Permit CITY • , F THGAF•? i ,, MECHANICAL PERMIT
°''. COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00222
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Tl A.,RD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/24/2007
PARCEL: 2S103DA -04100
SITE ADDRESS: 13365 SW 107TH AVE ZONING: R -3.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: LASATER
Project Description: Gas line to water heater replacement and outlet.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS: 1
Owner: FEES
KARL LASATER Description Date Amount
136 NW 107TH AVE
PORTLAND, OR 97229 [MECH] Permit Fee 4/24/2007 $72.50
[TAX] 8% State Surcha 4/24/2007 $5.80
Total $78.30
Phone: 503- 314 -0652
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact #:
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: - Permittee Signature: ,
Call 503.639.4175 by 7:00 a.m. for inspections that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical-Permit ApplicaAo > FOR OFFICE USE ONLY Received
City of Tigard E C E I V E D DateBy ^ �j Permit i� , �,� 7 Z
• 13125 SW Hall Blvd., Tigard, OR 97223 a'� / '�` E�`C /
C Phone: 503.639.4171 Fax: 503.598.19 Plan Revie
.
`� � 2007 Date/By: Other Permit:
Inspection Line: 503.639
T I G A R D � I \ Date Ready/By: kris. 0 See Page 2 for
Internet: www.tigard or.gov CITY Notified/Method: � Supplementallnformation
TYPE OF WORK'G DIVI'v$`()nj COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
ID 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: $
El I- and 2-family dwelling Commercial /industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: I ”65 Sid /07 Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: 7&,4, i2 oie 1 7 13 3 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: nW 77j, /1k'J L /0 7I Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00 Ir Ot)
" �1 Gas fireplace 10.00
,QEZ Vi �ivri ��Pj�� G. 7- 1, ��'n Flue vent for water heater or gas
fireplace •••••"-' / 10.00
//- ? CE�f.f r/./` 11 E A._ t---,e c Log lighter (gas) 10.00
J Wood/pellet stove 10.00
Wood fireplace /insert 10.00
0 PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 10.00
Other: 10.00
Name: K� 44r41-70.-e_ r4-' Environmental exhaust and ventilation
Address: / q (6 Range hood/other kitchen
ddress:
/ ✓3 �,� S L / G G 7t' Ale-- equipment 10.00
City /State /ZIP: �(y�•74 G� c 7)-)-3 Clothes dryer exhaust 10.00
/-7 Single -duct exhaust (bathrooms,
Phone: (03 )3/y a(5) Fax: ( ) toilet compartments, utility rooms) 6.80
IlrAPPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00 _
Business name: g� /� Fuel r r
PPnP,
Contact name: S5.40 for first four; 51.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: WalUsuspended/unit heater
Phone: ( ) Fax: : ( ) Water heater f
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: ow-4/,-7e.._ Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE "/g, 30
Authorized signature: /.,1 This permit application expires if a permit is not obtained within 180
/, • days after it has been accepted as complete.
t'rint name: `tc% [ L d o.r e- _ Date: ' Fee methodology set by Tri- County Building Industry Service Board
Lit
04 /06/06 440 -4617T (11 /02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation. : ` Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
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