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Permit CITY OF TIGARD MECHANICAL PERMIT a Permit # MEC2011 -00481 - • COMMUNITY DEVELOPMENT Date Issued 10/27/2011 T tGAAD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S103DD00433 Jurisdiction Tigard Site address 10710 SW FAIRHAVEN WAY Project CALDERON Subdivision FAIRHAVEN COURT Lot 5 Project Description Wood fireplace insert Contractor FOXS CHIMNEY SWEEPS Owner CALDERON, TOMAS D 33440 SLAVENS WAY 10710 SW FAIRHAVEN WAY WARREN, OR 97053 TIGARD, OR 97223 PHONE 503 - 366 -5555 PHONE FAX FEES Specifics Description Date Amount Wood Fireplace /Insert 10/27/2011 $23 32 Type of Use SF 12% Stale Surcharge - Mechanical 10/27/2011 $10 80 Class of Work ALT Type of Const Minimum Fee Adjustment - Mechanical 10/27/2011 $66 68 Occupancy Grp 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 0 Issued By / Permittee Signature , 1 (/ is Call 503 63'x -' 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 ® FOR / Ern OR OFFICE USEIONL) 72 City of Tigard �w gp�_�� anilin 13125 SW Hall Blvd, rlgard,Otf,Q7223� 1) o r M Phone 503 718 2439 Fax 503 (98: ISO Plan atte/By cw Ing Other Permit G ARD Inspection Line 503 639 4175 CA �� Date ReadyMy IZ See Page 2 for Internet www Tigard - gov Q �0 Noirfied/Method Supplemental Information .TI n F c\Ci P �1 ©N TYPE OF N}dRIWGI' COMMERCIAL FEE* SCHEDULE - USE CHECKLIST' K�,i Mechanical permit fees* are based on the value of the work ❑ New construction leAddttlon /alteratwn /replacement pertonned Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other mechanical materials, equipment, labor, overhead, and profit Value $ CATEGORY OF CONSTRUCTION RESIDES FIAL EQUIPMENT/SYSTEMS FEES* ® and 2- family dwelling ❑ Commercial /Industrial ❑ Accessory building For special information use c /echtut ❑ Multb family ❑ Master budder ❑ Other Description Qty Ha Total JOB SITE INFORMATION AND LOCATION Ileating/coohng• y ^ / I / Air conditioning / Job site address 1 0710 S(J lc /r4Que4/ 6../96( (requires site plan showing placement) 46 75 City/State/ZIP Furnace 100,00013'1 U (ducts /vents) 46 75 a / ( ace 0 )7- 972 2- Furnace 100,000+ BTU (ducts /vents) 54 91 Suite /bldg /apt no V I Project name (1,;1. /t Z) Heat pump (requires sift plan showing placement) 61 06 _ Cross street/directions to job site )2 At- � 1.7/,} y o 4 ' 6 , 4 , 48 . Duct work 23 32 l�� �F Hydronm 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 'fax map /parcel no Other fuel appliances: DESCRIPTION OF WORK Water heater 23 32 Gas fireplace 33 39 L on' (4 ..,47,1/7 vve T / Flue vent for water heater or gas / fireplace 23 32 Log lighter (gas) 23 32 Wood/pellet stove 33 39 / Wood fireplace/insert / 23 32 ?5 3)... PROPERTY OWNER I 0 TENANT Otherney /ImedffiIe /vent 23 32 Name - �(�d"94f �' �gei //�t /� // u (�✓ IQ�4T `I` //teN (..G (d2 /dam Environmental exhaust and ventilation: Address /0 ? c) 0--,,,/ air 6� L / cs equ egwpe hood/other kitchen n pment 33 39 City /State/ZIP ) /la IC Q R 97 Zz3 Clothes dryer exhaust 33 39 q 1 Single-duct exhaust (bathrooms, ' Phone ( j/) ? G — 4-7 f7 1 ( ) !/ - toilet compartments, utility rooms) 23 32 ❑ APPLICANT ❑ CONTACT PERSON Attm /crawlspace fans 2332 Business name Other 23 32 Fuel piping• Contact name 77-i WI a 3 ('G ( (-e(O,-) St4.15 for first four, $403 for each additional Address k /0 s Q a /I Lie A) L" ' Gas p + - Gas heat pump City /State /ZIP T/ r -/ ne 9 7 7_7_7 Wall /suspended/unit heater Phone ( zd _x1 eJ Fax ( *r - Water heater Fireplace E -mail Range CONTRACTOR Barbecue / Clothes dryer (gas) Business name fox rS c% /f.t/C� , P7 r 7 Other Address 3, > 4 (� 0 S'kue,✓S fir/ MECHANICAL PERMIT FEES* City /State /ZIP wa (r( A.1 Ors / 7 loS' Subtotal ,T''e v / Minimum permit fee ($90 00) 9`0, ) Phone (r d)) 3 6td - �,s ,5 Fax ( ) Plan review (25% of permit fee) - CCB he C z 4 1/ i79-?/ 42_ State surcharge (12% of penult fee) /f)a C� TOTAL PERMIT FEE f J. r This permit application expires if a permit is not obtained within ISO Authorized signature , .......,_,...._ '„ 4,./- ao days after it has been accepted as complete Print name C, I i' ' Date J S " Fee methodology set by Tn- County Building Industry Service Board a I \Budding \ Permits \MLC - PermitApp doe 09 /09/10 4414617T (I I/ /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- PermnApp doe 09/09/10 2