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Permit li . CITY OF TIGARD MECHANICAL PERMIT ° COMMUNITY DEVELOPMENT PERMIT #: MEC2009 -00077 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/25/2009 PARCEL: 2 S 112 BC -03400 SITE ADDRESS: 14660 SW 83RD AVE ZONING: R-4.5 SUBDIVISION: HAMBACH PARK LOT: 018 JURISDICTION: TIG PROJECT: WILLIAMS Project Description: Install wood burning stove. CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: WOD 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: WOODSTOVES: 1 FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Owner: FEES LESLIE WILLIAMS Description Date Amount 14660 SW 83RD PORTLAND, OR 97223 [MECH] Permit Fee 2/25/200c $72.50 [TAX] 12% State Surch 2/25/200E $8.70 Total $81.20 Phone: 503 - 598 -1283 Contractor: OWNER REQUIRED ITEMS AND REPORTS Contact #: Reg #: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Cry t i Yv o ` IM1 Permittee Signature: .4161.4312 4 ', `l/� Call 503.639.4175 by 7:00 a.m. for inspections 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. I. Mec anical Permit Applicatio ECE 1 E FOR OFFICE USE ONLY V C r I Received Ci of Ti and ��1 \ \ \� Permit No.: City g Date/By: i, . . 3 Q _ • U nr , • OOd77 • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 FEB 2 5 2009 Date/By: Other Permit: TIGARD Inspection Line: 503.639 Date Ready/By: , See Page 2 for Internet: www.tigard or.gov CITY OF TIGARD Notified/Method: Supplemental Information BUILDING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction ,J 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* g'] 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. - I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling Air conditioning or heat pump Job site address: / 1 C e, GS'Z) g� � 4-tie- (requires site plan showing placement) . 14.00 City/State /ZIP: i �f a fl o� Fumace 100,000 BTU ( ducts/vents) 14.00 v Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: 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 hydronic) 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 / A ��� � pcc Gas fireplace 10.00 © qU ,�G�p s; Z c y f 74- �LM'a ( /J' ) Flue vent for water heater or gas � // /A1J , / /I fireplace - 10.00 ! � I Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 ❑ PROPERTY OWNER ❑ TENANT Chimney/liner /flue /vent 10.00 Other: 10.00 Name: J( //e. / -6//7-//4,Z1015" f �� Environmental exhaust and ventilation P t'� Range hood/other kitchen Address: �� ti D S ®g✓ / ��- equipment 10.00 City/State /ZIP: /27 zeg0 C.-9'( 7 212-174 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: (-` (5 ,) W 1X /3 Fax: ( ) toilet compartments, utility rooms) 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: £ CS /` L (p /i/ //j i wfs ) . �i1/, $5.40 for first four; $1.00 for each additional Address: /7C6 e .C4 6-3 7 Gas Furnace, heat p ,Q de- Gas heat puu mp City/State /ZIP: 7 �yd( �� f7L 1� Wall/suspended/unit heater Phone: (.3 . /2.1'3 Fax: : ( ) Water heater Fireplace E -mail: Range • CONTRACTOR Barbecue la .i/1 dryer (gas) Business name: !l'GV�j vy /+4 .5 '/ aL/ 1 Other: Address: MECHANICAL PERMIT FEES* City/State /ZIP: Subtotal Minimum permit fee ($72.50) 70.S0 Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) 13 _ TOTAL PERMIT FEE 8 (. 2. O signature: ` This permit application expires if a permit is not obtained within 180 Authorized si I'Jt 0 + � days after it has been accepted as complete. Print name: lee/ e - / Z- i/a �� Date erd * Fee methodology set by Tri -County Building Industry Service Board 1:\ Building \PermitsVMEC- PermitApp.doc 01 /19/07 440- 4617T(II /02/COM/WEB) . —. Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC- PermitApp.doc 01/19/07 2