Permit CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit#: MEC2014-00470
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/27/2014
Parcel: 1S 135DB00600
Jurisdiction: Tigard
Site address: 11545 SW 90TH AVE
Project: BREWER Subdivision: TIGARDVILLE PARK Lot: 5
Project Description: Installing a wood stove insert in a masonry fireplace along with a direct connect chimney liner.
Contractor: OWNER Owner: BREWER, SCOTT&SEANA
SCOTT BREWER 11545 SW 90TH AVE
11545 SW 90TH AVE TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-849-0911 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Wood/Pellet Stove 08/27/2014 $33.39
Type of Use: SF Chimney/Liner/FlueNent 08/27/2014 $23.32
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 08/27/2014 $10.80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 08/27/2014 $33.29
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100 80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of OR Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION' Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application 1 olz OFFI( Ill SE O\I.1
Received
iii City of Tigard Date/By: Permit No.: i Ih•
e 13125 SW Hall Blvd.,Tigard,OR y: t ri ;O. � - 0
Phone: 503.718.2439 Fax: 503.5 Plan Review
RECBNI Date/By: Other Permit:
Inspection Line: 503.639.4175
T I C;A K I) Date Ready/By. ® See Page 2 for
Internet: www.tigard-or.gov AUG 27 2p14 NotifieaMlethod: Supplemental Information
�r.
TYPE OF V1 a�a i('T ) COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
�y��t+ Mechanical permit fees*are based on the value of the work
❑New constructionddition/alt� t�c � performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: J mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
l-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: /15,45 5(„„) /c�041.7 Ave__ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: -I-i O,g j) Q 12. c1 7 Z 2 3 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
G(ZEE'N/30 RC. Rb -� 5t,.) 9'D" Ave' 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
/NST41.-L WOO Si-oJt /NSte-T /n/ fireplace 23.32
Log lighter(gas) 23.32
Ir R SO rs/R`! r-112t P LA-c-t~ , Wood/pellet stove 33.39
/N STAL L A/2KT C4)N Ai a✓T,T C-Ifir,NCV L/NcZ - Wood fireplace/insert / 23.32 .23,3,A.
S y s • Chimney/liner/flue/vent / 23.32 A. 31
lig•PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: 6°97- EsglavE,2 Range hood/other kitchen
equipment 33.39
Address: //5415 S,../ 90th AVC Clothes dryer exhaust 33.39
City/State/ZIP: 7.-16 A.,�� OR 4772-23
Single-duct compartments,exhaust(bathrooms,rooms)s,
toilet compartments,utility ro 23.32
Phone:(5o3) ryy 7 -09// Fax:( ) Attic/crawlspace fans 23.32
lit APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: O i"7 G O w r,�- Anv Je Furnace,etc.
Gas heat pump
Address: -
Wall/suspended/unit heater _
City/State/ZIP: Water heater _
Phone:( ) Fax::( ) Fireplace •
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas) _
Other:
Business name: nOri E.7 CJ N NEB /9'$4 V E MECHANICAL PERMIT FEES*
Address: Subtotal 4 & j
City/State/ZIP: Minimum permit fee($90.00) 41 0_0U
Plan review(25%of permit fee) ''
Phone:( ) Fax:( ) o -
State surcharge(12/o of permit fee) 10--
CCB lie.: TOTAL PERMIT FEE re
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: S c t./- 5g etv e Date: 3-2-7 -11
I:I Building\PermitsVMEC_PermitApp_040113.doc 440-46177(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.
1:\Building\Permits\MEC_PermitApp_040113.doc 2
•
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing per mits.
Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not
submit this statement.This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this horn eowner statement is true and accurate.
Sc , y Ye_
Print Name of Permit Applicant
53/2
Sig re of Permit Applicant Date
Permit#: ,n1�C.,20/4(— )k 7Lt F
Address: /IS`r 5— St...) ti 6121 P TC ` _
:0/
Issued by: • Date: bid 7/i y LI •
This Copy for Permit Offices