Permit MECHANICAL PERMIT
CITY OF TIGARD we 7,
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00336
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 • Date Issued: 07!15/2011
Parcel: 2S 110AB03200
Jurisdiction: Tigard
Site address: 14285 SW 114TH AVE
Project: Watkins Subdivision: Lot:
Project Description: Gas piping and exhaust for clothes dryer. 11/4/11, reprint to change contractor.
Contractor: RELIANT PLUMBING & MECHANICAL Owner: WATKINS, PETER & MAGGIE
11575 SW PACIFIC HWY STE 219 14285 SW 114TH AVE
TIGARD, OR 97223 TIGARD, OR 97224
PHONE: 503 - 246 -1201 PHONE 541 - 740 -5415
FAX: 503 - 246 -1205
FEES
Specifics: Description Date Amount
Clothes Dryer Exhaust 07/15/2011 $33.39
Type of Use: SF Fuel Piping 07/15/2011 $14 15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 07/15/2011 $10 80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 07/15/2011 $42.46
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 rules adopted by the Oregon
Utility No a ion Ce :. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir- questions to OUN s .. Ilm. 503 232.1987 or 1 800.332.2344.
tss ed By: / Permittee Si • �� aliPthL r
Call 503.639.4175 by 7.00 a.m. for the next available ins. -ction 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.
CITY OF TIGARD MECHANICAL PERMIT
gt
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00336
T IQARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2011
Parcel: 2S 110AB03200
Jurisdiction: Tigard
Site address: 14285 SW 114TH AVE
Project: Watkins Subdivision: Lot:
Project Description: Gas piping and exhaust for clothes dryer.
Contractor: OWNER Owner: WATKINS, PETER & MAGGIE
14285 SW 114TH AVE
TIGARD, OR 97224
PHONE: PHONE: 541 - 740 -5415
FAX:
FEES
Specifics: Description Date Amount
Clothes Dryer Exhaust 07/15/2011 $33.39
Type of Use: SF Fuel Piping 07/15/2011 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 07/15/2011 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 07/15/2011 $42.46
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 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 1.800.332.2344.
`
.
Issued By: ` /�, / Permittee Signature: ;141011r
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 RECEIVED v ED FOR OFFICE USE ONLY Received
City of Tigard JUL 1 5 Z Q Date /By: .9 /S 4 i. Permit No yvEC �' / - _936,
ill 13125 SW Hall Blvd., Tigard,OR 97223 Plan Review
1 : Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639 CITY OF Date ReadyBy: luris: See Page e 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: i Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction X Addition/alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /:SYSTEMS FEES*
/il- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 'Lt �85 s v ' iy Ave, (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts /vents) 46.75
City /State /ZIP: T j , , OK 97 Furnace 100,000+ BTU (ducts /vents) 54.91
•
Suite/bldg. /apt. no.: Project name: W 1-kl ns Heat pump
(requires site plan showing placement) 61.06
Cross street/diredions 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
/ 1 J _ r Gas fireplace 33.39
G PIp1rtG� '(7) (.(o) WS drjP Flue vent for water heater or gas
�J fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
N RS PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: M cac�l2 Wa ys Environmental exhaust and ventilation:
Address: ) L 2 g5 5W 1-1- A-V�
Range hood/other kitchen 33.39
City /State /ZIP: T l`gaYck i OK 91 2.14 Clothes dryer exhaust / 33.39
J Single -duct exhaust (bathrooms,
Phone: ( 5111 ) -No_ 54/5 Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ 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: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Clothes dryer (gas) /
Business name: 6 ili/t/��
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) fQ ,
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) /6 , PO
1%k" �/ TOTAL PERMIT FEE /, , fd
Authorized signature: '"
' 1 / /. 7 , — This permit application expires if a permit is not obtained within 180
11 days after it has been accepted as complete.
M A
Print name: QOI'1 Q \4a f nS Date: — 7/( /Zo I( * Fee methodology set by Tri- County Building Industry Service Board
I:\ BuildingWermits\MEC- PermtApp.doc 09/09/10 440 -4617T (11 /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.
I:\Building \Permits \MEC- PermitApp.doc 09/09/10 2
RECEIVED
Property Owner Statement JUL 15 2011
Regarding Construction Responsibilities CITY OFTIGARD
Oregon Law requires residential construction permit applicants who are not licensed w iRINGDIVISION
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing per mits.
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 a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
/'�'�J" I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
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.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
J 6 9'i Q_ W ad - kids
Print Name of Permit Applicant -71 /5 /7_0 / /
Al " Akvi i
' ,
Signatu - of Permit Applicant Date
Permit #: a0 // d a . 3 - ?6,
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Address: r ; �`.∎Py
7--761-26 o� 9f/ *:146,0f04"4:"' ...
Issued by: 44'6 Date: - /.s/ // CL `-
This Copy for Permit Offices