Permit (2) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2022-00690
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/1/2022
Parcel: 2S111 DC14100
Jurisdiction: Tigard
Site address: 15735 SW OAK MEADOW LN
Project: WILLIAMS Subdivision: SUMMERFIELD NO.11 Lot: 637
Project Description: Venting for relocated microwave.
Contractor: OWNER Owner: WILLIAMS, DANIEL WARREN LIVING TRUST
15735 SW OAK MEADOW LN
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 08/01/2022 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 08/01/2022 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 08/01/2022 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090.zM
rules
Issued By: ermittee Signature: �`
Call 503.639.4175by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application
City of Tigard RECEIVE E IV E Received
g ene Permit Na.:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 AUG 222 Other Permit:
Date/11
Inspection Line: 503.639.ov Date RcadyBy: Juns: 0 See Page 2 for
Internet: www.tigard-or.goV Notified/Method: SupplementalInformation
7CITY OF TIGARD
. s 'l�100 ,
❑ ®New construction Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
ion/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
X❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. I E.-
Heating/cooling:
a.Heatin coolie
. Air conditionin 46.75
Job site address:15735 SW Oak Meadow Ln Furnace 100,000 BTU(ducts/vents) 46.75
City/state/ZIP: Tigard, OR 97224 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Kitchen renovation
Heat pump 61.06
Duct work 23.32
Cross street/directions to job site: H dronic hot waters stem 23.32
Residential boiler(radiator or
Driving west on SW Durham Rd just past Tigard High School,turn north onto SW h dronic) 23.32
Alderbrook EN. Oak Meadow Liv Is the first abeek on the right. 6 louse 03 10eated at the Unit heaters
end of the street on the left just before reaching SW Alderbrook Cir. Note that many of pe,not electric),
in-wall,in-duct,
s ss ded,etc. 46.75
the street names are the s me with street v r,a
which can be confusing. Flue/vent for any of above 23.32
Not sure-Summerfield over-55 community tY Lot no.: Other: 23.32
Other fuel a fiances:
Tax map/parcel no.: maps.tigard-or.gov show Taxlot ID 2S1 I l DC14100 Water heater 23.32
Gas fireplace/insert 33.39
am renovating Flue vent for water heater or gas
m y with Ikea cabinets,oven,cooktop,and an over the range fireplace 23.32
above the microwave oven,connecting to an existing 6"duct that goes through the attic Lo li ter as 2332
Wood/ ellet stove 3339
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
1f rM )L' � Other: 23.32
� Environmental exhaust and ventilation:
Name: Daniel Warren Williams Range hood/other kitchen
Address: 15735 SW Oak Meadow Ln equipment 1 33.39 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Tigard,OR 97224 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(503 ) 799-1291 Fax:( ) Attic/crawls ace fans 23.32
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
Wall/sus ended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
E-mail: Range
Barbecue
Clothes dryer(gas)
Business name:
Other:
MHA'ltTlfAil�>F?�'P'�
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee) '
CCB lic.: TOTAL PERMIT FEE r
This permit application expires if a permit is not obtai&d within 1110
JA16 days after it has been accepted as complete.
Authorized signature: rf ° Fee methodology set by Tri-County Building Industry Service Board
Print name: P A.W i e v W K>_I F N W I t_t�Or,l C Date:0,6 0/ z 0 22
1:\Buildmg\Pc�tslMEC_Perm#App_040113.doc 440-461 TT(11/02/COMAVEB)
Mechanical Permit Application - City of Tigard
Page 2-Supplemental Information
Commercial &Multi-Famq Fee Schedule:
' ► k":.. P Free
$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 CEIVED
Regarding Construction Responsibiliti
Oregon Law requires residential construction permit applicants who are not licen ekithUO2Z
Construction Contractors Board to sign the following statement before a buildin"vitclfF-WARD
issued. (ORS 701.325 (2)) BUILDING DIVISION
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.
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.
Print Name of Permit Applicant
f
Signature of Permit Applicant Date
Permit#: Z22ffe 20,M— A
Address: 1 S-2 357-,Sc,c, LAI
i
Issued by: Date: � xdl
This Copy for Permit Offices
Information Notice to Owners About
Construction Responsibilities
(ORS 701.325 (3))
Homeowners acting as their own general contractors to construct a new home
or make a substantial improvement to an existing structure, can prevent many problems
by being aware of the following responsibilities:
• Homeowners who use labor provided by workers not licensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
• Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages
at the time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
• Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance
purposes on the wages of all employees. For more information, call the Oregon Employment
Department at 503-947-1488.
• Oregon's Business Identification Number (BIN): is a combined number for both Oregon
Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or go to
http://www.oregon.gov/DOR/BUS/docs/211-055.12df for the appropriate forms.
• Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation
Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain
Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 503-947-7815.
• Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their website at www.irs.gov.
Other Responsibilities of Homeowners:
• Code Compliance:As the permit holder for a construction project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
• Property Damage and Liability Insurance: Homeowners acting as their own contractors should
contact their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation Insurance.
• Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140, Salem, OR 97309-5052
Telephone: 503-378-4621 —Fax: 503-373-2007
Website Address:www.oreaon.aov/ccb
f/property_owner adopted 9-23-08 This Copy for Permit Applicant