Permit q CITY OF TIGARD MECHANICAL PERMIT
; . . COMMUNITY DEVELOPMENT Permit#: MEC201300462
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/07/2013
Parcel: 2S 103BB03000
Jurisdiction: Tigard
Site address: 12168 SW 125TH AVE
Project: Hing Subdivision: BROOKWAY Lot: 30
Project Description: Replace wood stove
Contractor: OWNER Owner: HING, LEONARD F AND LINDA L
LEONARD HING 12168 SW 125TH AVENUE
12168 SW 125TH AVE TIGARD,OR 97223
TIGARD, OR 97223
PHONE: 503-590-2636 PHONE: 503-590-2636
FAX:
FEES
Specifics: Description Date Amount
Wood/Pellet Stove 08/07/2013 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 08/07/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/07/2013 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No - . Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain, a opy of the rules
or dirt questions to s UNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: / r# � � / Permittee Signature: X1110 (
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit A lica ' IOR OFFICE USE ONLY
City of Tigard CEIVED Date/By: b � Permit No 2a3-06 62
q 13125 SW Hall Blvd.,Tigard,OR 97223 y
Review 1 13 Phone: 503.718.2439 Fax: 503.598.1960, 7 .., Plan Other Permit:
- -
Inspection Line: 503.639.4175
T I G A R D
Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF WLORK G DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES"
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑ Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning _ 46.75
Job site address: / 2, / Ip q �j fit) /�541'4-i 1"Li Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: / I4,r��� D r 47 7 `�..,�.- Furnace 100,000+BTU(ducts/vents) 54.91
I , / / Heat pump 61.06
Suite/bldg./apt.no.: Project name: H t Duct work 23.32
Cross street/directions to job site: 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
fireplace 23.32
e- '� I �� C� I L �o/ s-� v- Log lighter(gas) 23.32
Wood/pellet stove / 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
c D PROPERTY..OWNER , ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: k we.v1.ol l.t t� (//..fr..��� 14 Range hood/other kitchen
`� 7 equipment 33.39
Address: /7 / 6, 0 t r (y, r �Q 11-C Clothes dryer exhaust 33.39
���' Single-duct exhaust(bathrooms,
City/State/ZIP:
/ /- , Cy- - toilet compartments,utility rooms) 23.32
Phone:(5-63 c1 b 2,_(,,3 t,, Fax:( ) Attic/crawlspace fans 23.32
7 ❑ 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)
Or� ,J 12 g- Other:
Business name: /l 'MECHANICAL PERMIT'FEES*
Address: _ Subtotal
City/State/ZIP: -- ----Minimum permit fee($90.00) - 9 , -
Phone:( ) Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee) /p.gD
CCB lic.: TOTAL PERMIT FEE Mo. cv
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board
Print name: /._,e,0 ,,,,,,e 1_1 / M Date: 6_7_ ,3
I:\Building\Permits\MEC_PermitApp_0401I3.doc y 440-4617T(11/02/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$10,00.0.00 $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 c •-
$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 •'
•
iu
• .'Ia
•
• t'
I J
• Y.
I:\Building\Permits\MEC_PermitApp_040113.doc 2