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Permit CITY OF TIGARD MECHANICAL PERMIT ph COMMUNITY DEVELOPMENT Permit #: MEC2009 -00664 .T t G Mk D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/11/2009 Parcel: 2S103CA00203 Jurisdiction: Tigard Site address: 11820 SW JAMES CT Subdivision: Lot: 0 Project: Dameron Project Description: Run gas line to new range and bbq, install range hood. Owner: FEES MODE, DEBRA KAY Description Date Amount FIELDS, TERRY LEE, 11820 SW JAMES Range Hood /Other Kitchen 12/11/2009 $33.39 COURT Fuel Piping 12/11/2009 $14.15 PHONE: 12% State Surcharge - Mechanical 12/11/2009 $10.80 Minimum Fee Adjustment - Mechanical 12/11/2009 $42.46 Contractor: SOLIS HEATING & A/C 3678 SILVERSTONE DR NE SALEM, OR 97305 PHONE: 503 - 932 -3259 FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas Gas Pressue: 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 -0100. You may obtain a copy of the rules or direct questions o OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: ` 0,0, : t ( h I 1 , • Permittee Signature: G Call 503.639.4175 by 7:00 a.m. for an inspection that busine s day. 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. �.,,, li t= ETC C �- {' ca i w'M�i>3 ' t A� t il w i 4 k. Mechanical Permit Application -,; ' . .. 1 c��lz`( Ic 0N101 A _ 4 ` r _, RECEIVE eceive t R r ,...r4 .. „... th .ry:n >,.... ,,ne .5. f a :�5 y A js,� City of Tigard Date/By: I i ,Permit No.: j 0e , 114 1 ' 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C Phone: 503.639.4171 Fax: 503.598.1960 DEC 1 1 200' DateBy: Other Permit: i :I ] It [ Inspection Line: 503.639.4175 Date Ready/By: Juris iii See Page 2 for .. . -- Internet: www.tigard- or.gov CITY OF TIGAR II Notified/Method: 1 I le. Supplemental Information BUILDING DIVISION • TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction E Addition /alteration replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ [� 1 -and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES* y g ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: '3 1 $ 20 em u' r 0.. " $� GAY 1 - 7i'cfc, Air conditioning 3 � -c- I (requires site plan showing placement) , 46.75 City /State /ZIP: 1 '12gny rt 0 9 '7 223 Fumace 100,000 BTU (ducts/vents) 46.75 Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump 61.06 Cross street/directions to job site: Duct work 23.32 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: I Lot no.: Other: 23.32 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF •WORK Water heater 23.32 Gas fireplace 33.39 • n flew C -Crc ' is yi ED p 0-Y c rtl e on d Flue vent for water heater or gas fireplace 23.32 • • • e x rS i' ; on C7'.' c' me 71 Log lighter (gas) 23.32 n ,, P o 4.l /5 i 'YCZ/Jq hood Wood/pellet stove 33.39 �l Wood fireplace /insert 23.32 Chimney /liner /flue /vent 23.32 ❑ PROPERTY OWNER • ❑ TENANT Other: 23.32 Name: Environmental exhaust and ventilation / cf ` Range hood/other kitchen Address: / '3 i 2 5 w An i9 A i V J. equipment , 33.39 City /State /ZIP: .7-116,1- u7� a y - 9 ' 2 2" ' Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON • Attic /crawlspace fans 23.32 Other: 23.32 Business name: _ Z i 5 / k a l in9- - 0/7 c . 4 /C Fuel piping Contact name: dal_, re, ?, $14.15 for first four; $4.03 for each additional i Furnace, etc. Address: "36 l ‘lo Q- 4O✓ e 4 7. 71 e Gas heat pump City /State /ZIP: Ja) (0/.4„ l,-)i . 9.730_5 Wall /suspended/unit heater Phone: ( ) ? •7 3 2 5-9 Fax:: ( ) Water heater Fireplace E -mail: n c Ran 3QV Y SO �!" S � /'YI S�7 C©/ Yi , Range I • 'CONTRACTOR Barbecue I Business name: Clothes dryer (gas) S Z I. - � ir cod_ 4 / C Other: Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) Plan review (25% of permit fee) CCB lic.: i 75 410 Q State surcharge (12% of permit fee) - ��� r " "' TOTAL PERMIT FEE I�6 r This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name: T /Q r ; .5 Date: * Fee methodology set by Tri- County Building Industry Service Board ol• I:\ Building \Permits\MEC- PermitApp.doc 10/01/09 440- 4617T(1t /02/COM/WEB) - Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: Total Valuation: ''Permit Fee: • . $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. 1:\ Building \Permits\MEC - PermitApp.doc 10/01/09 2