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Permit CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2011 -00045 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2011 Parcel: 2S 111 DC 12700 Jurisdiction: Tigard Site address: 15960 SW OAK MEADOW LN Project: STONEKING Subdivision: Lot: 0 Project Description: Gas furnace and water heater replacement. Contractor: HOLMES HEATING & COOLING Owner: STONEKING, GERALDINE 29360 HALE RD 15960 SW OAK MEADOW LN SCAPPOOSE, OR 97056 TIGARD, OR 97224 PHONE: 503 - 543 -2399 PHONE: 503 - 636 -6611 FAX: FEES • Specifics: Description Date Amount Furnaces < 100K BTU 01/27/2011 $46.75 Type of Use: SF Water Heater 01/27/2011 $23.32 Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 01/27/2011 $10.80 Occupancy Grp: Minimum Fee Adjustment - Mechanical 01/27/2011 $19.93 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 503.232.1987 or 1.800.33 Issued By: i ' •rmittee- Signature: Call 503.639.4 - 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 FO O FFICE USE ONLY Ci of Tigard Date/By �a� Permit No.: ". _ co '. ° 131 S W Hall Blv Tigard, OR 97223 � � Plan Review ' ' ° ' . Phone: 503.718.2439 Fax: 503.598.19.1 ; .�S Date/By: Other Permit: ' i + 064 T I GAR D Inspection Line: 503.639.4175 ' 1 Date Ready/By: 1 ® See Page 2 for Internet: www.tigard- or.gov e Q Notified/Method: Supplemental Information J P N a TYPE OF WORK OF •V1GPS Q� C FEE* SCHEDULE - USE CHECKLIST 1N Mechanical permit fees* are based on the value of the work ❑ New construction ❑Addition /alteratio r i� performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition �! J ( Other: 4� 8" » - f i2 mechanical materials, equipment, labor, overhead, and profit. Value: $ CATEGORY OF CONSTRUCTION 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. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: /5? iv Q 5 0 y � t J L /I/ (requires site plan showing placement) 46.75 / / Furnace 100,000 BTU (ducts /vents) / 46.75 li 75 City /State /ZIP: 7 6-7Syz- 1)4 - 9) 2 2 ?j Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump (requires site plan showing placement) 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: 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 Z3 .3Z Gas fireplace 33.39 t-A 9 ✓Q / - eAc.Q 54 ,s - /7�t^/1 a e..- Flue vent for water heater or gas / e / / fireplace 23.32 �1 P,t.�� Log lighter (gas) 23.32 Wood/pellet stove 33.39 _ / Wood fireplace /insert 23.32 tl_'f PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32 Other: 23.32 Name: %� /' _e_,-;, Environmental exhaust and ventilation: Address: C 7 j Range hood/other kitchen Sri e ' equipment 33.39 City /State /ZIP: Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32 4 APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 r��� Other: 23.32 Business name: ��/i4r PA/Z.- Fuel piping: Contact name: MSG y ^Z(--- $14.15 for first four; $4.03 for each additional /� ^ ^- Address: 7 "A / J� S- sr- Furnace, etc. Gas heat pump City /State /ZIP: ,2)/1--17-,4.2 /L 7 Z/ b Wall /suspended/unit heater Phone: 5 7 7 7 _ 3 ) 7 6 Fax: : ( 03) 777 - l/ 70 Water heater Fireplace E -mail: p .../4 — Q p , - CAM Range CONTRACTOR Barbecue � Clothes dryer (gas) Business name: /4/ , / � %> g 6/i+,X A - ,, - / '/J' Other: Address: 3b0 �Cy, .� - MECHANICAL PERMIT FEES* City /State /ZIP: c- 0 35 e.._ ( i r1 )0.5'6 Subtotal Phone: (G0 ) �� Fax: ( ) Minimum permit fee ($90.00) 1 f) ,.c +p hone: 3 . . Z 3 Plan review (25% of permit fee) CCB lie.: / i5 ©V6 l r /id— eL State surcharge (12% of permit fee) TOTAL PERMIT FEE /0 This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name: `-2,,A,-,-e---,- / Z 7 • /1 * Fee methodology set by Tri- County Building Industry Service Board I:\ Building \Permits\MEC- PermitApp.doc 09/09/10 440 -4617T (t 1/02 /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: \Building\Permits\MEC- PermitApp.doc 09/09/10 2