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Permit 78' n CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2009 -00560 r Date Issued: 10/21/2009 *TiGRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S133DD00700 Jurisdiction: Tigard Site address: 11689 SW 129TH PL Subdivision: VILLAGE AT SUMMER LAKE PARK 2 Lot: 46 Project: Barbu Project Description: Install (2) bath fans. Owner: FEES BARBU, DAN Description Date Amount 11689 SW 129TH PL 12% State Surcharge - Mechanical 10/21/2009 $10.80 TIGARD, OR 97223 Additional Permit 10/21/2009 $90.00 PHONE: Contractor: OWNER PHONE: FAX: Type of Use: SF • Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: 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 cop of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: f /t` C { �,�� ftjAL\ PermitteeSignature: (� X Call 503.639.4175 by 7:00 a.m. for an inspection that business 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. Mechanical Permit Application !,:, i 1, ' ",, , .I� c ii i Ich i i ��` k ` � F `, 'r *417F'' a P � , f ( , M ��n, �� z 1 City of Tigard RECEIVED DateBReceived y: i / 1b Permit No.: t wyl A 3? QO ' P; q 13125 SW H Bl Ti OR 97223 LLL777'L"L (_J . a Plan Review .z4 Phone: 503.639.4171 Fax: 503.598.1960 Other Permit: DateBy: Ins Line: 503.639.4175 ®See Pa e 2 for I +l A R D� 0 C T 2 `1 2009 D ate Ready/By: g ,,,, c13; "^ • u Internet: www.tigard - or.gov Notified/Method: SupptementalInformation CITY OF TIGARD �� . TYPE OF Vgli.DING DIVISION .COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ❑ New construction 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 ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* XI I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. 1 Ea. Total JOB SITE INFORMATION AND LOCATION . Heating/cooling Job site address: 1/6f / SW /2.9 p Air conditioning (requires site plan showing placement) 46.75 City /State /ZIP: 7 Q/-'f ©( 9. 722 3 Furnace 100,000 BTU (ducts/vents) 46.75 I 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: Lot no.: Other: 23.32 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 23.32 1 p pp ...,��II Gas fireplace 33.39 % W0 e! J• 2h t� WO #9On -*cad- 6 � P!M SCfL'ir1i/4 u/ae.0 Flue vent for water heater or gas / ` J -_ s fireplace 23.32 8 0 406 dne new seyoct/zhON wa rd an d -/ , nidtH7 Log lighter (gas) 23.32 nrce wcAes ,Fo evto it° fwd hay 1S4- .0WJ and 74.va Wood/pellet stove 33.39 Cero.cr S • CPe.lN, one wu i dW a`w/ Vor door criorN/Nys Wood fireplace /insert 23.32 ❑ PROPERTY OWNER I ❑ TENANT / Chimney/liner/flue/vent Other: 23.32 Name: d, ,,,fhe,S U Environmental exhaust and ventilation Address: fiCcf? s /22/44 R. Range hood/other kitchen equipment 33.39 City /State /ZIP: 7 Q� (9, ? 7203 Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, !'. Phone: (b 3) - 7 7_ 5/25- Fax: ( 5O3) — 372 - 504 toilet compartments, utility rooms) 2 23.32 46. 10'f ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Other: _ 23.32 Business name: Fuel piping Contact name: 514.15 for first four; $4.03 for each additional Furnace, etc. Address: Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: Clothes dryer (gas) Other: Address: o r --- MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal Minimum permit fee ($90.00) Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) p /� TOTAL PERMIT FEE \ ce •CC :f' This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name: 4,, L / 3,52,„e, j v Date: /0/� /e0Dy * Fee methodology set by Tri- County Building Industry Service Board I:\Building\PermitsUEC- PermitApp.doc 10/01/09 440 -4617T (11 /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 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 701.055 (4)) 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 g '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. Jim/ /3, i&u Print Name of Pe it Applicant X0 / %2 9 9 Signature of Permit Applicant Date Permit #: • Address: //685 � l,1 d�' ?Lace !; i ,cr trod , OA 9722 3 Issued by: Date: f_ This Copy for Permit Offices