Permit CITY OF TIGARD MECHANICAL PERMIT
11 : 1 - COMMUNITY DEVELOPMENT Permit #: MEC2012 -00500
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/02/2012
Parcel: 1 S134ACO2650
• Jurisdiction: Tigard
Site address: 11080 SW COTTONWOOD LN
Project: Haynes Subdivision: ENGLEWOOD NO.3 Lot: 216
Project Description: Replace gas fireplace
l
Contractor: OWNER Owner: HAYNES, KENNETH R & KELLY D
11080 SW COTTONWOOD LANE
TIGARD, OR 97223
PHONE: PHONE: 971- 344 -4789
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 10/01/2012 $33.39
Type of Use: SF 12% State Surcharge - Mechanical 10/01/2012 $10.80
Class of Work: ALT Type of Const:\ Minimum Fee Adjustment - Mechanical 10/01/2012 $56.61
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 Notifica 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 q eu stions to NC by calling 503.232.1987 or 1.800,332.2344.
Iss ed By: Permittee Sign; ure:
Call 503.639.4175 by 7:00 a.m. for the next available inspectio 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.
Oct 02 12 06:22a p
Mechanical Permit Appli ac t`o 1 ' FOR OFFICE USE ONLY
C1 of Tigard ■ Received pertn
t3 t Dato'By: ' ////.2� 0' ��C24 _6 n
1111111 ill 13125 SW Hall Blvd. Tigard. OR 7 1:' Plan Review
Phon 50 3.:182439 Fair: 503.398.19 TT 0 2 2U�2 DaterBy: Other Permit:
:
Inspection Line: 503.6 . , , y1 j - i :'•. a.i.
TIGARD Internet: www.tioard -0r•�ov `r:- DaeReadyBy: kris: EI Sec Page 2 for
o ,_�- = '� f Notified/Methad: Supplemental Information
CI ti e r I I g i, ��
TYPE OFMA t - COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
• Mechanical permit fees* are based on the value of the work
❑ New construction Addition/attcration/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
ION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
I.
- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. I Ea I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
•
Job site address: / /G;�Q ,S eQ77 L."/ ( require; site plan showin placement) 45.75
City/State/ZIP: Furnace 100 BTU ideas/vents) 46.75
Furnace 100,000+ BTU (ducts %scnts) 54.91
Suite/bldg. /apt. no.: Project name: i ./- y 4,-5Z S/A/E� Heat pump
f (recuites sire plan shaving 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
1 Unit healers (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 \VORK I Water heater f 23.32 /
k� (�,.Q f ,, ( X � fire 1 / insert I 33.39 1/
��( n p„r W( At� 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
PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: L. 1 e �1 f .. 1! Y C Environmental exhaust and ventilation:
`� G J ` C ` r ` J \ w . ` J Range hood/other kitchen
Address:
1 1 e� sC Ct� P rtrv, Cicjdd 1-i f equipment _ 33.39
City /State /ZIP: �-t S , J ( Clothes dryer exhaust 33.39
/ . _ 1 Single-duct exhaust r
Phone: 3 f ) s c L r /" ' }� z(78 Fax: ae: ( ) toilet compartments, utility �tili[y r000
ms} 23.32 '
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23 32
Business name:
Other: I 23.32
. Fuel piping:
Contact name: $14.15 for first four; $4.03 for etch additional
Address: Furnace. etc.
Gas heat pump
City /State /GIP: Wall /suspended/unit heater
Phone: ( ) I Ftx:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: 6 G(/N/&2 Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES`
C ity /State /ZIP: Subtotal
Minimum permit fee ($90.00) yj , az)
Phone: ( . ) Fax:( )
Plan review (25%
of permit fee)
CCBlie.: , State surcharge (12% of permit fee) /e) ,
/ TOTAL PERMIT FEE /44 t ; F)
This permit application expires if a permit is not obtained within 180
...----- Authorized signature: ....,52-7 . days after it has been accepted as complete.
/I' Print name: —21),./Vt(7.77/ ) . / (=.5 / ate: iai1 •t • Fee methodology set by Tri- County Building Industry Service Board
IS Buirding .Permiu \StEC- PmmitApp.doe 03/07/12 440 17T (I I l02/COlLWEa)
Mechanical Permit Applictll• V ED FOR OFFICE USE ONLY
City of Tigard
Received
a Permit No
13125 SW Hall Blvd., Tigard, OR 9 T 0 1 ZO12 Date/By: / / , ! Q _ ,_ /I • _ • •
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Date/By:
Other Permit:
TI G A R D Inspection Line: 503 CI n lJ FTIGARD Date ReadyBy: El See Page 2 for
Internet: www.tigard- or.gov D �� 1� � `]�SI ®N Notified/Method:
U t _ 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*
"pg- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. 1 Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
` �� / / D � Air conditioning
Job site address: // 0,0 �t./ (/ CO A./W 0 0 A 2."7 (requires site plan showing placement) 46.75
City /State /ZIP: Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: �� �/�ES 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
k (� �� �� A fire I insert 33.39
( A,Q Q X Ot,�} U..1( IIJX p2�, Flue vent for water heater or gas
I I 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: IK.e■A a 3 Environmental exhaust and ventilation:
Address: . , Range equipg hood other kitchen
Q � ` � „ Ldd (,t J ► I „N ment 33.39
City/State /ZIP: '� n � Clothes dryer exhaust 33.39
n 40 Single-duct (bathrooms,
Phone: 1) S C. Fax: toilet ( ) toilet t compartments, , utility lity 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
a � _ / Clothes dryer (gas)
Business name: /V /`
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Minimum permit fee ($90.00) y( , 07)
Phone: ( ) Fax:( )
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) /0 , (d
TOTAL PERMIT FEE / f 3
. signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
- Print name: \ : * Fee methodology set by Tri County Building Industry Service Board
...., „...1-
�/ � ,1 I:\ Building \Permits'MEC- PermitApp doc 03/07/12 440 -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
$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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