Permit n CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit# MEC2012 -00319
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/19/2012
Parcel: 2S104BB04100
• Jurisdiction: Tigard
Site address: 14048 SW LIDEN DR
Project: Moss Subdivision: CASTLE HILL Lot: 26
Project Description: (4) single duct exhaust bathroom remodel
Contracto • OWNER Owner: MOSS, WILLIAM
REyiscal 14048 SW LIDEN DR
TIGARD, OR 97223
a � r
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Single Duct Exhaust (Bathrooms, Toilet, 06/19/2012 $93.28
Type of Use: SF Utility Rooms) •
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 06/19/2012 $11.19
Occupancy Grp:
Water Heater 06/19/2012 $23.32
Stories: 12% State Surcharge - Mechanical ' 06/19/2012 $2.80
Fuel
Fuel Types:
•
Gas Pressure:
Total $130.59
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 - 0 You may obtain a copy of the rules
or direct questions to by calling 503.232.1987 or 1.800.332.2344.
-- ��YY�r�` , +
Issued By: �' ,/� ��. c C , c t Permittee Signature: OAS 4 P pG f e417041.
•
Call l5 50 ' 3 .6 6339.4175 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.
CITY OF TIGARD MECHANICAL PERMIT
s • - COMMUNITY DEVELOPMENT Permit #: MEC2012 -00319
T [ G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/19/2012
Parcel: 2S104131304100
Jurisdiction: Tigard
Site address: 14048 SW LIDEN DR
Project: Moss Subdivision: CASTLE HILL Lot: 26
Project Description: (4) single duct exhaust bathroom remodel
Contractor: Owner: MOSS, WILLIAM
14048 SW LIDEN DR
TIGARD, OR 97223
PHONE PHONE:
FAX:
FEES
Specifics: Description Date Amount
Single Duct Exhaust (Bathrooms, Toilet, 06/19/2012 $93.28
Type of Use: SF Utility Rooms)
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 06/19/2012 $11.19
Occupancy Grp: Water Heater 06/19/2012 $23.32
Stories: 12% State Surcharge - Mechanical 06/19/2012 $2.80
Fuel
Fuel Types:
Gas Pressure:
Total $130.59
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: AAJI-41 t Permittee Signature:
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 Ft)li c)Fricl-: till: ONLY
Received
City of Tigard R C� Date/By: (p( q (( 2- Permit No i a pl .p...... p0 '
Other Permit: IVE
13125 SW Hall Blvd., Tigard, OR 97222233
C Plan Review
Phone: 503.718.2439 Fax: 503.598.196 19 2� Date/By:
r I G n R D Inspection Line: 503.639 J Date ReadyBy: See Page 2 for
Internet: www.tigard - or.gov FC! vA�t� Notified/Method: IN ®
Supplemental Information
t b Q . Istorl.
TYPE OF 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*
4 - 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building For spec/ui Information use checldisL
❑ Multi family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
•
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
/ Job site address: (' S G/7)PN �� (requires site plan showing placement) 46.75
City /State /ZIP: 7 Z I Z' oil- ? 7 Z7-3 Furnace 100,000 BTU (du cts ve nt 46.75
FFurnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name:TZ i3 Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
VA/ t N u T /wit _u 7-1:)0 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 1 23.32
Gas fireplace/insert 33.39
Flue vent for water heater or gas
/1 LUX) 6 PeLti . /G/f-r /CEO / ,C,4 fireplace 23.32
;��,,,,,,.,, Log lighter (gas) 23.32
j�'l I�LV C2� ° /t 4 L ( Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Id PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 23.32
� i L L ` ^ /1/10 S Other: 23.32
Name: ri „ Environmental exhaust and ventilation:
Address: >VOL - s to .l66N Ai2 /ve Range hood/other kitchen
equipment 33.39
City/State /ZIP: �G (� Q l? 9722 Clothes dryer exhaust 33.39
Phone: (.57) S 7 ' 7 Fax: ( S .SZ it ?0ec Single -duct exhaust (bathrooms, (a\
toilet compartments, utility rooms) al 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name:
Other: 23.32
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
Business name: l L
�/ . X p G 2 Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal q 3. Aiii
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) ( i_ f
�
TOTAL PERMIT FEE / '7
Authorized signature: " dC ff/ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: C j (LL / ( 1aliS. Date: 6 ii 9 /20/2_ • Fee methodology set by Tri - County Building Industry Service Board
1:\ Building \Permits\MEC•PernitApp.doc 03/07/12 440-4617T(11/02/COM/WEB) I! W. S•9
•
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 ' ` 5 • .
$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:\Buildin PermitApp.doc 03/07/12 2
r
•
G,
1
Property Owner Statement
Regarding Construction Responsibilities . •
Oregon Law requires residential construction permit applicants who are with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
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.
1
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 all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
r e__
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.
(,v /LL[ /1iv4 1,0 S
Print Name of Permit Applicant
Ojegaca ith2(A. 6/7/20/
Signature of Permit Applicant Date
Permit #: A4 g c .9- 0o3 /q
Address: 1 40 e-fD dLU ki b7 ^ mot AL s : -f f _ z *„
• TI 0 A )2h , DE- cii. 23
�
.
' This Copy for Permit Offices
1 ,
I
\ • . ,
.: \.
f ir
. • 1 412 I
I , .
gi 71\3 -.)/ .2. (Y13 (.- . . •
.• .
. .
. 1
A . ...A•' ' , . ,.
- -• -... ''. , , '
. .
. ,
7 , • : - :, • . , . - ' __, ■ - ; ;:' 1`. .
. 1 . •
. .
. .
. •