Permit 1 x ,, CITY OF TIGARD MECHANICAL PERMIT
'1 3 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00190
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/03/2011
Parcel: 2S104BA08200
Jurisdiction: Tigard
Site address: 13818 SW LIDEN DR
Project: Phounsavath Subdivision: CASTLE HILL NO. 2 Lot: 117
Project Description: Install gas piping for replacement of existing electric range with duel fuel range.
Contractor: A -1 INSTALLATIONS NW LLC Owner: PHOUNSAVATH, BOUNTHIANG
15842 SW UPPER BOONES FERRY RD. HOMSANITH, VILAYVANH
TIGARD, OR 97224 13818 SW LIDEN DR
TIGARD, OR 97223
PHONE: 503 - 620 -5657 PHONE:
FAX: 503 - 620 -1696
FEES
Specifics: Description Date Amount
Fuel Piping 05/03/2011 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 05/03/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/03/2011 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: QN ,0/06,/ -77O
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
nEivED
Mechanical Permit AnpliEki cata rot; oFf-icc t sr 0.11
City of Tigard MAY 0 2 2011 Received
Date/By: --5 7 it .40" Per Mit NO.3416.. or i ...... 00 9 ,
_ . 13125 SW Halt Alvd., Tigard, OR 97223
Plan Review
' Phone: 503.718.2439 Fax 503.598.1
, 4 11
Other Permi
"'' . t
TIGARD :
- - l Line: 503.639.4175 ITY OF TIGARD
Jo& El See Page 2 for
9 6 Datt/BY:
In nspection ternet; www.tigard PLANNING/ENGINEEIRI It
-1 G." SIVPIentrntal Information
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r Mechanical permit fees* are based on the value of the work
0 New construction I:: • ddition/alteratiOn/replaCement perfonned. India te the value (rounded to the nearest dollar) of all
El Demolition 0 Other: mechanical materials c. ui. meat, labor. overhead, and .torn
Value: $
- and 2-family dwelling 0 Commercial/industrial 0 Accessory building
g,1
For special inform:110h use checklist
Multi-family CI Master builder 0 Other: Description
f Qty. I Ea. 1 Total
:,, ..1=i f ifti4Ai„ . ,:i ' tieti4El14,faigag t ik 754 - A n i e r a co tin n g d l i c ti t i i n n: 1
Job site address: • t
(requires sittplan showing placement) 46.75
II • „ 1 ILLA a _
Furnace 100,000 BTU (duets/vonts) 46,75
City/State/ZIP: V • "Z
'Ira wagla, lib , Furnace 100,000+ BTU (duets/veins) 54.91
Suite/bldg./apt. no.: Project name: Heat pump
frequires site plan showing placement) 61.06 _
Cross street/directions to job site: 1-k S',....t" 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 a .. fiances!
g. O ir; V. Water heater 23.32
Gas fireplace 33.39
X El:LAI-ewe- e v N6--- EL-& e.... Flue vent for water heater Or gas
j A166 437777 .61-C.-& .1t-e.----' fireplace
- 23.32
Lo: li:hter las 2332
WOod/Dellet stove 3339
Wood fi dace/insert 23.32
Y,t.43 ,.."::: ,.: 7i F iFtz4g ± ,- Ta Chimney/liner/flue/vent 2332
Other: 23.32
Name; 7/10 li./1/31 tr 4 7 6 • tot/ 77-7 /9--4/ Environmental exhaust and ventilation:
Address:
Range hood/other kitchen
A
equipment 33.39
City/State/ZIP:
Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms.
Phone: ( ) Fax: ( )
toilet compartments, utility rooms) 23.32
. kiL7,,70$4F,0,4. ',a4Rtila! 7.!;9:-Vrit.,:::V.04Z4r AtticfcrawisPace fans 23.32
Other: J... 23.32
12=Nk - _L .-
A. -‘, tl J.,...-ePrN ,_ Fuel piping:
Contact name:
$14,15 for first four: S4.03 for each additional
Address 0
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11
City/State/ZIP: , (fl? 0 3s Wall/sus ended/unit heater
-
Phone: (--63) to , imam Fax: : ( ) Water heater
-
Fireplace —
E-mail:
l
.. Range 1
q*Igt 433t EMiktV,6110 0 Barbecue _
Business
name: t - -...- 4) , itz ., : iL ru v o Clothes d Cr :as Ma
Other: NM
Address: _ ..__ R - .-Igp....4-- i2;ftar4.3... PeACY 0 g . #M71,,,EZ, : En
City/State/ZIP: 7-•,111:i bt2 •5 Subtotal MUM
411, '
hone:( ( . , _. . ,s- Fax!4 4ao -/6 - ... Minimum permit fee ($90.00) ct 0 . 0
Plan review (25% of pennit fee)
I CCB lie.: kr‘ , D
7( ., , c / State surcharge (12% of permit fee) 1 0. t
TOTAL PERMIT FEE /CO.
If •
Authorized signature:
This permit nonunion expires if a permit is not obtained within 180
A k hi ....„U o 11,,. days after it has been accepted as complete.
Print name: Lik /MIMI Date: a, . Fee methodology set by Tr-County Building Industry Service Board
imulletineermiiswEc-PermItApp.ene 0' °o/IS
4404617T (IlicocomAYEB)
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Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi-Famil Fee Schedule:
$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 550,000,00 $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.
1 ; \Building \Permits \MEC- PermitApp,doc 09/09/10 2
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