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Permit
CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2012 -00310 T [ G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2012 Parcel: 2S103BD02900 Jurisdiction: Tigard Site address: 12020 SW CARMEN ST Project: Horak Subdivision: CARMEN PARK Lot: 2 Project Description: kitchen remodel /relocation of water heater Contractor: OWNER Owner: HORAK, TRAVIS • pRIIED I 12020 SW CARMEN ST TIGARD, O R 97223 PHONE: PHONE: 541 - 231 -8161 FAX: FEES Specifics: Description Date Amount Water Heater 06/11/2012 $23.32 Type of Use: SF Flue Vent for Water Heater or Gas 06/11/2012 $23.32 Class of Work: ALT Type of Const: Fireplace Occupancy Grp: Range Hood /Other Kitchen 06/11/2012 $33.39 Stories: Fuel Piping 06/11/2012 $14.15 12% State Surcharge - Mechanical 06/11/2012 $11.30 Fuel Fuel Types: Gas Pressure: Total $105.48 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: ©k\ APR..) 64-71 l Q id 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. CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2012 00310 T t G AR. D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2012 Parcel: 2S103BD02900 Jurisdiction: Tigard Site address: 12020 SW CARMEN ST Project: Horak Subdivision: CARMEN PARK Lot: 2 Project Description: kitchen remodel /relocation of water heater Contractor: Owner: HORAK, TRAVIS 12020 SW CARMEN ST TIGARD, OR 97223 PHONE: PHONE: 541 - 231 -8161 FAX: FEES Specifics: Description Date Amount Water Heater 06/11/2012 $23.32 Type of Use: SF Flue Vent for Water Heater or Gas 06/11/2012 $23.32 Class of Work: ALT Type of Const: Fireplace Occupancy Grp: Range Hood /Other Kitchen 06/11/2012 $33.39 Stories: Fuel Piping 06/11/2012 $14.15 12% State Surcharge - Mechanical 06/11/2012 $11.30 Fuel Fuel Types: Gas Pressure: Total $105.48 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: }4111Ati 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 Applicati c" • F R OFFICE USE ONLY City of Tigard � 14 � • ' Date/By: 62( , Permit No. : , 111 a 13125 SW Hall Blvd., Tigard, OR 97223 "' Phone: 503.718.2439 Fax: 503.598.1960 JUN 1 1 2012 Plan Review Date/By: Other Permit: TI G A R D Inspection Line: 503.639 Date Ready/By: kris: ® See Page 2 for Internet: www.tigardor.gov CITY OF TIGARD Notified/Method: "il( Supplemental Information Bull i DING 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* ® I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For speda! Information use thecldlst ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: 12020 SW Carmen Street (requires site plan showing placement) 46.75 City/ State/ZIP: Tigard, OR 97223 Furnace 100,000 BTU ( ducts/vents) 46.75 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: .... e 1 laeWlocL9.-Q Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: 121" 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 I 23.32 23.32 Kitchen Remodel/ Relocation of water heater Gas fireplace/insert 33.39 Flue vent nt f fo e/insert or water heater or gas fireplace I 23.32 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 ® PROPERTY OWNER I ❑ TENANT Chimney/liner /flue/vent 23.32 Other: 23.32 Name: Travis Horak Environmental exhaust and ventilation: Address: 12020 SW Carmen Street Range hood/other kitchen equipment I 33.39 33.39 City/State/ZIP: Tigard, OR 97223 Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: (541- )231 -8161 Fax: ( ) toilet compartments, utility rooms) 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 1 14.15 14.15 E -mail: Fireplace Range CONTRACTOR Barbecue Business name: Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* City/ State/ZIP: Subtotal 94.18 Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) 11.30 4,,,.,- TOTAL PERMIT FEE 105.48.7 This permit application expires if a permit is not obtained within 180 Authorized signature: r days after it has been accepted as complete. Print name: Travis Horak Date: 5/22/2012 • Fee methodology set by Tri -County Building Industry Service Board I:\ Building \Permits\MEC- PernitApp.doc 03/07/12 440.461Tr(II /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 includingL $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- PermitApp.doc 03/07/12 2