Permit •
CITY OF TIGARD
MECHANICAL PERMIT
1 11 1 11 . COMMUNITY DEVELOPMENT Permit #: MEC2009-00089
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/05/2009
Parcel: 2S104AA10400
Jurisdiction: Tigard
Site address: 12135 SW 128TH AVE
Subdivision: BELLWOOD NO. 3 Lot: 123
Project: Watts
Project Description: Install gas piping for cooktop.
Owner: FEES
WATTS, CURTISS D & Description Date Amount
DEVITIS, MICHELE T, 12135 SW 128TH AVE Fuel Piping 03/05/2009 $5.40
TIGARD, OR 97223 12% State Surcharge - Mechanical 03/05/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 03/05/2009 $67.10
Contractor:
FLANDERS JR
33535 NW VADIS RD
CORNELIUS, OR 97005
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp: R -3
Stories:
Fuel
Fuel Types: Natural Gas
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 • • • k is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili. otification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
o• direct questions to OUNC • . Iling 503.246.6699 or 1.800.332.2344.
Is ed By: Permittee Signature: ��1 /
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.
L
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By: g 0 Permit No.: HQ/t o 9
• 13125 SW Hall Blvd., Tigard, OR 97223 �^-�r �+ "
Plan Review
11 I Phone: 503.639.4171 Fax: 5 6� Date/By: Datey: Other Permit:
TI K D Inspection Line: 503 M Date Ready /By: Iuris: 0 Page 2 for
Internet: www.tigard- or.gov ' Notified/Method: Supplemental lnformanon
\\ppR 0
4 2009 ' `
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ArAddition/iltiiiatidl/re �� Mechanical permit fees* are based on the value of the work
��° performed. Indicate the value (rounded to the nearest dollar) of all
,
❑ Demolition ❑ Other: UiLl mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
1- and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description I Qty. Ea. Total
JOB SITE iPIFORMATION AND LOCATION Heating/cooling
Job site address: i Z' 35 5 CA/ /Z ?IL- - 14v�_ Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State /ZIP: . t c`.vO 6 ve.-- rt — 7 12-3 Furnace 100,000 BTU (ducts/vents) 14.00
6 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: Duct work 10.00
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. 14.00
Subdivision: Lot no.:
Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
‘... 7 " J c� Y`, 45 f trt,t/r, r 2 A G �g Flue vent for water heater or gas —
fireplace 10.00
- -- �c� �/ Log lighter (gas) 10.00 _
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
Y PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: C v v -1 - 15 (j G-4-- Environmental exhaust and ventilation
Address: I 'L4'3 5 5., 2 4 1,, V�� Range hood/other kitchen
equipment 10.00
_City /State /ZIP: Ti q .Y D lee- 3 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phon 3) 21 — 7/ 5' 7 Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name: Other: 10.00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additiona
Address:
Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name:
\ c - S � 3'� Clothes dryer (gas)
A f kii
Other
Address: S I v MECHANICAL PERMIT FEES*
City /State /ZIP: Co i\ v- e.- "1' Q A. 1 7 I i 5 Subtotal
Phone: �1) Z0 I 5 7 Fax: ( 503 ( q — 5 Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB tic.: ` 02 y 7 3 State surcharge (8% of permit fee)
4 TOTAL PERMIT FEE
Authorized signature: ) This permit application expires if a permit is not obtained within 180
////'"' days after it has been accepted as complete.
J Print name: /` 14 •Jr- V 3 Date: 3/0 5 01 = Fee methodology set by Tri- County Building Industry Service Board
i:\Building\Permits \MEC -Pe itApp.doc 01/19/07 7T (11 /0 /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 tc $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.
I:\Building\Permits\MEC- PermitApp.doc 01/19/07 2