Permit CITY OF TIGARD MECHANICAL PERMIT
11111
COMMUNITY DEVELOPMENT Permit it: MEC2021-00390
13125 SW Hall Blvd.,Tigard OR 97223 503,718.2439 Date Issued: 6/8/2021
TIGARD 9 Parcel: 2S111 BD00404
Jurisdiction: Tigard
Site address: 9655 SW MURDOCK ST
Project: Ramaekers Subdivision: DARMEL NO.3 Lot: 22
Project Description: Replace water heater
Contractor: OWNER Owner: RAMAEKERS, DONALD B AND
CONNIE M
9655 SW MURDOCK ST
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Water Heater 06/03/2021 $23.32
Type of Use: SF 12%Slate Surcharge-Mechanical 06/03/2021 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 06/03/2021 $66.68
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: HO y VaNvDezWege Permittee Signature: Owl L(.C-A.ti,D-vt
Pp
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
n
+ Mechanical Permit ApplicatiggECEIVED
City of Tigard S Recei
Datesvedy, j3/1.OZ( tt Permit No.:lif eanal ne)
iii13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 NAY 2 F 2021 Date/By: ,— Other Fermi..
on Line: 503.639.4175 Q
i I C;A l:1> Inter Inspection Date ReadyBy: Q J f c 7� H See Page 2 for
Internet: www.tigtird ocgov CITY OF TIGARD Noti=e1 . - �.6 Supplemental Information
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TYPE OF WORK COMMERCIAL FEE" SCHEDULE— USE CHECKLIST
��/ Mechanical permit fees'are based on the value of the work
❑New construction ddition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition {LJ,Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES°
Vfl-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description Qty. I Ea. Total
•
JOB SITE INFORMATION AND LOCATION Heating/cooling:
p Air conditioning 46.75
Job site address: / ( , SC. 3 (� /71U J 00 eke ,S Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: filiQ c Or .p , , 7 2 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 2332
Residential boiler(radiator ar
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. 2332
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
X (�f�1- C e: GC/G f P j7-' Ij PCs to fireplace 23.32
/ Log lighter(Pas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimneytiner/flue/vent 2332
Val
OthPROPERTY OWNER 0 TENANTS 23.32
Environmental exhaust and ventilation:
Name: DON l?0!M a P_s l e V 5 Range hood/other kitchen
l equipment 33.39
c3 r Address: - S L J )l I i R /)O C 4 .. /L Clothes dryer exhaust 33.39
1 Single-duct exhaust(bathrooms,
City/State/ZIP: / ty
7 ,i/ C O {� 7 a toilet compartments,utility rooms) 23.32 ,
Phone:(, �!- Lt — G 3 L.G Fax:( ) Attic/crawlspace fans 23.32
APPLICANT 0 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
Walllsuspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
Range
E-mail: ci bra )4, 4,„ 7/i�l c„ L . e O %i1/1 Barbecue
ONTRACTOR Clothes dryer(gas)
Other
Business name:
MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lic.: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Authorized signature: (.ONX r�Co//n v / !/a'iyri[L.g. * Fee methodology set by Tri-County Building Industry Service Board
Print name: .9c y c7Zd i2a 4 a C/ v Date:6" — 3 - al
l:\Building\Permits1MEC_PemutApp_0401 13.doc 410-4617F(1 1/02JCOM/WEB)
RECEIVED
Property Owner Statement
MAY 2 6 2021 Regarding Construction Responsibilities
CITY OF TIGAHL
BUI �� quires residential construction permit applicants who are not licensed with the
onsfruc'fioh 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 permits.
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:
L� 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 all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
/
/ I will be performing work on property I own, a residence that I reside in, or a residence that I will
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 homeowner statement is true and accurate.
! OZ--d ea. 444PCr 5
Print Name of Permit Applicant
Signature of Permit Applicant Date
Permit#:
Address: �ti'!�
NI
Issued by: ___ Date:
This Copy for Permit Offices