Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00510
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/10/2011
Parcel: 2S105DA16300
Jurisdiction: Tigard
Site address: 14595 SW KLIPSAN LN
Project: WEAVER Subdivision: PACIFIC CREST Lot: 51
Project Description: Gas fireplace insert with fuel piping.
Contractor: BLAIRCO INC Owner: WEAVER, MARK B
7609 MACARTHUR BLVD 14595 SW KLIPSAN LN
VANCOUVER, WA 98664 TIGARD, OR 97223
PHONE: 360 - 695 -1476 PHONE:
FAX: 360- 699 -9310
FEES
Specifics: Description Date Amount
Gas Fireplace 11/10/2011 $33.39
Type of Use: SF 12% State Surcharge - Mechanical 11/10/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/10/2011 $56.61
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 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.
Issued By: Permittee Signature:
Pr
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 .
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City of Tigard Rec e i ved
� y Permit No.: _
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13125 SW Hall Blvd., Tigard,. ^> R�9Z123 ` Ae ^' q DateBy: /� �j� V 0- — L I - , j j -
�T a 9 p . \ Plan Review
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® Other Permit:
P hone: 503.718.2439 Fax: 50598.190 0 �. DateB
T I G AR U Inspection Line: 503.639 O � N` ;® Date Ready/By: ® See Page 2 for
Internet: www.tigard- or.gov r �y s \ �� Notified/Method: 1 111 Supplemental Information
O
TYPE OF WOK - ') - COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
jrw,ti - 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.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
r1i"I and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
1 Air conditioning
Job site address: I i ' 5 9 S S Vi K L 1 e S x (requires site plan showing placement) 46.75
City /State /ZIP: -}- r�/ Furnace 100,000 BTU (ducts /vents) 46.75
r CAP Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg./apt. no.: Project name: e Heat pump
v+` ' s l (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
//��
Q .q Gas fireplace / 33.39 7? >3
P is1 / r r 11 y a 9 iats2 S Y / )24.4 ' 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
❑ PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, 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
E -mail: Fireplace /
Range
CONTRACTOR Barbecue
Business name: L.
I /9 ) r c o T' Clothes dryer (gas)
Other:
Address: 7 X 0 ) 9 t ? ) 9 f.. s: iv(A)1 ) Z \i c/ MECHANICAL PERMIT FEES*
City /State /ZIP: V c C GU f 6 a 1 Subtotal
, f 10 Minimum permit fee ($90.00) ao
Phone: (36 Q) 6 9 S . O / �', D 7 • 6 Fax: Q) 9 .. -93/ Q Plan review (25 °/n of permit fee)
CCB lie.: 7 7 S 0 R! ' 1 3 State surcharge (12% of permit fee) (J
! TOTAL PERMTI' FEE `c4), D `
Authorized si nature: J3 r / This permit application expires if a permit is not obtained within 180
g V t! 0 m �_ days after it has been accepted as complete.
Print name: S fi () .i .0 V t -p p' S Date: / r I Q'_ I7 * Fee methodology set by Tri -County Building Industry Service Board
I \Building \Permits \M EC- PermitApp.doc 09/09/10 440 -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.
•
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