Permit CITY OF TIGARD MECHANICAL PERMIT
111 • COMMUNITY DEVELOPMENT Permit#: MEC2016-00688
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/29/2016
T t C.,h I<.f� g Parcel: 2S103DB04000
Jurisdiction: Tigard
Site address: 13340 SW GENESIS LP
Project: HOSFORD Subdivision: GENESIS NO.2 Lot: 38
Project Description: Gas fireplace insert installation.
Contractor: OWNER Owner: HOSFORD,WILLIAM E
WILLIAM HOSFORD 13340 SW GENESIS LP
13340 SW GENESIS LOOP TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-810-7410 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Gas Fireplace 09/29/2016 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 09/29/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 09/29/2016 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to
OUNC by calling 503.232. . .332.2344.
Issued By: /`)„. Permittee SignaturEF
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application
1 = FOR OFFICE GSE O1LI
Received
Cityof TigardIII
3' Permit No.: )
13125 SW Hall Blvd.,Tigard,OR 97223 "` Date/By: s. it jG�` _ 'l.��,��
IPMEME
g Phone: 503.718.2439 Fax: 503.598.196 Qt �1 Date/Plan Review
Other Permit:
TI G A R D Inspection Line: 503.639.4175 �C ', s ate Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov 4 JA . 'aed/Method: p� Supplemental Information
TYPE OF WORK t`11COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
�'Ics,_. Mechanical permit fees*are based on the value of the work
❑New construction [Addition/alteration/ Yl'acement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
0/1.-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: .' 3390 J 1,t) C,e tire.S';S L i,,ca e Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: -rt�Gsrt- Cd c t-7 a 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
I t s""rh ck.,N dc n e s,S Lv:-p 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 x Gas fireplace/insert 1 33.39 3
Flue vent for water heater or gas
,-
.......)C.3 .r e. el c c D r 1, U c_1/1 1 / Go,S \ V1 C- 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 0 TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: ,,t ( 405.cC,.f r-.( Range hood/other kitchenequipment 33.39
Address: S� 0 S w
" V\k i L;l J Clothes dryer exhaust 33.39
City/State/ZIP: ' ."-\---c exhaust(bathrooms,
l �G r �z toilet compartments,utility rooms) 23.32
Phone:(6U 5) -`6 i v .:-7 y 1 (0 Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT; ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
�� Vv.;./.."' v^ $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 . .... . Clotheser(gas)
(g )
Business name: (i1Other:
l V"� MECHANICAL PERMIT FEES*
Address: Subtotal -- .3'..--.3-7
Minimum permit fee($90.00)
City/State/ZIP: �/�„Liu
"
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) t C. )
CCB lit.: TOTAL PERMIT FEE i,(2),Pv
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: rs.1.// hiT,15-(t)/Z!( Date:5/2,1/442/A
l:\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