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Permit + ,.w ..i. e .: .. .... ..: ..,.... ... .»eAi�N ieiE-x}.i iiiett.a is ., .,,n •.. „ ,a a raver>.,, r re a ,n )tru ,e,a.,,... ,, CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit#: MEC2022-00026 Date Issued: 1/12/2022 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135AD02300 Jurisdiction: Tigard Site address: 10915 SW HALL BLVD 19 Project: Billye Maxine LLC Subdivision: METZGER ACRE TRACTS Lot: 6 Project Description: (1)bathroom exhaust fan. Contractor: OWNER Owner: BILLYE MAXINE LLC,THE 13500 SW PACIFIC HWY#499 TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Specifics: Description Date Amount Single Duct Exhaust(Bathrooms,Toilet, 01/12/2022 $23.32 Type of Use: SF Utility Rooms) Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 01/12/2022 $10.80 Occupancy Grp: Minimum Fee Adjustment-Mechanical 01/12/2022 $66.68 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: Permittee Signature: 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 Applic hl)It Or i I( 1. 1 SF ON I A City of Tigard ° CEiVED Received / 'i i j— PermitNo.: f rcr2-?)) ' ' s1 13125 SW Hall Blvd.,Tigard,OR 97223 6 ■ JANDate/By:Phone: 503.718.2439 Fax: 503.598.1960 --- ion an Review /V/4 Other Permit: Tit;A a I) Inspection Line: 503.639.4175 Date Ready/By: lurk g Internet: ww w.ti and-or. ov Supplemental See Page 2 for g $ Notiied/Method: 7y,_ Information CITY OF TIGAR I / ,fir Or ?pc.. 'TYPE OF #IlING DIViS1OI\t j1,;rr �«a,�-et MM RCIAL FEE SCHEDULE—USE CHECKLIST Mechanical permit fees*arc based on the value of the work ❑New construction L.Mr Addition/alteration/replacement pt,frnnted.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/SYS L LMS iFEES* l:11-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For spacial information use checklist ❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: /t O , f� meLL Air conditioning (ducts/vents) 46.75 Job site address: (✓ ! Furnace 100,000 BTU 46.75 City/State/ZIP: 77:17,dp L ' 10/ 9P j L Z.2 Furnace 100,000+BTU(ducts/vents) 54.91 ` Heat pump 61.06 Suite/bldgiapt.no.: / Project name: 1) JPj. t a t! ''G 6— Duct work 23.32 Cross street/directions to job site: ilydrtmic hot water system 23.32 z' ,e. /e S� Residential boiler(radiator or I �i,o �•••� h dronic) 23.32 ®� Unit heaters(fuel-type,not electric), 14 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 DF,SCRIPTIOI. OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas fireplace 23.32 h Log lighter(gas) 23.32 �� ��® Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 r5OPERTY OWNER I ❑ TENANT Other. 23.32 1e y� Envlronmentsl exltaust and ventilation: Name: ?e 11 c /// / P✓/A G G€ jy C/�f p it Range hood/other kitchen equipment 33.39 Address:/vfats<p J f A/4, -% L / f Clothes dryer exhaust 33.39 City/State/ZIP: 1.7:0, A e,/' '�' a/ 9 7 1 Z,', tingle-duct exhaust(bathrooms, / +f toilet compartments,utility rooms) .23.32 .3. S Phone:(,ra 3 C/y 2 fo hr--f'"Fax:( ) Attic/crawlopace fans 23.32 tE' PPLICANT ❑ coCoINTACT PERSON Other. 23.32 Business name: Fuel piping: ��� �� $14.15 for first four;$4.03 for each additional name. e_y7-fe' Furnace,etc. Address:/®?/,�""- cfd/ / 1Z /fL " ,/, Gas heat pump 1 v `' Wall/suspended/unit heater City/State/ZIP: ,o r a Water heater j Phone:( �J© 5/., 27 f-,j— Fax::( ) Fireplace Range E-mail: 200/77. ,(C.h J�,", ,9/p/LI,.v/eli+ti Barbecue CONTRACTOR a."" Clothes dryer(gas) Business name: .0 e.L Other. MECHANICAL PERMIT FEES* Address: Subtotal 2 3 L e City/State/ZIP: Minimum permit fee($90.00) Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) CCB lie.: TOTAL PERMIT FEE 2 3, ? 2-- This permit application expires if a permit Is not obtained within 1110 days after it bee been accepted as complete. Authorized si * Fee methodology set by Tri-County Buildimg Industry Service Board O Print name: / �.. Date,a,.2,0.2," /44 1: 6 d I:1Building1Pormits\MEC_rurn itApp_04a t t3.doc 440-4617T(111021COM/WEB) S Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction 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: I own, reside in, or will reside in the completed structure and my general contractor is: S'cG 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. (?ng7 (2e,,,/2 /7 Print Name of Permit Applicant 2_, Signature of Permit Applicant Date Permit#:ftnCc._.}o-,l-Oe%jd-cp F O Address: 1Uk 15" r,.,) 7,.Et �f'�+54�4 +:y,'V ji t Issued by: 4']• Date: //Al/ - •9 inThis Copy for Permit Offices