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Permit CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2010 -00623 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/01/2010 T t G ARD. Parcel: 2S 114 BD03800 Jurisdiction: Tigard Site address: 16560 SW COPPER CREEK DR Project: BREMNER Subdivision: COPPER CREEK NO. 3 Lot: 78 Project Description: Fuel piping for gas range. Contractor: RAYBORN'S PLUMBING INC Owner: BREMNER, CAROL D 19990 SW CIPOLE RD 16560 SW COPPER CREEK DR TUALATIN, OR 97062 TIGARD, OR 97224 PHONE: 503 - 692 -4139 PHONE: FAX: 503 - 691 -2328 FEES Specifics: Description Date Amount Fuel Piping 12/01/2010 $14.15 Type of Use: SF 12% State Surcharge - Mechanical 12/01/2010 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/01/2010 $75.85 Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas 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 rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1' : 0 Issued By: Ir ��.� Permittee Signature: ,A, CaII 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. ,.503 691 2328 Rayborns Plumbing 12:55:20 p.m. 12 -01 -2010 1 /2- Mechanical Permit Application alt co .: I O IF I ( i ( O MLy kN City of Tigard ( St ts o `c o, _ i ts Received Permit No.: • 13125 SW Hall Blvd., Tigard, OR 971 ,30 Date %By: I f�J No.://Fr �V �.* p � ` y Plan Review Phone: 503.639.4171 Fax: 503.598. a Date.'By: Other Permit: T 1 c.) A It i ...',. Inspection Line: 503.639.4175 t Date Read > Jut is: ® Sec Page 2 for Internet: www.tigard or.gov O` ` t Notified Method: asp , Supplemental Information TYPE OF WOK ` , r3 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST ❑ New construction Addition /alteration ace Mechanical permit fees* are based on the value of the work perfonned. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical rnalerials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: 5 RESIDENTIAL EQUIPMENT / SYSTEMS FEES* .- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special iq/ormation use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating /cooling Job site address: //6:1(0 ( C(ee Air conditioning or heat pump `-� r [requires site plan showing placement) 14.00 City: /State /ZIP: 4 © r Furnace 100,000 BTU (duct 'vents( 14.00 � a � Fumace 100,000+ BTU (duets'vents) 1 7.90 Suite /bldg. /apt. no.: l Project name: Gas heat pump 14.00 Cross street /directions to job site: Duct work 10.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronicl 14.00 —_ Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Flue /vent for any of above 6.80 Subdivision: Lot no.: Other: 10.00 Tax map/parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 r ?� - f { Gas fireplace 10.00 //fsix ,let.,) Pty % 1� e Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.0() Woodrpellet stove 10.00 Wood fireplace /insert 10 .00 ❑ PROPERTY OWNER Chimneyilin / er /Flue /v 10.00 ❑ TENANT Other: t J - ;`__,,,„ , 10.00 — Nance: Environmental exit t : ' tit! ve " • tion Address: Range hood/other kitchen equipment 10.00 City /State /ZIP: Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 ' ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 t Other: 10.00 Business name: � At 1 it f Irli ■.A.A. Fuel piping PP 1 _ , Contact name: / `� 4 $5.40 for first four; 51,00 for each additional Q Furnace, etc. Address: ` `��t _ Gas heat pump City /State /ZIP: 1 7 0 `a s4 k C9( et2o 6� Wall /suspended /unit heater Phone: (�3) 6.-9... - 413et Fax:: (40 3) ,q,•'/ -g' Water heater Fireplace E -mail: �J ��/�' �/ /f�P'�U� /' `�/ i'! N„5 ♦ e. ®v_'.. Range CONTRACTOR Barbecue Business name: r � \ , Clothes dryer (gas) f VlS 1 u V \/V1∎10 r Other: Address: 1 C�4C) s W Ct t o r MECHANICAL PERMIT FEES* City /State /ZIP' ` Or (1_706..-- Subtotal ) 1 C Fax: (� ) 6�r �� Minimum permit fee(S72.50) `? 1 U .t;� Phone: (6'03) t? ��' 3 3 Plan review (25% of pennit fee) , CCB lic.: ig 7g tj State surcharge (12% of permit fee) ! - 0 ` la TOTAL PERMIT FEE 5...2 1 00 Authorized signature: - This permit application expires if a permit is not obtained within 180 g r .`c am days after it has been accepted as complete. Print name: 4 „v e , 7,..,„ Date: — ' Fee methodology set by Tri- County Building Industry Service Board