Permit CITY OF TIGARD MECHANICAL PERMIT
III s , COMMUNITY DEVELOPMENT Permit #: MEC2013 -00102
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/19/2013
Parcel: 25111 BD02000
Jurisdiction: Tigard
Site address: 9775 SW PEMBROOK ST
Project: Thompson Subdivision: CLOUD CAP Lot: 2
Project Description: Install gas insert, gas line and venting.
Contractor: EVERGREEN GAS INC. Owner: THOMPSON, MARC R & DEANNA M
PO BOX 388 9775 SW PEMBROOK ST
WEST LINN, OR 97068 TIGARD, OR 97224
PHONE: 503 -407 -9542 PHONE: 503 - 620 -1846
FAX: 503 - 344 -6345
FEES
Specifics: Description Date Amount
Flue Vent for Water Heater or Gas 02/19/2013 $23.32
Type of Use: SF Fireplace
Class of Work: ALT Type of Const: Chimney /Liner /FlueNent 02/19/2013 $23.32
Occupancy Grp: Fuel Piping 02/19/2013 $14.15
Stories: 12% State Surcharge - Mechanical 02/19/2013 $10.80
Minimum Fee Adjustment - Mechanical 02/19/2013 $29.21
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 la All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuan =, or if wor suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification Center. Those - are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or d' ect questions to OUNC b •: ing 50 - •.1987 or 1.800.332.2344.
Is ued By: , 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 Applicati t ► F OR o FIC USI o1VLl , ..,:,...... ::
City of Tigard i Received n 41 Permit No.: ,�n p
71 ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Date/By
Phone: 503.639.4171 Fax: 503.598.1960 FEB 19 2013 Other Permit:
TI G A li D Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov
CITY OF TIG Notified/Method: Supplemental Information
TYPE OF �� ®ING DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
ID New construction Addition/alteration/replacement Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
LLLL�� Multi - family ❑ Master builder ❑ Other: For special information use checklist.
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: Air conditioning or heat pump
7.7 c ( .Q f t-`. ` (requires site plan showing placement) 14.00
City /State /ZIP: ���.I C `)7 7 Furnace 100,000 (ducts/vents) 14.00
�J 7 ` Furnace 100,000+ BTU BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name:
Gas heat pump 14.00
Cross street /directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace ) 10.00
4 5 4 / 4- � /1/'�'e/L -If Flue vent for water heater or gas
fireplace 10.00
tit O ` ,,� /�
/y/ / 6_,ts — Log lighter (gas) 10.00
JJJ Wood /pellet stove 10.00
. Wood fireplace /insert 10.00
. P ROPERTY OWNER I ❑ TENANT Chimney /liner /flue/vent ' 10.00
Other: 10.00
Name: 6 e � ,/ r , ` avo L„,„4r,.,,3 isb Environmental exhaust and ventilation
Range hood/other kitchen
Address: 75 �j equipment 10.00
Cit /State/ZIP: t Clothes dryer exhaust 10.00
y i j �� Z �� Z Single -duct exhaust (bathrooms,
Phone: (; 07) _ i z ,) Fax: ( ) toilet compartments, utility rooms) 6.80
' ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace i
E -mail:
Range
CONTRACTOR Barbecue
� / 43- xv,L Clothes dryer (gas)
�
Business name: ` Other:
Address: O t n MECHANICAL PERMIT FEES*
r0 yl.✓t C9 97b 6 f3 Subtotal
City /State/ZIP: O 90' OV
Phone: (�`� � 7 �Q !�Z Fax: ( ) � 9t�'� Minimum permit fee(s1;7� - SAj+ .
5 Plan review (25% of permit fee) •
CCB lic.: f ` S f � 3 / State surcharge (8% of permit fee) /d . YC�
J V TOTAL PERMIT FEE / 2 • 8'v
Authorized signature: ( This p ermit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: / I l > / I Z • Fee methodology set by Tri- County Building Industry Service Board
�
I:�Building�Permits Permit l.d6 04/ � Date: G
06 440 617T(11/ COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
_ $50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
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