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Permit f q CITY OF TIGARD MECHANICAL PERMIT `' 1111 a COMMUNITY DEVELOPMENT Permit#: MEC2022-00171 Date Issued: 3/3/2022 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102DC00400 Jurisdiction: Tigard Site address: 9265 SW EDGEWOOD ST Project: Blauer Subdivision: EDGEWOOD Lot: 16 Project Description: Mechanical for addition(MST2020-00256) Contractor: OWNER Owner: BLAUER, MARC 9265 SW EDGEWOOD ST TIGARD, OR 97223 PHONE PHONE: FAX: FEES Specifics: Description Date Amount Duct Work 03/03/2022 $23.32 Type of Use: SF Water Heater 03/03/2022 $23.32 Class of Work: ALT Type of Const: Flue Vent for Water Heater or Gas 03/03/2022 $23.32 Occupancy Grp: Fireplace Stories: Clothes Dryer Exhaust 03/03/2022 $33.39 Single Duct Exhaust(Bathrooms,Toilet, 03/03/2022 $69.96 Utility Rooms) 12%State Surcharge-Mechanical 03/03/2022 $20.80 Fuel Fuel Types: Gas Pressure: Total $194.11 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: Edgarolo-MaL.do ado- Permittee Signature: yet- 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. r .. MechanicaI Permit A licatl ila 2 4 2022 1 oU t►1 I.icy usu.ONI.1 k ) intn�nnrt Nn i2� c ir. of Tigard CITY OF TI ' tip, It p3d3, 22 �l - �' I xi^',S11'(tali Nicc9 lif,+rvt tsi; w'' `t (� OARU �I��I�I,a DIVISI�h' i laa tic (WWI i'mnnit. I �' . ... ... ........._. twz B) See Pale s far i s 1!i,:11;1I 9n 1�� ,n i a,,.: ,t+ i a l`; n to H Supplemental Informannn '�uk'9�,,;:.1* .,:,,, ° I#tt,"},tttrralto�rc+Iaccmrttt ' tuft+lLtt C"tl fhPfi siC o.dtnLW vai �; Neu,c ttatLKta,.,t ti,l. 1 Mcx innmcnl pc nnti fec•e"ate bawd on the value,of - pnrinrrncd Indic aletltt-Value•Iroundedtothentarestdolltr(,,fair.' , ' D'rnoline L. t1ih.a iuetitnnie,,it mrnt?eqt pu>tiwN Libor ovcrhead__nd puItt Asa.. � .• ,� : a r..., }y az1� � � ,s a �Ih�`;���,' t 4,. ..4.�' a, �n i, t a'wi_ ; rt,i}•tt„Clhtis; f4�ftuttt'�t�Ciol)itltluMttial' A'`t`.ds°s i I nr sptclal information oar checklist 'ciul i J unnts builder Other - Ott pa. Total IRR builder DCYLCIptipn _ ....._.-- �,_-,-i^ 1 `�+ } } t3 rti,a i°t, x ;z ticulilglconling: �_ 4,8 s,s , s cy. � m, . � ,.. Airconditioni�_ 46,75 �� tt�r sttx xdctrxr Ste_ t=C�(- UJvra V ST - furnace 100,000 BTU(ducts/vents) �46.75 ;, C r) Mate ZIP. "f -A -� ©g, 'f7 Z-2.3 Furnace 100.000+BTU(ductsrvcni,) i 54.91 t ` ,utte fildc apt.no ` Protect name; ' 1 r Heat pump -__ 6f.06 a ' �-_ _� V�Z Duct work 1 23.32 Z ,3 Z �, ? Cross s it et directions to job site: f O��� Hydronic hot water system 1 23.32 ,` Residential boiler(radiator or - -- - h dronic , 23.32 i' i' Unit heaters(fuel-type,not electric), 1 46.75 ' in-wall,in-duct,suspended,etc. l i ,C' Flue/vent for an o_f above 23.32 ` Subdoision: A G 23.32 I l t -.. � � � Lot no.: Other: l= D C w c� P Other fuel appliances: Ta\map paivelno.: 5I6 pc.--C7(j Lk ()(1 4 23.32 Z 3 , .. _---_ - Water heater DESCRIPTION OF WORK Gas fir lace insert 33.39 ( ) Flue vent for water heater or gas t $: pk IN-75(Y1 1 C..CR\ Tom( . �5-'A c) T-1,-C) vA Q pV-\ �- fire lace ` 23.32 4?i.52. r . (i{i,{acT � -e.,4--v/v.• A i i\�} G-QZ0- 0025-C' Lo li liter( as) _ 23.32 , { ' Wood/pellet stove 33.39 } a' �_._---- ---_----- --- Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 1 PROPER'I'9' OWNER ( _ 0 TENANT Other: 1 23.32 I Environmental exhaust and ventilation: (, ame: ���r j��Q\j Range hood other kitchen u�.` l / equipment 3,.3 ;.daress: Cl _ (c 5 S 1 i.+JC3U 4� 5, -- Clothes dyer exhaust \ 33.39 II-S, City State ZIP: -1 l 0 A 2.)() P.,._ CI-7 ZZ Single-duct exhaust(bathrooms. p y,,t} Z• t '? ci 6 nC I Fax:( i toilet compartments,utility moms) 23.32 tin t, ` -' � Attrc(crawlspace fans 't'31 " O"APPLICANT 431.CONTACT PERSON Other: 23.32 Business name: PCY>',€--c( LA (,� t,rU t`\`._V- Fuel piping: r- / - _ $14.15 for first four:S4.03 for each additional Contact name: �Y-� Vl`��.-Q� Furnace,etc. Address: Gas heat pump I, City,State2IP: Wall/sus ended/unit heater __-( '' -- -- Water heater (' Fax::( ) Fireplace i C; Phone:( ) . E-mail: Ran c s _-.___..._-___. CONTRACTOR Barbecue I - -_ - _ ._ Clothes dtycr(gas Rutiine;s name: 0 VtA `�'.CG+ )1J 6-riC,. Other: , .,x Address: v, _ Subtotal's 4' ., i City/State/ZIP: _ Minimum permit fee(S90.00) _ ' Phone:( ) Fax:( ) _-__ Plan review(25'1i,of permit fee) i - , - State surcharge(12%of permit fee) t 1'ZO . CC8 lie.: __-� TOTAL PERMIT FEE tgii,+l This permit application expires if a permit is not obtained within t80 days after it has been accepted as complete. Authorized stg iature: " Fee methodologyset byin-CountyBuildingIndust Service Board is ew Tint name: �i.'V tj e, _ t j fi---, Date 7 1. 1 I Bo„din•'rcvm, MS''P 252 • 440.40177(II d)2•COMr'WGn) crmnApp Qt_ '0-J(rC t:.. . o,ax- rroperty ' wrier atatertient Regarding Construction Responsibilities OFIGAR , Oregon Law requires residential construction permit applicants who are not licensed Alltffirlfm i , . i. 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: 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 1 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. . - - k f --gat, (- \F-- Print Name of Permit Applicant / ..•‘--- ', ', • -I,./`, A\-,- ' ,.• ' / / Signature of PermitApplicant Date Permit#' 9-r- Address: :Mr:71.1 . ; ':Ig.!"•-Z*** Issued by: Date: _____ __ /4.. •