Permit CITY OF TIGARD MECHANICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: MEC2013 -00085
T.IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/11/2013
Parcel: 2S104AA02400
Jurisdiction: Tigard
Site address: 12265 SW 127TH AVE
Project: Wyffels Subdivision: BELLWOOD Lot: 73
Project Description: Install gasline to fireplace.
Contractor: J & M CONTRACTOR SERVICES INC Owner: WYFFELS, HENRY R
15604 NE RUID RD 12265 SW 127TH AVE
AMBOY, WA 98601 TIGARD, OR 97223
PHONE: PHONE: 503 - 680 -6776
FAX:
FEES
} Specifics: Description Date Amount
Fuel Piping 02/11/2013 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 02/11/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 02/11/2013 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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Gas Pressure:
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- . 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 No • ion n 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 OUN by • . in 503.232.1987 or 1.800.332.2344.
lssu d By: i / 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.
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Mechanical Permit Application FOR OFFICE USE ONLY .
City of Tigard Datee/By: t c /� ,. / 3 eCe
Permit No.:
Illq ° 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Date/By:
T I G A R D Inspection Line: 503.639 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
' ° 5 ; _ 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" °
5 -i- 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: ` a._�6- ' I -2,---) `' \ A- _ (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP:
eN�� 1 1-)7—. l� � 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 (f:el -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 0 33.39
. `^-� --‘-:b ` .4— \ ..") 11: -.(� 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 1 ❑ TENANT Chimney/liner /flue /vent 23.32
/' Other: 23.32
Name: �v\� �1r \\I Environmental exhaust and ventilation:
Address: ` d S (�"1 "� Range hoo kitchen
�Pt)� equipment 33.39
City/State/ZIP: �' . Q Z c f t� a--� Clothes dryer er exhaust 33.39
ty 1 , l
/� cv � Single -duct exhaust (bathrooms,
Phone: (S .l
63) 4 & ( c Fax: ( ) toilet compartments, utility rooms) 23.32
0' APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: k p ^ Other: 23.32
5 \ � ` + fit\ � C�-' Fuel piping:
�
Contact name: �.1` f , k l ,, v $14.15 for first four; $4.03 for each additional
Address: (�h n N� c2„.....,,, Furnace, etc.
Gas heat pump
City/State /ZIP: A.,,iy\ L Lti/A g ' L ` Wall /suspended/unit heater
'y a. - t Water heater
Phone: (7 bt� n \ --) Fax:: ( )
Fireplace 0
E -mail: " -my N,C`j ∎ c ( (s\-e (, t�1 -, Range
CONTRACTOR Barbecue
Business name: . 4 \ . J'f). Vel-B `l �C, Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES" /�
City /State /ZIP: Subtotal 9'/2 • c.$0
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) - .
Plan review (25% of permit fee) ,
CCB lic.: -N6 SOl ///5-// l State surcharge (12% of permit fee) /a. $a
TOTAL PERMIT FEE / 40. irO
Authorized signature This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: K; ,_\„,,, 0 Date: ! ( * Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \Pennirs\MEC- PermitApp.doc 03/07/12 440-4 17T(II /02/COM/WEB) -
Mechanical Permit Application - City of Tigard
Page - Supplemental Information V
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