Permit a CITY OF TIGARD MECHANICAL PERMIT
"'! • COMMUNITY DEVELOPMENT Pe
COMMUNITY MEC2013 00207
TI GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/16/2013
Parcel: 1 S136CB00212
Jurisdiction: Tigard
Site address: 10870 SW 82ND AVE
Project: Schulz Subdivision: SHANNONDOW Lot: 11
Project Description: Installation of woodstove
Contractor: SHULZ CONSTRUCTION LLC Owner: SCHULZ, LINDA M REVOCABLE LIVING
11222 SW 84TH AVE 19105 NE HWY 240
TIGARD, OR 97223 NEWBERG, OR 97132
PHONE: 503 - 352 -4425 PHONE:
FAX: 503 - 352 -4425
FEES
Specifics: Description Date Amount
Wood /Pellet Stove 04/16/2013 $33.39
Type of Use: SF 12% State Surcharge - Mechanical 04/16 /2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04 /16/2013 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types: Solid Fuel
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. Specialt a if
- and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work I not sta es thin 180 days of
issor if wo 's suspended for more the 180 days. ATTENTION: Oregon law requires you to fo • . - rules -do by the Oregon
Uf Notification Cent Thos- ules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0W •. You ma obt- n a opy of the rules
o direct questions to OUN• • ailing 5' .232.1987 or 1.800.332.2344.
1 /. i
lss d By: / /i� / / Permittee Signature: /'
/ - , 11
Call 503.639.4175 by 7:00 a.m. for the next available inspection • =te.
This permit card shall be kept in a conspicuous place on the job site until co : 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 R EC FIVFD DateByd fPermit No.: �/ C
Iffl DateBy: q lP /7 l 13125 SW Hall Blvd., Tigard OR Plan Review !
Phone: 503.718.2439 Fax: 503.598.1 R 1 2013 Date/By: Other Permit:
503.639.4175
TIGARD Inspection Line: 503. Date Ready/By: El El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPE olillJOING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction 0 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*
- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building For special information use checklist.
Multi - family 0 Master builder ❑Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION
Heating/cooling:
1 �(� S(� 11D Air conditioning 46.75
Job site address: �
4 UC Furnace 100,000 BTU (ducts/vents) 46.75
City/State /ZIP: - b ARA> D fa. q ZZ7, Furnace 100,000+ BTU (ducts/vents) 54.91
Heat pump 61.06
Suite/bldg. /apt. no.: Project name: �l'-� u_L z___, Duct work 23.32
Cross street/directions to job site: � Z 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
Flue /vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map /parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
U■.) CODS 1 CAYE I). ATP L__L_ fireplace 23.32
Log lighter (gas) 23.32 ----- Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney/liner /flue /vent 23.32
❑ PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust 33.39
City /State /ZIP: Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
Phone: ( ) Fax: ( ) Attic /crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four; $4.03 for each additional
Contact name: Furnace, etc.
Address: Gas heat pump
Wall /suspended/unit heater
City /State /ZIP: Water heater
Phone: ( ) Fax: : ( ) Fireplace
Range
E -mail: Barbecue
CONTRACTOR Clothes dryer (gas)
Business name: � �„ f t� . Z �►.15T1?C) T1 ��
Other:
` y� MECHANICAL PERMIT FEES*
Z
Address: 1 V-22 S� S.4-77-, V Subtotal 71 " °'
City /State /ZIP: '1 (. QT) b I - I Z z ' Minimum permit fee ($90.00)
Phone: (9$) '352 "1-47._s f ( ) S ►-YILIE Plan review (% f permit fee)
State surcharge (12 12 /o of permit fee) / f
s CCB lic.: ' I 1� )A/1.4 / y 'o TOTAL PERMIT FEE _ f .TO
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signatu j ` � r 0 111 * Fee methodology set by Tri -County Building Industry Service Board
Print name: I Date:
I \Building\PermitsUMEC_P itApp_040113.doe 440- 4617r(I1/02/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.
I:\Building\Permits\MEC PermitApp_040113.doc 2