Permit 114CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT MECHANICAL
MEC2015-00417
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 I Date Issued: 06/29/2015
Parcel: 2S111AD16100
Jurisdiction: Tigard
Site address: 15034 SW 91ST AVE
Project: Caminschi Subdivision: MALLARD LAKES Lot: 27
Project Description: Remodel of bathroom&closet,(1)vent fan and gas piping for future fireplace. 11/16/16,REPRINTED to add(2)
gas outlets for future range and outdoor barbecue.
Contractor: OWNER Owner: CAMINSCHI,ANDREI&KIMBERLY S
ANDREI& KIM CAMINSCHI 15034 SW 91ST AVE
15034 SW 91ST AVE TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 425-753-6669 PHONE: 425-753-6669
FAX:
FEES
Specifics: Description Date Amount
Single Duct Exhaust(Bathrooms,Toilet, 06/29/2015 $23.32
Type of Use: SF Utility Rooms)
Class of Work: ALT Type of Const: Fuel Piping 06/29/2015 $14.15
Occupancy Grp: Misc Administration Fee 11/16/2016 $45.00
Stories: Minimum Fee Adjustment-Mechanical 06/29/2015 $52.53
12%State Surcharge-Mechanical 06/29/2015 $10.80
Fuel
Fuel Types:
Gas Pressure:
Total $145.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By.�k.ree9az_ot_42.1\ Permittee Signature: /( ��� �/ �'j
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. (/J/
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
f r4-111
'e. 4T ,,i
Mechanical Permit Application FOR OFFICE USE("LI
City of Tigard 1'i` `/ 1 ') ] Received
�•1 Date/By: , to, dip Permit No.:
111 13125 SW Hall Blvd.,Tigard,QR 97223 �C 0,..„(5---00/71/
II �
I Phone: 503.718.2439 Fax: 5Q3;5Q8 11641. Plan Review
d" Date/By: Other Permit:
T t G n R U Inspection Line: 503.639.475,r - ,q
Internet: www.tigard or gov'('.. t,;V 2 fl 1 Date Ready/By: kris: ® See Page 2 for
_, U ,;1 lzr Notified/Method: Supplemental Information
F1'5
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
❑ 1-and 2-famil RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
y dwellin g ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family 0 Master builder
0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: / S7 Air conditioning 46.75
f c7� S�4 � %� /l �C-__, Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:
7-76,' ,e9 Ofre-... �1 702 ,G� Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: / Heat pump 61.06
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
0-* - 0 , �.C1O&-P-I �O? 6,x_71.4.4...e.„ ,/Ad--.gyp: 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 23.32
1] TENANT .
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
Address: equipment 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
O APPLICANT ❑ CONTACT PERSON Other:
23.32
Business name: Fuel piping:
$14.15 for t four; .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)
Business name: Other:
MECHANICAL PERMIT FEES*
Address:
Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Phone: Plan review(25%of permit fee)
( ) Fax:( ) State surcharge(12%of permit fee)
CCB lie.: TOTAL PERMIT FEE if4C-
Cappi,/,&..e„?..._
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:,4 .4'7 'ectlan 5c Gro, Date: / )—lb-/‘,
1:\Building\Permits\MEC_PermitApp_040113.doc 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$10,000.00 $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\Pennits\MEC_PermitApp_040113.doc 2
CITY OF TIGARD MECHANICAL PERMIT
3 COMMUNITY DEVELOPMENT Permit#: MEC2015-00417
TIIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/29/2015
Parcel: 2S111AD16100
Jurisdiction: Tigard
Site address: 15034 SW 91ST AVE
Project: Caminschi Subdivision: MALLARD LAKES Lot: 27
Project Description: Remodel of bathroom&closet,(1)vent fan and gas piping for future fireplace.
Contractor: OWNER Owner: CAMINSCHI,ANDREI&KIMBERLY S
ANDREI & KIM CAMINSCHI 15034 SW 91ST AVE
15034 SW 91ST AVE TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 425-753-6669 PHONE: 425-753-6669
FAX:
FEES
Specifics: Description Date Amount
Single Duct Exhaust(Bathrooms,Toilet, 06/29/2015 $23.32
Type of Use: SF Utility Rooms)
Class of Work: ALT Type of Const: Fuel Piping 06/29/2015 $14.15
Occupancy Grp: 12%State Surcharge-Mechanical 06/29/2015 $10.80
Stories: Minimum Fee Adjustment-Mechanical 06/29/2015 $52.53
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: jam,.y rn
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. "`//
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application,,EIS'El) FOR OFFICE USE ONI.1
City of Tigard Date/By: CF' �/�j��. Permit No.:HE 91 7
III 13125 SW Hall Blvd.,Tigard,OR 97223 y c)6/6-.-00
Phone: 503.718.2439 Fax: 503.598.1960 L 9 7 O 15 Plan Review Date/By: Other Permit:
I I(;1 It 1 Inspection Line: 503.639.4175 U Date Ready/By: runs. El See Page 2 for
Internet: www.tigard-or.gov 11 y OF IIGArcRUA Notified/Method: Supplemental Information
i3U�[WORK DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
TYPE OF WORK
Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
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 1 Qty. 1 Ea. _ Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: d S� q,S-T
ieNe___ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: -no_/21-1-a. 0 te_. �� Furnace 100,000+BTU(ducts/vents) 54.91
. Heat pump 61.06
Suite/bldg./apt.no.: Project name: cium4,1 5c41 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
n , Flue vent for water heater or gas
P -0 O. -- 9 R J y^1 rO Y)n cold,- fireplace 23.32
CA (r_� _----1---• DJ eh C 1.c� Q� �( L Log lighter(gas)
Wood/pellet stove 23.32
33.39
4e a m� bccrh y n e_N; n Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
•
Name: +‹.,k_)1(-) CCL Ynk -)c C hA, Range hood/other kitchen
�``IJ equipment 33.39
Address: ! J3� S�j l S� Clothes dryer exhaust . 33.39
City/State/ZIP: [I 121(-) e....2___ 9 _Z4 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 1 23.32
Phone:(-y Z("---- �- &2cj Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ` ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc. .
Gas heat pump
Address: - -
Wall/suspended/unit heater ,
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace I
Range
E-mail: Barbecue
�M CONTRACTOR /�r'p Clothes dryer(gas) ,
�r�V f 1 L►CY`ujK Other: .
Business name: MECHANICAL PERMIT FEES*
Address: �`S _ -t C'(k__) l Pn/c�� Subtotal
City/State/ZIP: r '"` Minimum permit fee($90.00) %)'
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) /O..70
CCB lie.: TOTAL PERMIT FEE /p0•geO
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: 1 1 --11 Date: I I
1.\Building\Permits\C_PermitApp_040113.doc 440.4617T(I I/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_040 I I 3.doc 2