Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00400
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/08/2011
Parcel: 2S103DC00500
Jurisdiction: Tigard
Site address: 13705 SW 110TH AVE
Project: ROGERS Subdivision: FAIRHAVEN COURT Lot: 4
Project Description: Gas piping for gas meter relocation.
Contractor: ALL PIPE SYSTEMS Owner: DAVIS, JANET E
PO BOX 393 ROGERS, MARK W
BEAVERCREEK, OR 97004 13705 SW 110TH AVE
TIGARD, OR 97223
PHONE: 503 -793 -4013 PHONE: 503 - 624 -6493
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 09/08/2011 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 09/08/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 09/08/2011 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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 adopt-d by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtai a copy of the rules
or direct questions to OUNC by calling 503.232.1987 s :04.
Issued By: Permittee Signature: / 1,
/1"1/", 1
Cal • .639.4175 by 7:00 a.m. for the next availabl- •inspection date. date.
This permit card shall be kept in a conspicuous place on the job site until completion of the prof- .
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard
Received
�, � Permit No
'� 13125 SW Hal Blvd., Tigard,OR 97223 Date/By: • i1� .V �(( —t — CO L IC
UP I
I' Phone: 503.718.2439 Fax: 503.598.1'dl rL Plan Review Other Permit
TI G A R D Inspection Line: 503.639 • 05 Y' Date Ready/By:
d /Meth : MN H See Page 2 for
Internet: www.tigard- or.gov
<(? C. 0 ��� 4 � �+' `c Notified/Method: � Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
��
`) 7 Mechanical permit fees* are based on the value of the work
❑ New construction XAddition/alteration /rment performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
4 _
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
Multi- family 0 Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
C' �
���1 )44),-( Air conditioning
Job site address: (3 9-0 S 9, I CM- J (requires site plan showing placement) 46.75
City /State /ZIP: 11 `�� C�, �'} 9—. -���^^��v Furnace 100,000 BTU (ducts /vents) 46.75
`T Furnace 100,000+ BTU (ducts /vents) 54.91
pump
bldg. /apt. no.: Project name: Heat p p
. (requires site plan showing placement) 61.06
Cross street/directions to job site: 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 appliances:
DESCRIPTION OF WORK Water heater 23.32
r
t Gas fireplace 33.39
oA )1, i p l; -6.1/ G t`` �j b+l ?1 -eft ( 14'1 Flue vent for water heater or gas
I, fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
ROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: / / /at iZ.- IDS Environmental exhaust and ventilation:
Address: 05 LAY t "- Range hood/other kitchen
�.� 0 � /�-1� equipment 33.39
City /State /ZIP: - 6 ` A ay.,,I2_ 04 Gl3Z� Clothes dryer exhaust 33.39
.) Single -duct exhaust (bathrooms,
Phone: (50 ) 6, / b 3 F a x: ( ) toilet compartments, utility rooms) 23.32
`:APP ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: Other: 23.32
/A, Fuel piping:
Contact name: U''tGt,, - 4 (cQ/ s $14.15 for first four; $4.03 for each additional
.)
Address: F-40,5 1 10 , Furnace, etc. Gas heat pump
City /State /ZIP: -- 1 . -', N'tk Oze-- Wall /suspended/unit heater
Phone: ( 523 ) t /I-0_ bC/ 3 Fax:: ( ) Water heater
E -mail: WLLyV'C �7 \ A 0A, L [ �' �, k W I - ' I Fireplace
@ 'N Range
C CONTRACTOR Barbecue
Business name: l( `, e �
Clothes dryer (gas)
.Dn Other: -.1.14-S /r t -bk./ j
Address: T C" 6 ze v MECHANICAL PERMIT FEES*
City /State /ZIP: 6 C yk OIL. q7- D9' f Subtotal
Phone: ( ) � _ 9 (f79 . 3 Fax: ( ) TT Minimum permit fee ($90.00) `l a OJ
` Plan review (25% of permit fee)
CCB lic.: C gg 9 , 7h11/0 State surcharge (12% of permit fee) 4 T OTAL PERMIT FEE
Authorized signature: T his permit application expires if a permit is not obtained within 180
g j /- days after it h as been accepted as complete.
Date: * Fee methodology set by Tri County Building Industry Service Board
Print name: ma/ e �� C/ g" l/
I: \ Building \Permits\MEC- PermitApp.doc 09/09/10 441 -4617 (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.
$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.
•
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