Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2014-00222
T f G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/12/2014
Parcel: 1 S 134AD07300
Jurisdiction: Tigard
Site address: 10557 SW WINDSOR PL
Project: Windsor Subdivision: WINDSOR PLACE Lot: 10
Project Description: Kitchen Remodel: range hood and gas piping.
Contractor: CORNERSTONE BUILDERS INC Owner: LIPSCOMB,THOMAS R III&JANIELL
7849 SW CIRRUS DR 10557 SW WINDSOR PL
BEAVERTON, OR 97008 TIGARD,OR 97223
PHONE: 503-671-9538 PHONE:
FAX: 503-671-9640
FEES
Specifics: Description Date Amount
Single Duct Exhaust(Bathrooms,Toilet, 05/12/2014 $23.32
Type of Use: SF Utility Rooms)
Class of Work: ALT Type of Const: Fuel Piping 05/12/2014 $14.15
Occupancy Grp: 12%State Surcharge-Mechanical 05/12/2014 $10.80
Stories: Minimum Fee Adjustment-Mechanical 05/12/2014 $52.53
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You tain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:
Permittee Signature:
Q
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applicat UEIVEI I O't (" ' '( I l tit ()\I l
City of Tigard Receive DateB . /2- / 45.1e Permit NoMc(azo/y_Q j 22
• 13125 SW Hall Blvd.,Tigard,OR 972 Plan Review
Phone: 503.718.2439 Fax: 503.598.1 Y 12 2014 DateBy: Other Permit:
I I t `I<I Inspection Line: 503.639.4175 / y Date Ready/By: Sufis: El See Page 2 for
r
Internet: www.tigard-or.gov CITY OF I IGARI) Notified/Method: 776_,. Supplemental Information
BU DIVISION
WORK
TYPE OF WO COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction -Addition/a1teration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
�,/ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
V t-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating cooling:
Air conditioning 46.75
Job site address: /D ss-7 S WI Ki)'�- PL • Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: T1/ u,i) �7n - 17 it.3 Furnace 100,000+BTU(ducts/vents) 54.91
u�'W n 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
Other: 23.32
Subdivision: Lot no.: -
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
(U5iiit/ 6NO tin c. r7 N G g ig� p,tvsT)41/ fireplace 23.32
a 7ShGT1KC QXtE .- '°Y Log Wlighter ood/pellet 23.32
Wood pellet stove 33.39
Wood fireplace/insert i 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
Address: equipment I 33.39
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
Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address:
Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater _
Phone:( ) Fax: :( ) Fireplace
Range —7C' _
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas) _
Other:
Business name: ( (LN J 13_' rt)q,- Q(A,l DWI-S. Imo, MECHANICAL PERMIT FEES*
Address: 7$y9 s w ciYLn-t4S )7t. Subtotal 49p,a)
a
City/State/ZIP: Oin/2,7b? ott. 970043 Minimum permit fee($90.00)
��yyff
Plan review(25%of permit fee)
Phone:
(9D ) &7 95 3$ Fax:( ) State surcharge(12%of permit fee) / ), ' 7
CCB lic.: he(,5–y TOTAL PERMIT FEE /do ,efo
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: .`J " Fee methodology set by Tri-County Building Industry Service Board
Print name: $41/06/ �itn/�a)t (i ) Date:SI/3��/
I.\Building\PertnitsV�C_PertnitApp_040I13.doc / 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