Permit CITY OF TIGARD MECHANICAL PERMIT
11
S. COMMUNITY DEVELOPMENT Permit #: MEC2012 -00510
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/08/2012
Parcel: 1 S125DB12100
Jurisdiction: Tigard
Site address: 9415 SW 74TH AVE
Project: Reding Subdivision: 1990 -008 PARTITION PLAT Lot: 2
Project Description: (1) gas fireplace /insert
Contractor: GASPRO INC Owner: REDING, LANNY D & BRENDA S
7603 SE LOUNSBERRY LN 9415 SW 74TH AVE
PORTLAND, OR 972056 TIGARD, OR 97223
PHONE 503 - 775 -7020 PHONE 503 - 245 -7263
FAX 503 - 775 -7019
FEES
Specifics: Description Date Amount
Other, Fuel Appliances 10/08/2012 $23.32
Type of Use: SF 12% State Surcharge - Mechanical 10/08/2012 $10 80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/08/2012 $66 68
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 • started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION Oregon law requires you to follow the rul-s adopted by the Oregon
Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. Yo may obtain a copy of the rules
or direct questions to OUNC / by calling 503 232 1987 or 1.800.332 2344
Issued By: }Slate/ Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection
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 DateBy. tom a_ — Permit No. mcc d ol , _ g7 a
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 DateBy. Other Permit.
T I G A R D Inspection Line: 503.639 Date Ready/By Juns ® See Page 2 for
Internet: www.tigard -or.gov Notified/Method: 77 f 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*
)41- 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: ?gig $ 74' m A Jd (requires site plan showing placement) 46.75
City/State /ZIP: 02 ! 722-3 Furnace 100,000 BTU (ducts/vents) 54.9 Furnace 100,000+ BTU (dus /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
Cebh cfresr / 7 Hydrontc hot water system 23.32
(/ Residential boiler (radiator or
A no�� i �� K ' e � hydronic) 23.32
VC ° � T 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
,�+ ei Gas fireplace/tnsert 1 33.39
F ' i . ( Q[ -�t e ( ��'" 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: L/4 Ahv Y /l-N. 9 5VDA- p ed r Environmental exhaust and ventilation:
n'J i i i s s , W 7
Address: Range hood/other kitchen equipment 33 39
City /State /ZIP: --/&(J -4 Q 2 97223 Clothes dryer exhaust 33 39
Fax: Single -duct exhaust (bathrooms,
Phone: (
SJ3 z 1 S 776 3 ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT • ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: Other: 23 32
Fuel piping:
Contact name: 514.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name:
(ts Pf-o (9dw (pt ( ?f Clothes dryer (gas)
Other:
Address: '7t$ 0 3 Se L o uNg f e -r y L N MECHANICAL PERMIT FEES*
City/State /ZIP: e 0 r rt..c 9 72Q Cl Subtotal
Phone: (,Sa) 7 7 S 7 0 Z Fax: ( ) V Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: / C 7 L( q 3 / 1-tri13 State surcharge (12% of permit fee)
TOTAL PERMIT FEE WrI .0
Authorized signature: This permit application expires if a permit is not obtained within 180
/ / p days after it has been accepted as complete.
Print name: (/ t di- p at M �4 V...,..4 (j v�(J Date: 10 8 (-2_ • Fee methodology set by Tn -County Building Industry Service Board
I \Butlding\PermitsU�C- PenmtApp doe 03/07/12 I 1 440-4617T (1 I /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 $10,0 $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.
I:\Building\Permits\MEC- PermitApp.doc 03/07/12 2 'k