Permit CITY OF TIGARD MECHANICAL PERMIT
le • COMMUNITY DEVELOPMENT Permit #: MEC2012 00240
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/14/2012
Parcel: 1S 134CA06400
Jurisdiction: Tigard
Site address: 11990 SW BURLHEIGHTS ST
Project: Hopman Subdivision: BURLWOOD NO.2 Lot: 17
Project Description: Add gas line and vent for new water heater.
Contractor: EX INSPECTORS LLC Owner: HOPMAN, LANCE
15112 SE YAMHILL ST 11990 SW BURLHEIGHTS ST
PORTLAND, OR 97233 TIGARD, OR 97223
PHONE: 503 - 575 -0644 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Flue Vent for Water Heater or Gas 05/14/2012 $23.32
Type of Use: SF Fireplace
Class of Work: ALT Type of Const: Fuel Piping 05/14/2012 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 05/14/2012 $10.80
Stories: Minimum Fee Adjustment - Mechanical 05/14/2012 $52.53
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 Noti • •• • 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 • uestions to • UNC • : ling 503.232.1987 or 1.800.332.2344.
Issued y: �1/ / / Permittee Signature:
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
City of Tigard Received ! permit No He a, n
74 City g Date/By: 4 / � p 0 / I T , r /�2 ° 13125 SW Hall Blvd., Tigard,OR 9722 REC Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 1 4 2 01'1 Date/By:
Other Permit:
T I G n R D Inspection Line: 503.639.4175 MAY Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov , Notified/Method: Supplemental Information
CI I OE fI C�A ?D
TYPE OF W L���� � i I . 3 3v1 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"
F p 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: // 990 � w /� •% L,� /! . pry !J 0 (requires site plan showing placement) 46.75
I�/v f" G K i /" Furnace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP: 7 fG 40_
Q le-- - Furnace 100,000+ BTU ( ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump
P M #1, (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
Gas fireplace/insert 33.39
POO (5 ' G a$ LlN'fc l VG t4 -c-J12 Flue vent for water heater or gas
N 1C� GA-t- Gik5 uPPTEf— OPP�TEO- • fireplace ( 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32
Name: L4N4 £ appmApj Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State /ZIP: Clothes dryer errhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) _ 23.32.
in APPLICANT IS CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name: sr 1NS ?G�.,„ t Fuel piping:
Contact name: 17 �' p„.24 MA y $14.15 for first four; $4.03 for each additional_
Address: , 57, 2 5 LiA M 1 - i I. L 5.r Furnace, etc.
Gas heat pump
City /State /ZIP: PJQ3rL 1„x.1 t;7 b2 C " z 3 3 Wall /suspended/unit heater
Phone: (p9 5- O b Li L' Fax: : (3G 0) 723' 5-153 Water heater
Fireplace
E- mail: O c iN4petli)se_5 ( (ML .Lot Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
Other:
Address: (s I , Z 5E - 4 otkeN 14 ILL 51 MECHANICAL PERMIT FEES*
City /State /ZIP:
C��,. 6e- 172$3 Subtotal
3 ) S1 S - D 6 y 4 Fax: Q Q) 12 Minimum permit fee ($90.00) •
Phone:
(0 3'��� P lan review (25% of permit fee)
CCB lic.: /Q Zo91� State surcharge (12 %ofpermit fee) /60.80
TOTAL PERMIT FEE /OG • eO
Authorized signature: it ,� // This permit application expires if a permit is not obtained within 180
�I days after it has been accepted as complete.
Print name: ] 4N M ? y 6 I Date: c V. /# * Fee methodology set by Tri -County Building Industry Service Board
:\
1Building \ Permits \MEC- PermitApp.doc 09/09/10 / 440-4617r(II /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. •
•
•
■
IABuilding\Permits\MEC- PermitApp.doc 09/09/10 2