' (requires site plan showing placement) 46.75 Fumace 100,000 BTU (ducts/vents) 46.75 City /State /ZIP: t t 1 C l Z 2..q Fumace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump 61.06 Cross street/directions to job site: Duct work 23.32 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 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 23.32 Gas fireplace 33.39 ..e; ; N-( I iv 5-p,,; L f 4-1- .)-•t_ Flue vent for water heater or gas fireplace 23.32 , Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert i 23.32 Chimney /liner /flue /vent . 23.32 Z PROPERTY OWNER ❑ TENANT Other: 23.32 Name: ( Ct t5P / tJ(L.,/ S ) Environmental exhaust and ventilation L Range hood/other kitchen Address: / ( Z G ,v S ,,, G A-✓-4 S'( ' equipment - 33.39 City /State /ZIP: —77 4 9 - z - q Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: (0 63 ( - 7�c/ —cio 1 Z J Fax: ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Other: 23.32 Business name: Fuel t to P g Contact name: $14.15 for first four; $4.03 for each additional Address: Fumace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range CONTRACTOR : ' , Barbecue Business name: A j , '• G� 1 ,1_ , Clothes dryer (gas) N/�r►•►-TP, ✓.Sn.tt^_s: / Other: Address: O. get, y 6 (p MECHANICAL PERMIT FEES* City /State /ZIP: —B�c( Qg , ) 77 d7 Subtotal �� p© Phone: (cj /) 7 � Q Fax: ( ) Minimum permit fee ($90.00) �/ - r _ - Plan review (25% of permit fee) �' CCB lic.: / 7 L/ 6 i // State surcharge (l2% of permit fee) /a. fa lllf ) TOTAL PERMIT FEE /00. q(0 This permit application expires if a permit is not obtained within 180 Authorized signat � � ' t.� - days after it has been accepted as complete. Print name: 9-1 Date: r' * Fee methodology set by Tri- County Building Industry Service Board I:\ Building \ Permits \NEC- PermitApp.doc 10/01/09 440-4617T(11 /02JCOM/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.doc 10/01/09 2