Permit CITY OF TIGARD MECHANICAL PERMIT
» - COMMUNITY DEVELOPMENT Permit #: MEC2011 -00130
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/29/2011
Parcel: 2S102CC04300
Jurisdiction: Tigard
Site address: 13655 SW STEVEN CT
Project: SCHEIDERICH Subdivision: Lot: 0
Project Description: Fuel piping installation for range.
Contractor: RAYBORN'S PLUMBING INC Owner: SCHEIDERICH, WILLIAM J
19990 SW CIPOLE RD 13655 SW STEVEN CT
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES
Specifics: Description Date Amount
Fuel Piping 03/29/2011 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 03/29/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/29/2011 $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 0 C by calling 503.232.1987 or 1.: I e •
Issued B �� Permittee Signature: "•,%11.. �✓�
/ /
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.
-503 691 2328 Rayborns Plumbing 11:02:57 a.m. 03 -28 -2011 1 /2
Mechanical Permit Application FOR OFFICE I SE O\1.1
R eceived y �,�
Cl of Tigard r7 i i f ,,& Permit No: n.. . ,J w 130
• 13125 SW Hall Blvd., Tigard. OR Sit -i) 9 I Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 a i/ - - . Date 'By: Other Permit:
I I L, rA k 1, � �
Inspection Line: 503.639.4175 Ty I � ,, _ y . By: kris: : ®See Page e 2 for
Internet: www.tigard- or.gov j ` i D ate Ready.
, Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ddition /alteration /replacement 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: $
dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
nd 2 g ❑ Commercial /industrial ❑ Accessory building
❑ Multi - family ❑Master builder For special information use checklist.
❑ Oth Description Qty. Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
��
Job site address: // ,1 '' 11 A cond or heat pump
I CJ < W +ems f9 �/� (requires site plait showing placement) 14.00
City /State /ZIP: 4 •... V I 4 .3 Furnace 100,000 BTU lducts'ventsl 14.00
Furnace 100,000+ BTU tducts vents) 17,90
Suite/bldgiapt. no.: l Project name: Gas heat pump , 14.00 ~
Cross street/directions to job site: Duct work 10,00
. Hydmnic hot water system 14.00
Residential boiler (radiator or
ydronic) 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 - Gas fireplace 10.00
/ %,,J a ; p,.i ,t,t 0 e — Flue vent for water heater or gas
•J fireplace 10.00
Log lighter (gas) 10.00
Wood&peltet stove 10.00
Wood fireplace insert 10.00
PROPERTY OWNER I ❑ TENANT Chimney /liner/flue /vent 10.00
Other: 10.00
Name: \ Environmental exhaust and vendlation
6 `,� e v� Range hood/other kitchen
Address: 1'1 6 l. j S•}e,V e \A,c C. k equipment t 10 3
City /State /ZIP: l t r Q (4.'1 (4.'1 Z 3 Clothes dryer exhaust ., 10.00 / r T
Single-duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
- -. . --- -- - ❑ APPLICANT ❑ CONTACT PERSON Attic /craw pace fans 10.00
Business name: pl t
Other: 10.00
y ! flit 4 \ Iv MA, al vtArj �l \ &f Fuelpiping
Contact name: �„�� r� ' k $5.40 for first four; $ 1.00 for each additional
Address: 1(,i� {ef t) s w ,e. , e (�" GaFurnace. eat etc.
um
City /StateIZlP:�.. Cis Wall /suspended /unit heater
1, fra 1d � , R. i
Phone: (&0 J) op .. //j ► f Fax :: ( "ov el � , Water heater
7`M" 7 Fireplace
E -mail: / //Q e /7„))42, fa 5 . Kee,- Range . . J
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name:
Ay t^ Yt e U �M�, `1�C Other:
Address: 1 C CtC(0 W c 4 ?cite, K MECHANICAL PERMIT FEES*
Cit /State /ZIP' Subtotal
y ea ...._ O r x, •�'"
b Minimum permit fee (1.7.2.750 -CA-)
Phone: (50 6 1a� L i 131 F a x : ( ) (a ! g Plan review (25 %ofpennit fee)
CCB tic.: "''D State surcharge (12% of permit fee) 1 t tZy
i TOTAL PERMIT FEE i /' IQO, )
This permit application expires if a permit is not , . ne , within 150
Authorized signature: i � r i /,J / / days after it has been accepted as complete.
Print name: A ja. pl. ^, , t + 4 Date: • .. j\ • Fee methodology set by Tri- County Building Industry Service Board