Permit irte' CIT Y OF TIGAR®
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00373
Date Issued: 07/29/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S111CB01721
Jurisdiction: Tigard
Site address: 10250 SW KABLE ST
Subdivision: HOOD VIEW NO. 2 Lot: 20
Project: Dorr
Project Description: (1) clothes dryer exhaust and (1) exhaust fan for relocated laundry room.
Owner: FEES
DORR, PATRICK M Description Date Amount
JANICE M, 10250 SW KABLE ST
TIGARD, OR 97224 Clothes Dryer Exhaust 07/29/2010 $33.39
Single Duct Exhaust (Bathrooms, Toilet, 07/29/2010 $23.32
PHONE: Utility Rooms)
Minimum Fee Adjustment - Mechanical 07/29/2010 $33.29
Contractor: 12% State Surcharge - Mechanical 07/29/2010 $10.80
HANDY HOME SERVICES LLC
22225 SW MANDAN DR
TUALATIN, OR 97062
PHONE: 503 - 577 -8052
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 copy of the rules
or direct questions to OUNC by calling 2 .6699 or 1.800.332.2344.
Issued By: / —� Permittee Signature: .
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.
.001 cc, Co+y 0'n j ,, ,,,,, Mechanical Permit Application
1 .4 . g/ ty www.co.washington.or.us Phone: 503-846-3470 Fax: 503-846-3993
155 N. 1 Ave, Suite 350, MS 12 Inspection Request Line: • 503- 846 -3699
N EGON Hillsboro, OR 9712 Pola0tJ- lXj� -t ?
Land Use Approval: T ` Zt t �, 7 2 Project #: e p p —#4 Permit #: flEc t)(0
TYPE OF WORK
,�L.S CO L FEE SCHEDULE — USE CHECKLIST
❑ New construction ddition /alteration /replacement Mec anical permit fees are based on the value of the work performed. Indicate
the value (rounded to the nearest dollar) of all mechanical materials,
❑ Demolition ❑ Other:
equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION value: $ / L61 - 04)
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES
❑ Multi - family ❑ Master builder ❑ Other:
For special information use checklist.
JOB SITE INFORMATION AND LOCATION Description Qty. Ea. Total
Job site address: 0 5 Sc./ k /1 `. Heating /cooling
�l / ��S
Furnace, incl. ductwork. vent. and liner 8.50
City /State /ZIP: •176/1- 9 lrn 9'722 7 Air conditioner (site plan required) 8.50
Suite /bldg. /apt. no.: Project name n Heat pump (site plan required) 8.50
t� Duct work, alterations and additions 8.50
Cross street/directions to job site: ✓Or
Hydronic piping system 8.50
Boiler. incl. vent ** State Permit Required
Gas heaters /unit in -wall. in -duct.
suspended. etc. not incl. vent. 8.50
Other:
Other fuel appliances
Subdivision: Lot no.: Water heater 8.50
Tax map /parcel no.: Gas fireplace /insert/stove 8.50
DESCRIPTION OF WORK Gas log /log lighter 8.50
Pool or spa heater, kiln* 8.50
g ‘ . GQCPC7 G A(JN1)j' R 7y%. Wood /pellet stove /insert 8.50
rn0�l � `la'sn -n) (3,_ , �,� _ / Wood fireplace 8.50
I^ ` L'•`� Chimney /liner /flue /vent w/o appliance 8.50
Oil tanks /gas /diesel generators 8.50
Other:
PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation
Range hood /other kitchen equipment 8.50
Name: A Q ^./�/ :77 . 3 „,./ n � Clothes dryer exhaust 8.50
Address: / 2 5'� /3 L - ()A Single -duct exhaust (bathrooms, toilet / ii<iet /` compartments, utility rooms) I 8.50
City /State /ZIP: ' 644 n n cr el72 2) Attic /crawlspace fans 8.50
Phone: (� Z ) / 79 — �/ Fax: ( )
Whole a house ventilation or Radon
/ {D / VV mitigation 8.50
APPLICANT Other:
Business name: f"l tvo ,/ f.„.„ F S�� v, cry LL Fuel piping
/ $8.50 for first four: 51.00 for each additional
Contact name: r� Sf l� alp L ri -wayr. /� Fumace By outlet #
Address: 2 22 2______.5/ / y p �/ 9th Wall /suspended /unit heater By outlet #
�7 Water heater By outlet #
City /State /ZIP: •7—(//9 to .F r ,. / � et 70L Fireplace /log lighter /gas log By outlet #
(9
Phone: ) z ) 5 --y? — 03 Fax: ( ) Range By outlet #
1 Barbecue By outlet #
E -mail: I/M „1 9 , go»1 vice j e Lai, eon Clothes dryer By outlet #
CONTRACTOR Other:
Business name: MiNO Y M. "; 5FZV /Cif L-L C MECHANICAL PERMIT FEES
Address: Subtotal $
Minimum permit fee s j ILI 9 ''O. OO
City /State /ZIP: Plan review (65% of permit fee) $
Phone: ( ) Fax: ( ) State surcharge (12% of permit fee) $ it) t Fjd
TOTAL PERMIT FEE 5 %CIO,.
E -mail:
This permit application expires if a permit is not obtained within 180
CCB Iic.: / g3 i ' 7 /,, , J City or metro lie.: days after it has been accepted as complete.
� / Site plan required Division's outdoor unit
Authorized ** State B
e Buildildinng Codes Divivision''s s approval required
signature:
Print name$, tr c D ! i (- . 1 E Date: J 440 -46I7T (l0 /07 /COM /WEB)
l o L +NI Sir.