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Permit . . CITY OF TIGARD MECHANICAL PERMIT a. COMMUNITY DEVELOPMENT Permit #: MEC2013 -00761 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2013 Parcel: 1 S134AD01000 Jurisdiction: Tigard Site address: 11386 SW IRONWOOD LP Project: HERR Subdivision: ENGLEWOOD Lot: 29 Project Description: Gas fireplace insert with fuel piping. Contractor: R & D INSTALLATIONS Owner: HERR FAMILY TRUST 5246 SE 62ND 11386 SW IRONWOOD LOOP PORTLAND, OR 97206 TIGARD, OR 97223 PHONE: 503 - 774 -7142 PHONE: FAX: 503 - 774 -7142 FEES Specifics: Description Date Amount Gas Fireplace 12/16/2013 $33.39 Type of Use: SF Fuel Piping 12/16/2013 $14.15 Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/16/2013 $10.80 Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/16/2013 $42.46 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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1 �.On.332 -2 '4. Issued By: II y' Permittee Signature: ` —'.` O f+,+✓ 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 Application �1 F•t)li 01. 1.1(.1.: 1 SE t>NI.) City of Tigard I DateBed Permit No.: �1 13125 SW Hall Blvd., Tigard, OR 97223 �� y �� / �O � >// � / � C ' [ � - a � ( ' I Phone: 503.718.2439 Fax: 503.598.1960 ii + Date/By: Plan Review Other Permit: � 9.417 M TI �; .A K I > Inspection Line: 503 5 0 G� 1 g Q \ Date Ready/By: Juris: El See Page 2 for Internet: www.tigard or.gov ` O��\ ; otified/Method: '7 Supplemental Information TYPE OF WORK ` g4 Mechanical permit fees* are based on the value of the work u New construction ❑ Addition/alteration/rep ement 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* 0 1- 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 46.75 Job site address: 1 1 3 y W S° 1 2 o N w on p (....P Furnace 100,000 BTU ( ducts/vents) 46.75 City/State /ZIP: -j- \ Gvk rz n O R 9 7 2 Z ? Furnace 100,000+ BTU (ducts/vents) 54.91 Heat pump 61.06 Suite/bldg. /apt. no.: Project name: 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.: I (p Other: 23.32 �T� w o ° Other fuel appliances: Tax map /parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 1 33.39 Tug Flue vent for water heater or gas Pt'' 5 t.l ( - S F rLr P L4. C E- fireplace 23.32 Log lighter (gas) 23.32 W tlln Oc /) ) ' W `') Wood/pellet stove 33.39 vv J Wood fireplace /insert 23.32 Chimney /liner /flue /vent 23.32 tEl PROPERTY OWNER I TENANT Other: 23.32 Environmental exhaust and ventilation: _ Name: C ur T1 5 © A R Range hood/other kitchen equipment 33.39 Address: I 'T L{ 5 A B a V L Clothes dryer exhaust 33.39 City/State /ZIP: Single -duct exhaust (bathrooms, toilet compartments, utility rooms) 23.32 Phone: (5o 3 ) 3 o i , b $ 2 g Fax: ( ) Attic /crawlspace fans 23.32 I] APPLICANT al CONTACT PERSON Other: _ 23.32 Fuel piping: Business name: , 4 s 0 1L $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) P._ r Other: Business name: P._ F D IN S X L..t -- il- T7 0 N * 1 MECHANICAL PERMIT FEES Address: SOZi-u, 5 6) — Subtotal _ City/State /ZIP: per-t-te„,./A v Ll 7 G9 Minimum permit fee ($90.00) . V,J t Plan review (25% of permit fee) Phone: (5' - 7' Li — 7/1. 7 Fax: ( ) S tate surcharge (12% of permit fee) j V_ �) CCB lic.: 1 5-23 TOTAL PERMIT FEE /pd.. This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: 0 * F e e m etho dology set by Tri- County Building Industry Service Board Print name: Q LIAZ \ l S 0, .0 .tk R. I Date: 1 2. - I L, • ( 1 I :\Building\Permits\MEC PermitApp_040113.doc 440- 4617T(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