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Permit 7 ,, CITY OF TIGARD MECHANICAL PERMIT 1 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00371 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/09/2011 Parcel: 1 S134BD07900 Jurisdiction: Tigard Site address: 11676 SW PENN CT Project: COFFIN Subdivision: PENN LAWN ESTATES Lot: 7 Project Description: Gas fireplace with fuel piping. Contractor: MERIT CONSTRUCTION INC Owner: COFFIN, ORAN C 14685 NW JOSEPH CRT 11676 SW PENN CT PORTLAND, OR 97229 TIGARD, OR 97223 PHONE: 503 - 793 -7003 PHONE: 503 - 524 -7590 FAX: FEES Specifics: Description Date Amount Gas Fireplace 08/09/2011 $33.39 Type of Use: SF Flue Vent for Water Heater or Gas 08/09/2011 $23.32 Class of Work: ALT Type of Const: Fireplace Occupancy Grp: Fuel Piping 08/09/2011 $14.15 Stories: 12% State Surcharge - Mechanical 08/09/2011 $10.80 Minimum Fee Adjustment - Mechanical 08/09/2011 $19.14 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. Allah Issued By: ' = Permittee Signature: J l Call 503.639.4175 by 7:00 a.m. for the next available inspectio 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. Mechanical Permit Application OFFICE USE ONLY City of Tigard C�` 1� �1 Received Date/B Ci 1/ Permit No.: _ 7 . " 13125 SW Hall Blvd., Tigard, OR 97223 y 111 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 VW Date/By: Other Permit: F i G A R D Inspection Line: 503.639.4175 03 t , Date Ready /By: ®See Page 2 for Internet: www.tigard- Or.gOV ���. ,t Supplemental Information OF I N0... TYPE OF WORK 0 . �,NG� 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: $ 1 - and 2 dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES* y g ❑ CommerciaUindustrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: j 1 6 76 .5 t,e, 7 N G--( Air conditioning (requires site plan showing placement) 46.75 City /State /ZIP: ev d © , "F6-0 iti q 7 z 2-3 Furnace 100,000 BTU (ducts /vents) 46.75 Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: , 1 t✓ Heat pump 61.06 Cross street/directions to job site: // ,• - 121 n ( " E 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: Pe Z2.37 / zJ Lot no.: Flue /vent for any of above 23.32 ! 7 f/ ����'f Other: 23.32 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 23.32 Gas fireplace 6 ` 33.39 33,3 e ern d U e - >s457 V /� ,0 00 / ,6 t i ^ n / J Flue vent for water heater or gas / J , fireplace 0 23.32 n, �J- / 7 € �9 / -( /� ,- -e p )4,rCZ. 3 / 4S /qi/ �'7eOr/ Log lighter (gas) j 23.32 � Q� / / /f � 9Cf G�j // / y � f / /' /e { �i r yj � °S Wood/pellet stove 33.39 .V- e /) t I eg Z ., Al , e �i Wood fireplace /insert 23.32 Chimney /liner /flue /vent 23.32 A, PROPERTY OWNER ❑ TENANT `� Other: 23.32 Name: / c Is /. r 09.<4 y p��,L/ C7 i n Environmental exhaust and ventilation �6 S'(�J PPS Range hood/other kitchen Address: / /6 /�J � � equipment 33.39 City /State /ZIP: / /^i Q, q -7 2. 23 Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: (Sps) j - .- ? S'9d Fax: ( ) toilet compartments, utility rooms) 23.32 APPLICANT ]a CONTACT PERSON Attic /crawlspace fans 23.32 /�' O r, _ Other: 23.32 Business name: / % �� r l C' �S f ,e 7 /Or Fuel piping Contact name: j n jtOa.. 7° /-' $14.15 for first four; $4.03 for each additional /4.07 Furnace, etc. Address: (V6 , S- !L (2/ 3-0.3,14 I_7 - Gas heat pump City /State /ZIP: PO G--1 /a.4(./ / O , p X9' 7 2 2 Gr Wall /suspended/unit heater Phone: (j Fax:: ( ) (5 ( Water heater � 3 � ��� Fireplace C) x f'1 E-mail: 3 0 rent -er - Cr)/J..57 e-1 of ,c d kklr Range CONTRACTOR Barbecue ,/' Clothes dryer (gas) Business name: / [ �,e / 7 c -YS 7izeic / 7.6 Other: Address: 7 4/ (4 5- /U I A, 7 J -P)j Co (4 /- / MECHANICAL PERMIT FEES* City /State /ZIP: Mr /4,,,v 0 6 -' 9. -7 Subtotal Phone: (S63) ? 3 - 70 mss' Fax: ( ) Minimum permit fee ) �O -'-�t� Plan review (25% of permit rmit fee fee) CCB lic.: 3s 9 7 j4 12 /if State surcharge (12% of permit fee) //), f (6-e © 6 TOTAL PERMIT FEE /00..f50 This permit application expires if a permit is not obtained within 180 Authorized signature: / days after it has been accepted as complete. Print name: 7py/ - t pC"„`o,- -, Date: /q// • Fee methodology set by Tri- County Building Industry Service Board I:\ Building \Permits\MEC- PermitApp doe 10/01/09 440 -4617T (I 1 /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. 1:\ Building \Permits\MEC- PermitApp.doc 10/01/09 2