Permit y CITY OF TIGARD MECHANICAL PERMIT
! , ' - COMMUNITY DEVELOPMENT Permit #: MEC2012 -00037
T1G,ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/18/2012
Parcel: 1 S 134CA00509
Jurisdiction: Tigard
Site address: 11055 SW 119TH AVE
Project: Geist Subdivision: PANORAMA NO.2 Lot: 20
Project Description: Install gas fireplace, gas piping for fireplace and water heater.
Contractor: GASPRO INC Owner: GEIST, DENISE E & DANIEL J
7603 SE LOUNSBERRY LN 11055 SW 119TH AVE
PORTLAND, OR 972056 TIGARD, OR 97223
PHONE: 503 - 775 -7020 PHONE: 503 - 853 -4532
FAX: 503 - 775 -7019
FEES
Specifics: Description Date Amount
Gas Fireplace 01/18/2012 $33.39
Type of Use: SF Fuel Piping 01/18/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 01/18/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 01/18/2012 $42.46
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, . wor suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N. ification 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 direc questions to OUNC b c- in•- ; i . 32.1987 or 1.800.332.2344.
Issued :y: I ^ Permittee Signature: AL:
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.
RECEIVED
Mechanical Permit Applica ion � FOR OFFICE USE ONLY
City of Tigard AN 1 Q V 2 ("12 Received Permit No.:
14
Date /By: / /4/MM Mfc o /9 3
'. 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
_ Phone: 503.718.2439 Fax: 503.e9 6OF TIGARD Date/By: Other Permit:
T I G A R -D Inspection Line: 503.639 BUILDING DIVISION Date Ready/By: y: El See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK 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.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ 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: /10 SS SiAr // '7 A-t/E_ (requires site plan showing placement) 46.75
77 q ,� 2 7 � Fumace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP:
/ l (I'�- i 0 ! 3 Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: GE- / S T 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
G /3 / i�' PCACE S c _ -/ T7 a N
Gas fireplace 33.39
/� �} 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
'A Other: 23.32
Name: ,),9 /J 1 dJ � Arf .f
/.S T Environmental exhaust and ventilation:
Address: / ( 05 S J c--) /11 ,9.vr` Range hood/other kitchen
equipment 33.39
City /State /ZIP: '776 / 9Y�10 t O R 4 7 _23 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (93 ) f3. ,_ cis 3 Z 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: G AS P,K.c - /v C., Clothes dryer (gas) _
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Minimum permit fee ($90.00) 90 •
Phone: ( 3 ) 7 75 _ 7 O Zp Fax: ( )
Plan review (25% of permit fee) �—
CCB lic.: / l0 7 93 1 x k fi) State surcharge (12% of permit fee) /U '8
� TOTAL PERMIT FEE /60 • tO
jot This permit application expires if a permit is not obtained within 180
Authorized signature: �,
days after it has been accepted as complete.
Print name: b4Aj c Gc /S Date: / — / S .- -2,0/-2_ * Fee methodology set by Tri- County Building Industry Service Board
h1Building \Permits\MEC- 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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