Permit :: CITY OF TIGARD MECHANICAL PERMIT
IL
ri. a : . COMMUNITY DEVELOPMENT Permit #: MEC200900596
; A R 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/10/2009
Parcel: 2S114BB20500
Jurisdiction: Tigard
Site address: 16431 SW 103RD AVE
Subdivision: RIVERVIEW ESTATES NO. 2 Lot: 49
Project: Anderson
Project Description: Install gas line for range.
Owner: FEES
ANDERSON, STEVE Description Date Amount
16431 SW 103RD AVE
TIGARD, OR 97224 Fuel Piping 11/10/2009 $14.15
12% State Surcharge - Mechanical 11/10/2009 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 11/10/2009 $75.85
Contractor:
HAVEN SPAS AND POOLS
10560 SE HWY 212
CLACKAMAS, OR 97015
PHONE: 503 -655 -9440
FAX: 503- 655 -9514
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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 th ! es adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -01 . e. ou may ••btain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
'
Issued By: /( nun n v �(1/1 f, Permitt• = _nature:
/PP ...41._ i
l 'C Call 503.63 a.m. for an inspec on that, < s' / =ss day.
This permit card shall be kept in a conspicuous place on the jo• - • until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
S
Mechanical Permit Application i OR (tITICE USE ONLY Received
City of Tigard RECEIVED Date/By: / J 1 r Permit No.: Q 1 „ et * IF ,
:� q 13125 SW Hall Blvd., Tigard, OR 97223 lIl Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598. NOV 1 O DateBy:
T I G A IZ Il Inspection Line: 503.639 2UU9 Date Ready/By: ® See Page 2 for
Internet: www.tigard -or.gov Notified/Method:
KM ______ Supplemental Information
CITY OF TIGARD
TYPE OF tVADINC1 DIVISION 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*
❑ 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
1 f Air conditioning
Job site address: /� Y3�1 5W I / 3 p Ave (requires site plan showing placement) 46.75
City /State /ZIP: 716.)19g O O . 4 9 22.1 ) Furnace 100,000 BTU ( ducts/vents) 46.75
1 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: AN (2€ Heat pump 61.06
Cross street/directions to job site: C:71 17VA/4A RD- . 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
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 23.32 _
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
r\ 0. 5 %c -Q -Pic fancy Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner /flue/vent 23.32
❑ PROPERTY OWNER ❑ TENANT Other: 23.32
Name: S7L - "- /4-0,) Environmental exhaust and ventilation
Range hood/other kitchen
Address: v equipment 33.39 ,
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) 424 -24 fib Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name: Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Address:
Furnace, etc.
Gas heat pump
City / State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: �� '�04.1 -J o} , AMA/ _CMG' Clothes dryer (gas)
H Other:
Address: t ()5 0 SE A u t At7i. .4 t STY MECHANICAL PERMIT FEES*
City /State/ZIP: ao_c lec nivi. M S 7 (t S Subtotal
Phone: (j ) 455-...5-0 I Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: 115,1 O 4 26- I t State surcharge (12 %ofpermit fee)
/ TOTAL PERMIT FEE
Thi ermit alication permit expires if a permit is not obtained within 180
Authori - . �/� �p -�i days after it has been accepted as complete.
Print name. ��� 1 i t A I Datej(�i p(61' • Fee methodology set by Tri County Building Industry Service Board
I:' Building \Permits\MEC- PermitApp.doc 10/01/09 / 440.4617r(II /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.doc 10/01/09 2