Permit y CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00421
Date Issued: 09/21/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Parcel: 2S112CB11000
Jurisdiction: Tigard
Site address: 15369 SW KENTON DR
Project: Caruso Subdivision: ASHFORD OAKS NO 2 Lot: 124
Project Description: Install gas piping for range
Contractor: HOLMES INSTALLATION SERVICE Owner: CARUSO, JUDY I
33535 NW VADIS RD 15369 SW KENTON DR
CORNELIUS, OR 97005 TIGARD, OR 97224
PHONE. 503 - 647 -9320 PHONE' 503 - 968 -5499
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 09/21/2011 $14 15
Type of Use: SF 12% State Surcharge - Mechanical 09/21/2011 $10 80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 09/21/2011 $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 t / o OUNC by calling 503.232 1987 or 1 800.332 2344.
Issued By: ,r- / st j Permittee Signature:
t l/
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.
Mechanical Permit Application • FOR OFFICE USE•ONLY
IN City of Tigard DateBy ? a/ / / A I PermitN 1E7 2 / 'PVC/ 2/
'1 13125 SW Hall Blvd., Tigard, OR 9 7223 Plan Review y
0 Phone. 503.718 2439 Fax. 503 5 98.196 Other Permit'
ate
TIGARD Inspection Line 503.639 E P 21 2011 Date Ready/By Juns See Page 2 for
/ Internet: www.tigard -or gov Notified/Method 6.- Supplemental Information
�yi' OF TIGARD
TYPE OPW1hV DIVISION 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
CI Demolition ( ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1 and 2- family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
. - • Air conditioning
Job site address: 153 O 9 S 0 / IceArra ik ' D� (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP: Ti q ,,,,I. ) 6)r'. 77 Z L y Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: / / Project name: Heat pump
(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
..-tN 5 1 I • r pits /7'-, P- � Gas fireplace g 33 39
G 4 �.. Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Igi
PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
�_ Other. 23 32
Name: f..4 J C' A&LvS 0 Environmental exhaust and ventilation:
Address: is 3 to _ 1 5 � DA_ Range hood /other kitchen
equipment 33.39
City /State /ZIP: 'r a ` D 0 R. � 7 z7i ki Clothes dryer exhaust 33 39
9�i • � y j� Single-duct compartments, (bathrooms,
Phone: 3) q
F ax ( ) toilet compartmrtmentss , utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23 32
Business name: Other 23 32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: (
Range /
CONTRACTOR Barbecue
Business name: gob" e9 : $ Q Clothes dryer (gas)
Other
Address: 3 5-35 1� t� U 4�S 'RD MECHANICAL PERMIT FEES*
City /State /ZIP: C e I v x/q � 0 l 2 � Cl 71 t 3 Subtotal
Minimum permit fee ($90.00) 9,* at
Phone: (503) Z,6 7x75 - 7 y Fax:( ) Plan review (25% of permit fee)
/CB lie.: f 0 Z-- 7 3 State surcharge (12% of permit fee) /D 1 id
TOTAL PERMIT FEE 19 , , 7)
Authorized signature: This permit application expires if a permit is not obtained within 180
g days after it has been accepted as complete.
Print name: )74. I l'-4 Date: / 9 * Fee methodology set by Tri- County Building Industry Service Board
� 1
i \Building\Permits\MEC -Per ItApp doc 09/09/10 440 -4617T 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 r '
$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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