Permit r
a CITY OF TIGARD MECHANICAL PERMIT
IF1 • COMMUNITY DEVELOPMENT Permit #: MEC2009 -00414
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/11/2009
Parcel: 1 S133DD10500
Jurisdiction: Tigard
Site address: 11894 SW 125TH CT
Subdivision: VILLAGE AT SUMMER LAKE PARK 4 Lot: 142
Project:
Project Description: Install stove and bbq.
Owner: FEES
RUECK, GREG D & DORSEY J Description Date Amount
11894 SW 125TH CT Fuel Piping 08/11/2009 $5.40
TIGARD, OR 97223 12% State Surcharge - Mechanical 08/11/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 08/11/2009 $67.10
Contractor:
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281
PHONE: 503 - 484 -5105
FAX: 503- 624 -2173
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
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: ' y( n C Permittee Signature:
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 IV VE I I Ui, O l I I ICE USE ONLY
RECF . Received
City of Tigard Date/By: 13 Permit No.: O a j; , p•) 1 y
• II I I 13125 SW Hall Blvd., Tigard, OR 97223 12009
Phone: 503.639.4171 Fax: 503.598.1960 AU G 1 Plan Review Other Permit:
Inspection Line: 503.639.4175 Date/By: I I G A R D
CITY OF TIGARD Date Ready/By: riN RI See Page 2 for
Internet: www.tigard- or.gov 1 ,�,: Notified/Method: Supplemental Information
RU1ll. DING DIVISr1
r ,, ,, . TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ddition/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 0 Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value $
;
� RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
.1E11 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
/ !� i 5 �/ / 1 Air conditioning or heat pump
,
Job site address: � � � -
Ft� (requires uires site plan showing placement) 14.00
City /State/ZIP: 77,6‘,€_,..0 v Furnace 100,000 BTU (ducts/vents) 14.00 •
Suite/bldg. /apt. no.: Project name: I� U ( _
Furnace 100,000+ BTU (ducts /vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: 6 t o r ,-,3 Duct w 10.00
2 � - L t ,J- Hydronic hot water system 14.00
2• cv Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION ZMORK Water heater 10.00
' - ; , Gas fireplace 10.00
'f V r � ,� S - f -- c -, Flue vent for water heater or gas
fireplace 10.00
g ( Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue /vent 10.00
❑ PROPERTY OWNER ❑ TENANT
Other: 10.00
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00 ,
City/State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawispace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State /ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E - mail: Range
CONTR ACTOR Barbecue {
Business name: B r u I e 1j (J � ` . 1 4� j ` / Clothes dryer (gas)
1 / ` t ' Other:
(� ER ' - x 2.- ,' M'E
Address: t .) MEGHANICAI PERMIT FEES*
City/State/ZIP: 11 at C�� e 7 Subtotal
5
/ Minimum permit fee ($72.50)
Phone: ( G , ZY y l ee Fax: (s ) &? Y Z- I _ � Plan review (25% of permit fee)
CCB lie.: fc I 5 .' 7 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature:
days after it has been accepted as complete.
Print name: t . J'2. r7 y u n Date: /-.7 / D 7 * Fee methodology set by Tri County Building Industry Service Board
1:\ Building \Permits\MEC- PermitApp.doc X 011 / /19/07 440.461 (I1 /02/COM/WEB)
Mocliinical Permit Application - City of Tigard
Pak = p eii al.'Information
Commercial Fee Schedule:.
� " u
$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.
1:\ Building \Permits\MEC- PermitApp.doc 01/19/07 2