Permit MECHANICAL PERMIT
; CITY OF TI
e4D
s COMMUNITY DEVELOPMENT Permit #: MEC2010 -00315
,TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date, Issued: 07/07/2010
Parcel: 2S104DA05600
Jurisdiction: Tigard
Site address: 13210 SW RAPTOR PL
Subdivision: Lot: 0
Project: Dukart
Project,Description: Install tankless water heater, change gas line system to 2 Ib. Fuel piping for water heater,
fireplace and range. Plumbing done under minor label.
Owner: . FEES
DUKART, DIANA M Description Date Amount
13210 SW RAPTOR PL
TIGARD, OR 97224 Water Heater 07/07/2010 $23.32
Fuel Piping 07/07/2010 $14.15
PHONE. 503-521-8279 12% State Surcharge - Mechanical 07 /07/2010 $10.80
Minimum Fee Adjustment - Mechanical 07/07/2010 $52.53
Contractor:
STAN THE HOT WATER MAN
PO BOX 33157
PORTLAND, OR 97292
PHONE: 503 - 760 -2992
FAX: 503 -761 -0159
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 Notific. • _ - ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 - 0100. You may obtain a cop of the rules
or direc . uestions to 0 • by calf 503.246 6699 or 1.800.332.2344.
Issue By: i ` ' Permittee Signature: /
._I r
Call 503.639.4175 by 7:00 a.m. for an inspection that bu mess 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.
s"l -
Mechanical Permit Application ,, " ' . FOR ;OFFICE•USE ONLY ''' � r`'z " :)` • .�.�
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Clty'of - Received Tigard Date/By: Permit no.. , G / �, 'D' i,
9 13125 SW Hall Blvd,, Tigard, OR 97223 Plan Review O .....40,
a Other Permit:
Phone: 503.639.4171 Fax: 503.598.1 Date/By:
°T IGAR .6" i ' _Inspection Line: 503.639.4:175 Date Ready /By: Jura: Ed See Page 2 for
. ago Internet: www.tigard- or.gov Notified/Method: Supplemental Information
riV 'fi . N, .. �,�' ."r - r w- a'4R - 'sz•xtr. i a* oT sg r.. �s^"V'`3s'. _ .;'.y, a .q q-.h , ��...,. .x. E x r.,,: ;a .,..+., .:x.
: eam V .:xa r:wx- wo- r
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��? .' •» . �. k x „ f ., COMMERCIAL E CHEDULE SSE CHECKLIST
.us� x `��ry���� t `':�,�, �� Ty,YPEOEWORK�.�� � .�.:.:w ,� � � � ,. , s.:, �.�__ "��,�, .>���., . ,�;: .. ,� ,. .�f���r� =;
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.
�;_ •-��r i ?`NZ .:�nx . *v '` fiRit, �r ' E '' -#' .v ;:v ,r t °. ;.:+ ., ..xic -" xx:r, ?w , V.F. ' F 6 7 ; 5fi 's ` Value: $
-. X }, „-•M „- CATEGORY .OF C,ONSTR�UCTIiALW .;° . " ., � *i t - an. us : $ a _ , 1
= rr. :� s Z �x , , ,.. ., s r O J4 RESID NTIALN, CN SYST MS FEES* ...
. f 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. Ea: Total
RS %' � ��JOBRS TE I FORMATIOI`1, . AND LQCA I Ng i ' , Heating /cooling
Air conditioning
Job site address: /32 Su n 4. ^7017 at__ at__ (requiies :site plan showing placement) 46.75
City /State /ZIP: `7'� e-- c 7 -7223 Furnace 100,000 BTU (ducts /vents) 46.75
1 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
i �', ,4 t t y,11� DESCRIPTION ®F W�OR ti 4 4 .4 V!ater heater / 23.32
Gas fireplace 3139
N.5 74.-i{ - LS IA /A )- fr / . Flue vent for water heater or gas
"r 'y j ' P , C fireplace 23.32
/AI .I�UII/ km u41. iN4 q,A-5 ?'� L fJ ' J c J )eJ7 Log lighter (gas) 23:32
1 , JN dYL (�8 Wood /pellet stove 33.39
V���Irkc ��arv�i'Lfr� �tl � � t
Wood fireplace /insert 23.32
) " J m �� c • " g r# . t " n -, a Chimney /liner /flue /vent 23.32
;:+, , ,. ,, ,-Ait, PROI ERTr OWN as n ,, "� ,'. KK w ,TENANT. 4,,,_. �_- Other: 23.32 .
N ame: J IA , „p„, b J 4�7 Environmental exhaust and ventilation
f Range hood /other kitchen
Address: 13 2_10 i .,,., a ' L Ft_ equipment 33.39
City /State /ZIP n� (j ' , I _,7,.. g 1 223 G 3 Clothes dryer exhaust 33`.39
� "-_�'+�' ✓ 1 Single -duct exhaust (bathrooms,
Phone: ( O3 52 1. -- -5g2 Fax ( ) toilet compartments, utility rooms) 23.32
g t V:T AtitI*IGrANT ° P r 4 -- .oNT�A PERSON` ' , Attic /crawlspace fans 23.32
= Other: 23.32
Businesslname :. Fuel t In
pip' g
Contactina_me: S14.15 for first four; $4.03 for each additional -
Furnace, etc.
Address:
Gas heat pump
City /State /ZIP: Wall /suspended /unit heater
Phone: Water heater / ( ) Fax: ( ) /
- Fireplace
E -mail: Range
€ x - , ` ` � rs rt , ), ,- 141 �.°s r " a' Barbecue
Clothes dryer (gas)
Business name: S. 4t __7„, eo, L,,/� ,,, Other:
Pa 33 i p
Address: � ME"CHAICAL°PERI�IITFE54, A: /
City /State /ZIP: r.7,p e�/��L ,� \ t7 ` L 4, 7 Subtotal 7p,
' r Minimum permit_ fee ($90.00)
7�
Phone:,( ). "7 wd __ Z,g Z Fax: (503) -6 1 _,(:),A1 Plan review (25% of permit.fee)
CCB lic:: i 3 p J
State surcharge (12% of permit fee) /0.
. TOTAL PERMIT FEE /Oa 4
This permit application expires if .a permit is not obtained within 180
Authoriz t t. .'e: �''/ ; days after it has been accepted as complete.
r _
Print n. / � - " JCDT'T A ' y Date: 7 _-' _-' ► /D * Fee methodology set by Tri- County Building Industry Service Board
440 - 4617T 1 I /02 /COM/WEn
[ �BwldingU'er i \MEC P errri i t A pp d oc 10%01%09� - � )
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi- Family Fee Schedule:
Awaki4.Y.1.44114
$0.00 to $500.00 Minitnum 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. \Buildin \ Permits \MEC- PermitApp.doc 10/01/09 2,.