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Permit
:. , CITY OF TIGARD MECHANICAL PERMIT • ' • ' o : - COMMUNITY DEVELOPMENT Permit #: MEC2012 -00555 :TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/24/2012 Parcel: 2S 111 CCO3900 Jurisdiction: Tigard Site address: 10160 SW CENTURY OAK DR Project: Peterson Subdivision: SUMMERFIELD Lot: 62 Project Description: Installation of gas insert, venting & gas line. Contractor: EVERGREEN GAS INC. Owner: PETERSON, CLARK & JUDY PO BOX 388 10160 SW CENTURY OAK DR WEST LINN, OR 97068 TIGARD, OR 97224 PHONE: 503 - 407 -9542 PHONE: 208- 315 -4621 FAX: 503 - 344 -6345 FEES Specifics: Description Date Amount Gas Fireplace 10/24/2012 $33.39 Type of Use: SF Flue Vent for Water Heater or Gas 10/24/2012 $23.32 Class of Work: ALT Type of Const: Fireplace ' Occupancy Grp: Fuel Piping 10/24/2012 $14.15 • Stories: 12% State Surcharge - Mechanical 10/24/2012 $10.80 Minimum Fee Adjustment - Mechanical 10/24/2012 $19.14 • 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 N. ' a ion - • - r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or dire' questions to OU • k allin. 503.232.1987 or 1.800.332.2344. // Issue. :y: ♦ Permittee Signature: It /,/ZJ 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 A licat' E FOR OFFICE USE ONLY Cl of Ti and 1 v Received (E / �� '3 `•7 g Date/By: 9Q ! Permit No.: ' _/GC:� 514 ° 13125 SW Hall Blvd., Tigard,OR 97223 C . Phone: 503.718.2439 Fax: 503.598.1960(: j' I r Date/By: ew 4 ( il _ Other Permit: T I G A R D Inspection Line: 503.639 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard - or.gov crrY (FTIGARD Notified/Method: Supplemental Information ilJILDING TYPE OF ORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction ■ A p dition/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* and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. Multi - family ❑ Master builder ❑Other: Description I Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: (requires site plan showing placement) 46.75 City /State /ZIP: � �' Furnace 100,000 BTU (ducts/vents) 46.75 � I ' 9 7 ZL / Furnace 100,000+ BTU (ducts /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 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 S / n / 4-5- / 5e- Gas fireplace/insert 33.39 T d / (� �L Flue vent for water heater or gas VZI`/A47 / - _ L / � -- fireplace 23.32 17 y (�"'�J Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 1 23.32 PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent I 23.32 Other: 23.32 Name (! ` F l „` Environmental exhaust and ventilation: /Address: 6 5 CG, Address: tl J i 9 /r& diz- Range hood/other kitchen equipment 33.39 City/State /ZIP: / ,�., -- &,[L 9" Z ? K Clothes dryer exhaust 33.39 Q Single -duct exhaust (bathrooms, Phone: (70 o J / s' : fr6 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 CONTRA Barbecue �j.e f� ,ree l��L Clothes dryer (gas) Business name: T 6 3 ' Other: Address: MECHANICAL PERMIT FEES* City /State /ZIP: (4 S 11--- Z.„4,-1_, - - , f Subtotal �7 Minimum permit fee ($90.00) 9 0 • eliP Phone: 6;) ) 027 ,,`s--z//z., Fax: ( ) Plan review (25% of permit fee) ----- iiJJ CCB lic.: l g/17 f2/g // 3 State surcharge (12% of permit fee) lam, KO TOTAL PERMIT FEE /� • W Authorized signature: f W f I I Ill � / i (iP, ✓Lj 7 This permit application expires if a permit is not obtained within 180 / days after it has been accepted as complete. Print name: v I Date: /© 1 . 1 / a____ ' Fee methodology set by Tri -County Building Industry Service Board 1:\Building\Permits\MEC- PermitApp.doc 03/07/12 44 617T /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. 1:\ Building \Permits\MEC- PermitApp.doc 03/07/12 2 ti