Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit#: MEC2010 00576
T [ G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/10/2010
Parcel: 25102DC00202
Jurisdiction: Tigard
Site address: 9320 SW OMARA ST
Project: Brandt Subdivision: Lot: 0
Project Description: Wood stove installation.
Contractor: OWNER Owner: BRANDT, SETH
9320 SW O'MARA ST
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount f
Wood /Pellet Stove 11/10/2010 $33.39
Type of Use: SF 12% State Surcharge - Mechanical 11/10/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/10/2010 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
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 es pled by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. Yo y o. :7/copy of the rules
or direct questions to OUNC by calling 503.232�: • 332.2344.
Issued By: / . Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 roll of i ici.: Hsi.: t)NI.)
CE iii) Received City of Tigard F Date/By: y: Permit No.: C L
:�. q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 n Date/By: Other Permit:
r 1(; A R 1, Inspection Line: 503.639.4175 V \I 1 0 20 1 U Date Ready/By: ® See Page 2 for
Internet: www.tigard - or.gov .ry Notified/Method: Supplemental Information
T OF WORK CI1 s NCjMN / 1b10� rin
�U.. ni COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction 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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1- and 2- family dwelling ❑ 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: ` 73' '! O,icva 11- Air conditioning
d � (requires site plan showing placement) 46.75
,OWIY
City /State /ZIP: Dg qwf Furnace 100,000 BTU (ducts/vents) 46.75
I I Fumace 100,000+ BTU (ducts/vents) 54.91
Ink Suite/bldg. /apt. no.: Project name: WD 16 3r 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
Subdivision: 1 Lot no.: Flue /vent for any of above 23.32
Other: _ 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
/ Gas
_ ` 5 Gas fireplace 33.39
c�ai V� ( r � /� >14 000‘-'4 r J t f e Flue vent for water heater or gas
j 1L fireplace 23.32
1! ' -�% �'T 9' } Y� 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
� �J Other: 23.32
G JS.
Name: J ,��/ Environmental exhaust and ventilation
Address: (�!� Ad ir Range hood/other kitchen
equipment 33.39
City /State /ZIP: )/ 2 .7 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( 5 n) 6v, 9 '/ 7I Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT TTII ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: _ 23.32
Business name:
Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump .
City /State /ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
t Other.
Address: / MECHANICAL PERMIT FEES*
City /State /ZIP. (A) Subtotal v°
Minimum permit fee ($90.00)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee) gyp.,`
CCB lic.: �� State surcharge (12% of permit fee) /v, a c)
TOTAL PERMIT FEE / .20
This permit application expires if a permit is not obtained within 180
Authorized signature: / days after it has been accepted as complete.
Print name: e ll g f Date: ft//0 * Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \PermitsUMEC- PemtitApp.doc 10/01/09 440-4617T (1I /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 $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:\ BuildingTermits \MEC- PennitApp.doc 10/01/09 2
it.
i
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB$ 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.
1 have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and 1 hereby certify that the information on this homeowner statement is true and accurate.
101
Print Name of Pe Ap • i
� j
Air ,./1 fiNd
Sig ature of Permit • pplicant Date
Permit #: 1 2.0 I D —cJ0
Address: 613)) SW- v4✓q 51
(�
774 6X17111 _ �,
A 2_ 4 .
Issued by: /, 7 - Date: 11 1 /v 'Is:
This Copy for Permit Offices