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Permit
CITY OF TIGARD MECHANICAL PERMIT III s. COMMUNITY DEVELOPMENT Permit#: MEC2021-00541 Date Issued: 8/5/2021 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S133DC14100 Jurisdiction: Tigard Site address: 13134 SW SHORE DR Project: Wachsmuth Subdivision: ARI GREEN Lot: 32 Project Description: Gas piping for kitchen range. Contractor: OWNER Owner: WACHSMUTH,ANDREW J& ANNE-MARIE 13134 SW SHORE DR TIGARD, OR 97223 PHONE PHONE: FAX: FEES Specifics: Description Date Amount Fuel Piping 08/05/2021 $14.15 Type of Use: SF 12%State Surcharge-Mechanical 08/05/2021 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/05/2021 $75.85 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 Issued By: 34ndly V�x,h fle �tivJn Permittee Signature: ©vt AppllC4atan 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. RECEIVED -/ a / Mechanical Permit Application CI of Ti and JUL7 202A Received ' 2 n PermitN t �ry `J g Date/By: / 11 4e e I to (,d il'00s-y i II . 13125 SW Hall Blvd.,Tigard,OR 97223 I,tir ry Plan Review Phone: 503.718.2439 Fax: 503.598.1960 nF i I .'GAR® Date/By: Other Permit: I t G A li L) Inspection Line: 503.639.4175 Date Ready/By: lurir ® See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method7/ZZ/ COFc Supplemental Information 1i yr TYPE OF WORK r A, fl- / t J, MMERCIAL FEE* SCHEDULE - USE CHECKLIST — Mechanical permit fees*are based on the value of the work ❑New construction IN Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$400 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 Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address:13134 SW Shore Drive Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: Tigard,OR 97223 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 Near intersection of SW Shore Drive and SW Winter Lake Drive 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 Other: 23.32 Subdivision: Lot no.: 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 Laying new gas line from garage to kitchen through crawlspace. fireplace 23.32 Log lighter(gas) 23.32 25-30 feet total. Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 J PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation: Name: Andrew Wachsmuth /✓ ,j�, i9--//____ Range hood/other kitchen equipment 33.39 Address: 13134 SW Shore Drive Clothes dryer exhaust 33.39 City/State/ZIP: Tigard,OR 97223 Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( 503 ) 278-1070 lax:( I Attic/crawlspace fans 23.32 0 APPLICANT 0 CONTACT PERSON Other: 23.32 / Fuel piping: Business name: 4_4d r-e,:J._q PAS—an/Le-Ai et-r,r�64J Y(Aoi , C.4/h $14.15 for first four;$4.03 for each additional Contact name: ` Fumace,etc. Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater : Fireplace Fax: Phone:( ) ( ) I Range E-mail: Barbecue CONTRACTOR Clothes dryer(gas) Other: Business name: /V 1 /Vf C�� MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) ,-Gl „ Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) AI. 16 CCB lic.: TOTAL PERMIT FEE it-0 ,"0 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: Andrew Wachsmuth Date: July 6,2021 1:ABuildingVPermits\MEC_PermitApp_040113.doc 44(1-4617T(I I/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi-Family Fee Schedule: Igoe $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 Property Owner Statement RECEIVED Regarding Construction Responsibilities �IT4�ilr ° 1 OF TIGAf�I7 Oregon Law requires residential construction permit applicants who are not licensed with um Construction Contractors Board to sign the following statement before a building permit ikitG DIVISION 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: 1 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 -7< 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. riAhdre t of Permit Applicant tit/ W D1G'lS 44,4 d 7/0Z/ Signature of Permit Applicant Date Permit#: /1 EC d / —a).s4// / r,.3`j' 5 ) S ,2. - 6A- I , t!t.4 Address: r .4 ,";,_' ?, \**,: ... Issued by: Date: Its This Copy for Permit Offices