Permit CITY OF TIGARD MECHANICAL PERMIT
1- a • COMMUNITY DEVELOPMENT Permit#: MEC2013-00702
T I G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/20/2013
Parcel: 2S103AD00502
Jurisdiction: Tigard
Site address: 11200 SW ERROL ST
Project: Block Subdivision: ECHO HEIGHTS Lot: 10
Project Description: Installation of gas insert and gas line.
Contractor: HIGH QUALITY STOVE SERVICES LLC Owner: BLOCK,WILLIAM J&GWEN G
10360 SE REEDWAY ST 11200 SW ERROL ST
PORTLAND,OR 97266 TIGARD,OR 97223
PHONE: 503-440-7259 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 11/20/2013 $33.39
Type of Use: SF Chimney/Liner/FlueNent 11/20/2013 $23.32
Class of Work: ALT Type of Const: Fuel Piping 11/20/2013 $14.15
Occupancy Grp: 12%State Surcharge-Mechanical 11/20/2013 $10.80
Stories: Minimum Fee Adjustment-Mechanical 11/20/2013 $19.14
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utilit otifica i• Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain , copy of the rules
or rect questions to o UNC • ;.fling 503.232.1987 or 1.800.332.2344.
Iss d By: Permittee Signature:ft � '
Call 503.639.4175 by 7:00 a.m.for the next available inspection da e. /•_•
This permit card shall be kept in a conspicuous place on the job site until comple ion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR oFFIcv USE ONLY
City of Tigard Received // Permit No.:/ (tG /5_,,x)70
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
II Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: ruris: El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: ,f1/( y,4// / mechanical materials,equipment,labor,overhead,and profit.
/ _ ` Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS,FEES*
4 I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family . ❑Master builder ❑Other: Description Qty. I Ea. I Total _
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: I I Zoo. c t.,/ r i, S I Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: ¶I G A.4.,0 Ut... GI 72II Fumace 100,000+BTU(ducts/vents) , 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/diredions to job site: //2 L. 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
i vk (9- (..t A4--- 7b h 1.14 p. o& (rns r 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 ❑ TENANT Other: 23.32 ,
Environmental exhaust and ventilation:
Name: 1J/-1 401 IliCe...., Range hood/other kitchen
equipment 33.39
Address: //iv 0 Sw l-R k-CL .5,r-, Clothes dryer exhaust 33.39
City/State/ZIP: b,kitp oL (�' 7 2 ZS Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( c--b3,) 6v6- 61, Fax:( ) Attic/crawlspace fans 23.32
[APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional_
Contact name: Furnace,etc.
Address: c./444/te_ Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR t-r', tJO,jLe, Clothes dryer(gas)
��� ) Other:
Business name: 1-FI if at A Li r ,3T--tJ� ,iaJt Cf5 ae- MECHANICAL PERMIT FEES*
Address: /0 34,0 gE AiEa it), y a.r" Subtotal 90,470
City/State/ZIP: PD2 ri_4-Ay-r-, p/Z 97 2.,44, Minimum permit f e e($90.00) .----
Plan review(25%of permit fee) —
Phone: ) 1 t -7,251? Fax:( ) State surcharge(12%of permit fee) /p.te)
CCB Iic.: i q 40 7/ a//'2ic TOTAL PERMIT FEE kV..W
/// 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: �f,u ti4tti f f�C K Date:
I.\Building\Permits\MEC_PermitApp_040I 13.doc 440-46171'(I I/O2JCOM/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