Permit 1 .. CITY OF TIGARD
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00558
a ra Date Issued: 10/21/2009
TiGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S104AD03101
Jurisdiction: Tigard
Site address: 12976 SW WALNUT ST
Subdivision: Lot: 0
Project: Layton - Weihrauch
Project Description: Install gas pipe to generator.
Owner: FEES
LAYTON, ELIZABETH F Description Date Amount
12976 SW WALNUT
TIGARD, OR 97223 Fuel Piping 10/21/2009 $14.15
12% State Surcharge - Mechanical 10/21/2009 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 10/21/2009 $75.85
Contractor:
OWNER
PHONE:
FAX:
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 the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 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\ (1 k. 3 Permittee Signature: Q P
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 1 �
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 A licati a FC t � _ Apo'. i u4 4, I o (�- I Le x,51 a z i a a 4
? City of Tigard Received li C ■ Date/By: Permit No.: �(Q�2i� (, `r .(! i
" ° 13125 SW Hall Blvd., Tigard, OR 97223 OCT 2 1 2009 y w�l V —`JJ
[7 Plan Review
Phon 503.639.4171 Fax: 503.598.1960 Other Permit:
s.f Other
tG )(C'n It [a: Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: J s: ® See Page 2 for
t.;_= N Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: 1 1 C Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ❑ Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
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. 1 Ea. I Total
- JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 Z_ 1 6 Sly Leo I � St Air fires ite plan ng g placement) t (requires site Ian showin lacement 46.75
City /State /ZIP: 1 1g afd , De, 9 - .7-ZZ 3 Furnace 100,000 BTU (ducts/vents) 46.75
t Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: La t4 ion _We lira a 1,11 Heat pump 61.06
Cross street/directions to job site: 7 Sj7s 1) Gas 6 e ri e 05 4 or 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
G
C x-ie/in lay-) 0-f 9G S pip gexi Q�rof 1-° r Flue vent for water heater or gas
J J fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
![ ].PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: aylun — W-e1 r (4 (-11 Environmental exhaust and ventilation
C
Address: 1 Z 9 16 SW W a I v 1 &[, S I- Range hood/other kitchen
equipment 33.39
City /State /ZIP: --n ctrd Ole 3 j 3 ' 7 Clothes dryer exhaust 33.39
1 Single -duct exhaust (bathrooms,
Phone: so-) 540- 02) 6 Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name:
Fuel piping
Contact name: 514.15 for first four; S4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: I ' 1 '� Clothes dryer (gas)
�.1�/ ( V< r Other: 0 aa_ra' '-
Address: MECHANICAL PERMIT FEES* •
City /State /ZIP: Subtotal
Minimum permit fee ($90.00) 9o, or)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB Iic.: State surcharge (12% of permit fee) a, (!
In � , I TOTAL PERMIT FEE 100, ( c- . 1 C\
X Authorized si � 4 ature: /Ed , W This permit appas bs if permit is not within 180
1 �� MMM///rrrlllJJJ`���""" . ) days s after er r it t has been n accepted as complete.
Print name: C I% 'r J t ,r, - 41 , rr• _ r, KKH U , Q Date: 1 p p / O 1 ' Fee methodlogy set by ri- County Building Industry Service Board
\ \ I:\BuildingPermitsMEC- PermitApp.doc 10/01/09 "ice" 440 -46!7T(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.
$1 0,000.01 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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