Permit (2) CITY OF TIGARD MECHANICAL PERMIT
�°. `` COMMUNITY DEVELOPMENT MECHANICAL
MEC2023-00904
T f f,'A R 0 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued:
Parcel: 1 S 134C B04600
Jurisdiction: Tigard
Site address: 12310 SW NORTH DAKOTA ST
Project: Kennedy Subdivision: ANTON PARK Lot: 8
Project Description: Gas water heater replacement. Work by owner
Contractor: Owner: KENNEDY,JONATHAN&CARMEN
12310 SW NORTH DAKOTA ST
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Water Heater 11/28/2023 $23.32
Type of Use: SF 12%State Surcharge-Mechanical 11/28/2023 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment-Mechanical 11/28/2023 $66.68
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: i )4
A!\ Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection ate.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit App ` _ p ` FOR OFFICE LSE ONLY
Cityof Tigard \7 '``y,"" Received
3 0- Permit No.: + ? L G 1�
I g 13125 SW Hall Blvd.,Tigard,OR 3 PlanDate Review
�(� /� .J (�
g 2 Plan Review
Phone: 503.718.2439 "fl^ Other Permit:
' a I. ! �'t] � Date/By:
II e,A R I) Inspection Line: 503.639.4175 Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGAA F Notified/Method: 1\In G I Supplemental Information
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0 New construction 0 Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition Other mechanical materials,equipment,labor,overhead,and profit
,�" fTiON / '` Value:$
r gym. m, ��
SiXtk P1"tTt L . 14S Egs 3..,
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 ccessory building
For special information use checklist.
❑ Multi-family 0 Master builder Other: Description Qty. Ea. Total
1,,,,,.:„,,,OR 5 l R 4.,, . ' .,.` ,, ' Heating/cooling:
Job site address: /2_3/0 5 /v f--1-ti ',., C Air conditioning 46.75
Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: / `j o' Furnace/' -'2-23 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: l Project name: Heat pump 61.06
Duct work 23.32
Cross street/directions to job site:
Hydronic hot water system 23.32
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
Subdivision: Lot no.: Other: 23.32
Tax map/parcel no.: Other fuel appliances:
+" Water heater 23.32
w. .
_; e � DESC-t1P ` F=WO1t 44 °„v= �f ,, Gas fireplace/insert 33.39
C:ti s b (41.. /'- // �"p� �� , Flue vent for water heater or gas
Akirl fireplace 23.32
f ed' yAl fly(./ i��- Log lighter(gas) 23.32
5 �k Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
1" PEt * I Other: 23.32
' ' Environmental exhaust and ventilation:
Name: I C„"li 44,-, kQ,,,, , ✓ Range hood/other kitchen
Address: 12 3 /e $l.- /Jo lei / ,�._ equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: ,.-7' .!mod Q�- 7 'Z`L 3 Single-duct exhaust(bathrooms,
,��'� ( � toilet compartments,utility rooms) 23.32
Phone:( '�i/) j r� Fax ( ) Attic/crawlspace fans 23.32
M'PLI A c P t .
sa
_ w) � ,,,= Other: 23.32
Business name: 3k OW rift Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name:
Furnace,etc.
Address: Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater t
Phone:( ) Fax::( ) Fireplace
E-mail: Range
""" ';. Barbecue
COT s : Clothes dryer(gas)
Business name: Other:
Address: t (/P\ p h CITICAI,IHMt*#E,S*
/ Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
State surcharge(12%of permit fee)
CCB lie.: TOTAL PERMIT FEE /
This permit application expires if a permit is not obtained within 180
days after it* has been accepted as complete.
Authorized signature: *r /
Fee methodology set by Tri-County Building Industry Service Board
Print name: "�l tt A ,-^ k-e�,it `/� Date: r' ? 2-3
I:\Building\Permits\MEC_PennitApp_082520.doc / 440-4 17T(I I/02/COM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Submittal Requirements:
• (2) sets of plans, drawn to scale.
• (2) sets of equipment cut sheets.
• (2) copies of site plan for ground and roof top equipment
location and screening per Tigard development code.
Commercial & Multi-Family Fee Schedule:
T.{ ;,. ihtion� v , , Permi 'ee zx
$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.
I:\Building\Permits\MEC_PermitApp_082520.doc 2
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:
/
j1,4‘.k Ail it.6)f,14 e-tt/Y
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.
e_ Oie
Print Name of Permit Applicant
Signature of Permit Applicant Date
Permit#: y'A C 'aca Zj- OG 1 a 4
Address: (I310 C\A) ("c.('111 �, _�'.;-. - :'
Issued by: K/4- Date: L(/ /S 111-17
This Copy for Permit Offices