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Permit
CITY OF TIGARD MECHANICAL PERMIT IN I . COMMUNITY DEVELOPMENT Permit #: MEC2010 00453 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/16/2010 Parcel: 1 S 136AA00303 Jurisdiction: Tigard Site address: 10280 SW 69TH AVE Subdivision: Lot: 0 Project: Williamson Project Description: Gas line for furnace and water heater. Owner: FEES WILLIAMSON, KRISTOPHER Description Date Amount 10280 SW 69TH AVE TIGARD, OR 97223 Fuel Piping 09/16/2010 $14.15 12% State Surcharge - Mechanical 09/16/2010 $10.80 PHONE: 503 - 866 -8923 Minimum Fee Adjustment - Mechanical 09/16/2010 $75.85 Contractor: OWNER PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas Gas Pressue: Total $100.80 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may • btain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800 2.231 . Issued By: Permittee Signature: `Ae/ U A..■ 7 Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application NH iii, orrice.: Hsi.: si.: oNi.v' t\\4\1(s° City of Tigard Date/By � a : 4 � r Permit No.: _ 1 1 _ • + �. q 131 25 SW Hall Blvd., Tigard, OR 97223 O Plan Review '� C Phone: 503.639.4171 Fax: 503.598.1960 cQ) Date/By Other Permit: 1 LGa _QUSO1 1 it 1 Inspection Line: 503.639.4175 1 C 0 a eady/By: Juris: ® See Page 2 for Internet: www.tigard- or.gov � Q �`1. e th o d: � - Supplemental Information Q c$ TYPE OF WORK G� '� O ��C ? COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction ❑ Addition /alteration/replacen 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: $ 01- and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES* y g ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family 0 Master builder ❑Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling /-� / Air conditioning Job site address: /C/ Z___ W ' v t't -i AZ (requires site plan showing placement) 46.75 City /State /ZIP: 767 (:) _ g7ZZ Furnace 100,000 BTU (ducts/vents) 46.75 • p � / Furnace 100,000+ BTU (ducts/vents) 54.91 _ W Suite/bldg. /apt. no.: Project name: t (l / ',, 4 � c 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 Gas fireplace 33.39 X /1/C) / /^ J 6 —/ _( // f p-- f )f , Flue vent for water heater or gas , ) fireplace 23.32 / (� T /( - `/ri9-7 e tC))'C/v!Q-CJE_ Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32 Other: 23.32 Name: ! v z s it! l -fril.g Environmental exhaust and ventilation 2.,C) ,..54) Range hood/other kitchen Address: /0 fT / - / �� -/g. equipment 33.39 City /State /ZIP: / c7i /I.,,9 t /j Clothes dryer exhaust 33.39 - � q- j' Single -duct exhaust (bathrooms, ['U Phone: `� -D X66 -' e___73 Fax: ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32 Other: _ Business name: Fuel piping Contact name: $14.15 for first four; 54.03 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall/suspended/unit heater 1 Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue • Business name: /') , , t fir r r S i U � Clothes dryer (gas) � 1/� � e Other: Address: MECHANICAL PERMIT FEES* City /State /ZIP: Subtotal iy t 15 Minimum permit fee ($90.00) - t , $ Phone: ( ) Fax: ( ) Plan review (25% of permit fee) r CCB lic.: State surcharge (12% of permit fee) i d. i TOTAL PERMIT FEE j cI). This permit application expires if a permit is not obtained within 180 f Authorized signature: - ■ days after it has been accepted as complete. Print name: /4et g lc �. A V1/) I Date: ) 6� © • Fee methodology set by Tri County Building Industry Service Board 1:\BuildingiPermits\MEC- PermitApp.doc 10/01/09 440-4617T (1 1102/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. I:\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. 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. /42( s LL /A - So,J Pame of Permit APP licant nature f Permit Applicant Date 7,1 9.00 — a0`i53 Permit #: PLC—WO S $j Address: J 0 SW • G • -w' v T 5us4 u4 4 17)4-3 ,�,; Issued by: 6. I - Date: c]/ i C bp E �' This Copy for Permit Offices