Permit CITY OF TIGARD MECHANICAL PERMIT
,..
`!'! ,, COMMUNITY DEVELOPMENT Permit#: MEC2016-00681
Date Issued: 09/26/2016
T f{ AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S111 CA09300
Jurisdiction: Tigard
Site address: 15380 SW 100TH AVE
Project: Verdon Subdivision:3TATES NO.2 A REPLAT OF"GULF SII Lot: 37
Project Description: Gas fireplace,range hood and gas piping for fireplace and range.
Contractor: DONALD BRENNFLECK INC Owner: VERDON, KEVIN W&
PO BOX 55848 WASHABAUGH, MONA G
PORTLAND, OR 97224 15380 SW 100TH AVE
TIGARD, OR 97223
PHONE: 503-380-7284 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 09/26/2016 $33.39
Type of Use: SF Range Hood/Other Kitchen 09/26/2016 $33.39
Class of Work: ALT Type of Const: Fuel Piping 09/26/2016 $14.15
Occupancy Grp: 12%State Surcharge-Mechanical 09/26/2016 $10.80
Stories: Minimum Fee Adjustment-Mechanical 09/26/2016 $9.07
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direr estions to NC by calling 503.232.1987 or 1.800.332.2344.
Issues,By: ,1,� 4 / C Permittee Signature: 11 i ,,i
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE FSI:ON t.)
Cl of Tigard RDate/Bea W'e�Ql�
`5 g e 5 t y / Permit No.:
� 13125 SW Hall Blvd.,Tigard,OR '' .►%� ��6.���AA{VJ •
II Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 c c 6 Date Ready/By: lure H See Page 2 for
Internet: www.tigard-or.gov J C 2016 Notified/Method: Supplemental Information
CITY OF TIGARD
TYP1136AMPPIGCOMMERCIAL FEE* SCHEDULE - USE CHECKLIST
—...-ION Mechanical permit fees*are based on the value of the work
❑New construction ddition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT i SYSTEMS FEES*
fly i-and 2-family dwelling 0 Commercial/industrial 0 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:
Air conditioning 46.75
Job site address: 5 3 Li() J r�, / 0'f In v(/r^J t/ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: -T-,, /j e/ � r '7
J Z 44 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: / Project name: Heat pump 61.06
j
�'���%�'''"� L(/��/��``�� ' 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.: �'� 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
' DESCRIPTION OF WORK' Gas fireplace/insert 33.39
s
A - v. Flue vent for water heater or gas
("4--< I-t f--e/,4 c.e J 4 UI k"- rc f l/.9x 4E'/05; 0/C--"' fireplace 23.32
J� Log lighter(gas) 23.32
P c AI,-
l e Ilr a V (u / Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
- � PROPERTY OWNEROther: 23.32
r 0TENANT"=.r,.
Environmental exhaust and ventilation:
Name: Range hood/other kitchen
equipment ) 33Address:
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
'N-APPLICANT" ❑`CONTACT PERSON Other: 23.32
Fuelt m
Business name: Do,v A L h 13 e E-.-A,tcaf lee >'1.)( P P g•
$14.15 for first four;$4.03 for each additional
Contact name: L 61),„4,. , SMI Le,c....,-.. etc.
/76143 l/ , Gas heat pump
Address: E '1C �7
L!
City/State/ZIP: j7.7
// Wall/suspended/unithenter
G� f-/,,j✓✓ I /
Yj Z- -
3 7j Water heater
Phone:(50 5) . qt,- .7 z ci`1 Fax::( ) Fireplace 1
Range 1
E-mail: //
1� j% f r ckc'/.icC ✓•`e/ 1, t' 0,---- Barbecue •
1*1717GTOR. Clothes dryer(gas)
Business name: A �;G Other:
�j
MECHANICAL PERMIT FEES*
Address: Pe; i3,.),,x- .5 -d Subtotal
City/State/ZIP•� o.1 f.,„,d « "7 2 -e 4Minimum permit fee($90.00).
!!�� , Plan review(25%of permit fee)
Phone:(''o 3,..<;:0,7 2g1.1 Fax:( ) State surcharge(12%of permit fee)
CCB lic.: 72 6/p0//g TOTAL PERMIT FEE 700•elO
This permit application expires if a permit is not obtained within 180
,�s �,�1 days after it has been accepted as complete.
Authorized signature: �______� 1 ...c, * Fee methodology set by Tri-County Building Industry Service Board
Print name: /..-)„,„,-Jt/ j p�,,,,777✓,r/ii.,�/. r Date: 2 l'r-7/el
I:\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\Permits\MEC_PermitApp_040113.doc 2