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Permit II CITY OF TIGARD MASTER PERMIT 2 • • COMMUNITY DEVELOPMENT Permit #: MST2012 -00057 T [ GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/05/2012 Parcel: 1 S133DD10000 Jurisdiction: Tigard Site address: 11774 SW 125TH CT Subdivision: VILLAGE AT SUMMER LAKE PARK NO.4 Lot: 137 Project: Gastek Project Description: Interior remodel BUILDING Floor Areas Required SetbacksRequired Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 0 sf Value: $15,000.00 Rear: 0 PLUMBING Sinks: 1 Water Closets: 1 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 0 Urinals: 0 Lavatories: 1 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 1 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Drywell- Trench Drain: 0 Other Fixtures: 0 Other Fixture Units: MECHANICAL • Fuel Types Air Conditioning: N Vent Fans: 1 Clothes Dryers: 1 Heat Pump: N Hoods: 0 Other Units: 1 Fum <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Fum > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add'i 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 4 Mfd Home /Feeder/Svc: 0 401 -600 amp: 0 401 -600 amp: 0 . 601 -1000 amp: 0 601 +amp- 1000v: 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R -3 0 Owner: Contractor: GARSTECK, CHRISTINE DEPENDABLE HOME REMODELING INC Required Items and Reports (Conditions) 11774 SW 125TH CT 29000 SW MCNAY RD TIGARD, OR 97223 HILLSBORO, OR 97123 PHONE: PHONE: 503 -572 -5588 FAX: • Total Fees: $841.35 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 24.: or 1.8i x.332.2 44. Issued By: 4 Permittee Signature: l �r• Call 503.639.4175 by 7:00 a.m. for the next available Inspection dat ..1 i/r This permit card shall be kept In a conspicuous place on the Job site until completion of the project Approved plans are required on the job site at the time of each Inspection. Building Permit ApplicatCEIVED Residential MA FOR OFFICE LSI; ONLY 2 1 2 012 City of Tigard R eceived Deem : Sff�rf�rl Permit No.: 0/. -GO 0 14 13125 AU 13125 SW Hall Blvd., Tigard , trIltOFTIGARD Plan Review Other Permit: Phone: 503.718.2439 Fax$���� Date/By: R ol N bill., Inspection Li ne: 503.639.4175 I DIVISI Date Rea By: kris: ® See Page 2 for i IGARiD p ON Date Internet: www.tigard or.gov Notified/Method: , Supplemental Information TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all X Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 1 - and 2- family dwelling ❑ Commercial/industrial Valuation: $ 5 t Q Q 0 ` ❑ Accessory building ❑ Multi - family Number of bedrooms: i stk..) ❑ Master builder ❑ Other: Number of bathrooms: N0 ,j QW JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: I 1 1 1- S UU IS 5 * (e' d Y 1— New dwelling area: square feet City /State /ZIP: ' t t a rd , OR Garage /carport area: square feet Suite/bldg. /apt. no.: I Project name: 94 r9fec-k Re'.ob I Covered porch area square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: VI L,L c,E 1A vFPA(tK Li I Lot no.: / 3 7 Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Tn 1 _ 1, re - r0 etc/ 1 Valuation: $ Existing building area square feet New building area: square feet 'PROPERTY OWNER ❑ TENANT Number of stories: Name: C 11 r is G t as f t, Jc. Type of construction: Address: / / 7 C W 4 (2S TX Call V• f Occupancy groups: City/State /ZIP: l 1\ film f © Existing: Phone: 6 34) 9641 Fax: ( ) New: ❑ APPLICANT CONTACT PERSON BUILDING PERMIT FEES* Business name: N Y 5 /4-550c I a f°S (Please refer to fee schedule) Structural plan review fee (or deposit): Contact'name: St 5 D 2 S o 5 w / y � 1 ^ FLS plan review fee (if applicable): Address: Y /-r v City /State /ZIP: -T- fil.✓pjr D P.- Ji 2 23 Total fees due upon application: /9 Phone: (503) 2 a 5^ Z ` I Fax ( ) J 9a. yyLe. Amount received: E -mail: h rI g r &S 0 C e , Ct tA p O t Co'14� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* (` J � Co • 1 ercial and residential prescriptive instal . ' • n of CONTRACT � / t roof -top • •unted PhotoVoltaic Solar P.. - ystem. Business name: pop o tA 8 L E � i; jet yrib b e Ld N G Submit two ets of roof plan • - connection details ,�1 and fire departme . • ccess, . . g with the 2010 Oregon Address: 3 9 / r 000 •CNi- y Solar Installation Spec •t Code checklist. Permit Fee • cludes I • . review City/State /ZIP: E/ u,58 � go, Co 2 d administrative s): $180.00 Phone: (613) 5 7,2- 5- $ g Fax: ( ) S - surcharge (12% of permit fee): $21.60 CCB lic.: / to / i 3 JO /l , / , � Total fee due upon application: $201.60 Authorized signature: L� This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: C imi 5 5 r-K Date: . 1,agilD... * Fee methodology set by Tn County Building Industry Service Board. 1:\ Building \Permits\BUP- RESPerrnitApp.doc 02/24/2011 440 -4613T(11 /02/COM/WEB) Building Permit Application Checklist One- and Two - Family Dwelling hole OFFICE USE ONLY Received City of Tigard Date/By: Permit No.: n 13 125 SW Hall Blvd., Tigard,OR 97223 III ; Phone: 503.718.2439 Fax: 503.598.1960 Associated permits: I' I G A R D 24- Hour Inspection Line: 503.639.4175 ❑ Electrical ❑Plumbing ❑Mechanical Internet: www.tigard - or.gov ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 1 e No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ • 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ ' 4 Fire district approval required. Name of district: . ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. _ ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. _ 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- 0 ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Ore Ion and shall be shown to be a, •licable to the •ro'ect under review. JURISDICTIONAL SPECIFICS 23 Three (3) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ 0 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations, driplines, ❑ ❑ ❑ and protection measures must be drawn to scale and must include the project arborist's signature of approval. 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings • on a lot of record approved prior to September 9, 1995. I:\Building\Permits\BUP- RESPermitApp.doc 02/24/2011 440 -4613T(I I /02/COM/WEB) Plumbing Permit Application REC EP Ii,,_ _ Site Utilities FOR OFFICE I o APR 5 2012 R eceived ,�- S��U�d -00 5 7 City of Tigard Permit No.- 111 • 13125 SW Hall Blvd., Tigard, OR 97223 PFD g OF ►P� R • Plan Review C Phone: 503.718.2439 Fax: 503.598.1960 ®� �t�''I� Date/By: Other Permit No.: T I G n R D Inspection Line: 503.639.4175 BIJ9LD! G 0 : t j _ . i Date Ready/By lens: Si See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For spedal information use checklist Description I Qty. I Ea. I Total ® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 ID Accessory building ID Multi-family SFR (3) bath 500.32 Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other. Fire sprinkler ( sq. ft-) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site a dress: 11774 SW 125 Court Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City/ : Tigard, Oregon 97223 " "- Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: ( Project name: Garsteck Remodel 2012 Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear R.: ) Page 2 Water service (no. linear ft.: _ ) Page 2 Subdivision: Village at Summerlake Park 4 I Lot no.: 137 Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 1 25.02 Interior Remodel: Shower & Laundry Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Chris Garsteck Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: 11774 SW 125 Court Garbage disposal 25.02 City/State/ZIP: Tigard, OR 97223 Hose bib 25.02 Phone: (503)347 -9841 Fax: ( ) Ice maker 12.51 ❑ APPLICANT ® CONTACT PERSON Interceptor /grease trap 25.02 Business name: Nys Associates Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Steve Nys Roof drain (commercial) 12.51 Address: 10250 SW 87 Ave Sink/basin/lavatory 1 25.02 City/ State/ZIP: Tigard, OR 97223 Solar units (potable water) 62.54 Phone: (503) 245-6721 I Fax: : ( ) Tub /shower /shower pan 1 12.51 E -mail: nys.assoc@yahoo.com Urinal 25.02 Water closet 25.02 - @ONTRtAC FORS _ F � ( ( /� / �( �^ Water heater 37.52 Business name: 0 EL ''(. /� ..OL /4 �v Water piping/DWV 56.29 Address: (Z Z. 5 - / t_1� Other: I I 25.02 city/ State/ZIP: ' ible OR ` `- Oi _ d Subtotal Phone: ' ', . 9' 8 etiriN Fax: ( ) Minimum permit fee: $72.50 i CB Lic.: j g i a i Atrfi' ' lumbing Lic. no.: 4 Plan review (25% of permit fee) ,/ State surcharge (12% of permit fee) ■ Authorized signature: Or 9 / /7 TOTAL PERMIT FEE Print name: r66 � 1 � Date: 3 Z This permit application expires if a permit is not obtained within 180 days after it bas been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. I:\ Building \Permits\PLMU- PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) Electrical Permit Application ps ► . (11 :1:1(1: [SE o\I City of Tigard � � L e Permit No."7:57 4 ) /e7 �J005 • 13125 SW Hall Blvd., Tigard, OR 97223 C 5 e Plan Review Phone: 503.718.2439 Fax: 503.598.1960 APR 2 012 Date/B : Other Permit: ►. G t� R l� Inspection Line: 503.639.4175 Date Ready/By: tuns: ® See Page 2 for Internet: www.tigard - or.gov CITY OF 70 ° 1 � Notified/Method: Supplemental Information TYPE OF Wot thLDRNC D; OS ( PLAN REVIEW ❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ® I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ `A », "E" `I -2 ", `l -3 ", Job no.: Job site address: 11774 SW 125` Court 100a-IP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: Tigard, OR 97223 ❑ Healthcarc facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt no.: Project name: Garsteck Remodel 2012 ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description t p I Qty. I Fee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Village at Summerlake Park 4 Lot no.: 137 1,000 sq. ft or less 168.54 4 Ea. add'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi- family 75.00 2 Interior Remodel: Bathroom & Laundry residential (with above sq. ft) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 Name: Chris Garsteck 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: 11774 SW 125` Court Over 1,000 amps or volts 552.26 2 City/State/ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or g relocation Phone: (503)347 -9841 Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT ® CONTACT PERSON above service or feeder fee 7.42 2 each branch circuit Business name: Nys Associates B. Fee for branch circuits without service or feeder fee, first I 56.18 2 Contact name: Steve Nys branch circuit Each add'I branch circuit 3 7.42 2 Address: 10250 SW 87 Ave Miscellaneous (service or feeder not included) City/State/ZIP: Tigard, OR 97223 dwelling, service and/or feeder 67.84 2 Phone: (503) 245 -6721 Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: nys.assoc@yahoo.com Sign or outline lighting 67.84 2 CONTYRACIIOR Signal circuit(s) or limited- energy Business name: r�Z.ien c/eGfv uz.- panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: Zl ? gy 6i) Kricki a Additional inspection (l hr min) 66.25/hr City/ State/ZIP: 4 (Q lit a / OK. 91006 Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: Fax: ( ) Inspections for which no fee is (Jj7 ) 5� (' 3 ,i thca1 90.00 /hr pically listed (%z hr min) CCB Lic.: Ig97 f e Lic.: C fl I Suprv. Lic.: �5Z $ s ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: . 10 I I - Plan review (25 %of Subtotal: Print name: ./ ` O tn311 Date: 3M State surcharge (12% of permit fee): TOTAL PERMIT FEE: Authorized signature: if This p ermit application expires if a permit is not obtained within 180 �— / days after it has been accepted as complete. Print name: ��. �� v / 5.01 Date: '� l02' �� • Number of inspections allowed per permit. :\ 1Building \Pennits \ ELC- PermitApp.doc 07/01/10 44 o x 0- 461sr( 1ro5 /COMIWEB Mechanical Permit Applica CEIVED FoR 01.. Icl.: Lis,: (Ni 11, . City of Tigard Received Permit No.: , II 13125 SW Hall Blvd., Tigard, OR 9722LAn 21 2012 Plan Review ! V— r Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: 1' 1 C. A It D Inspection Line: 503.639 Date Ready/By: ru ris: dv y Supplemental See Page l Information Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental loformation BUILDING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees* are based on the value of the work ❑ New construction ❑ 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* ❑ 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 Job site address: 1 17 7 4 S � 1 2 J T J 1 A C o u i /) (requires site plan showing placement) 46.75 City/State /ZIP: I t A v ® R Furnace 100,000 BTU (ducts/vents) 46.75 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: V, LLAGE / fl - 1-SU Eg1-AKE'QPr( Lot no.: / 37 Flue /vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK �1 Water heater 23.32 In w r e, 'IA o� Gi I ` L a v r- V Gas fireplace/insert 33.39 Flue vent for water heater or gas h �h r O t2 �� fireplace 23.32 ICJ Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 ❑ PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32 Other: 23.32 Name: Ch r 1 S G Q r S 2 G'C Environmental exhaust and ventilation: Address: J f 7 '7 4 s' W , Z c.-f -1 C u - of - Range hood/other kitchen equipment 33.39 City/State /ZIP: TT GL' d > .) R 9 12 2 3 Clothes dryer exhaust v 33.39 ( Single -duct exhaust (bathrooms, Phone: ( 56 3 4 9 et' , Fax: ( ) toilet compartments, utility rooms) ' 23.32 ❑ APPLICANT CONTACT PERSON Attic /crawlspace fans 23.32 Business name: Alit c A-s G IBC PS Other: 23.32 Fuel piping: Contact name: 514.15 for first four; $4.03 for each additional Address: Furnace, etc. Gas heat pump City/State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: 0 tPE1/4SDA 6 LE ICU r /Q6y)' /N 6 Clothes dryer (gas) Other: Address: )9%) me_ A/Ay MECHANICAL PERMIT FEES* City/State/ZIP: giLt,$, 9eo A Subtotal � ) p Fax: ( ) Minimum permit fee ($90.00) Phone: ( 3 v 7,9 - 5 6-0 O Plan review (25% of permit fee) CCB lic.: la / / / 3 9 State surcharge (12% of permit fee) / / T OTAL PERMIT FEE Authorized Signature: This p ermit application expires if a permit is not obtained within 180 I I days after it has been accepted as complete. Print name: //7Z/ 5 �,5 -' - c'K I Date: 3 J • Fee methodology set by Tri - County Building Industry Service Board I:\ Building )PermiuVMEC- PermitApp.doc 03 /07/12 440-4617T (I I/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- Permit.App.doc 03/07/12 2