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Permit
CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2012 -00381 Date Issued: 07/18/2012 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S110BA05700 Jurisdiction: Tigard Site address: 11885 SW WILDWOOD ST Project: Balmer Subdivision: SHADOW HILLS Lot: 8 Project Description: Radon Mitigation (1) Attic/crawl space Contractor: CASCADE RADON INC Owner: BALMER, MARK 2761 NE HALSEY SUITE B 11885 SW WILDWOOD ST PORTLAND, OR 97232 TIGARD, OR 97224 • PHONE: 503 - 421 -4813 PHONE: FAX: 503 - 281 -6170 FEES Specifics: Description Date Amount Attic/Crawlspace Fans 07/18/2012 $23.32 Type of Use: SF 12% State Surcharge - Mechanical 07/18/2012 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/18/2012 $66.68 Occupancy Grp: Stories: Fuel Fuel Types: Gas Pressure: Total $100.80 Required Items and Reports (Conditions) • This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. r /P1 D /� n Issued By: Permittee Signature: OI f u(�fi �ULL Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. From Cascade Radon 1.503.281.6170 Wed Jul 18 11:01:53 2012 MST Page 1 of 2 Mechanical Permit A I f li. . 1 C)R :OFI lC I t`SF ON L] ' .- _ Received • City of Tigard . _ E I\ J E D . Darcy. 1 it B" O ..r" Pe rmitht E - o 1.2 . © 038/ i 13125 S W Halt Blvd Tigard, O' 9 .. Pen Review s Phone: 503.718.2439 Fax: Darc+Fiy 1 . 503.598..k51ry 1 8 2012 Other Lt_ A R'D Inspection Line: 503.639.4175 • ,JJUU Date Reody1By: ftui ' RI 'See Page 2 for Internet: www.tigard- or.gov �/ OF T4GARD Notified/Method: l to Supplemental Information C ! I 1 1 O - -•- 1 •PYPF. gitillt l COMXIERCIAL FEE* SCHEDULE - USE CHECKLIST r--- I Mechanical permit fees are based on the value of the work i ❑ New Construction ( Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all 0 Demolition 0 Other: mechanical materials, equipment, labor, overhead. and profit. Value: S CATEGORY OF CO'!$'1'RUCTION — RESIDENTIAL EQUIPMENT /SYSTEMS FEES* 1 XI - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building r For special Information lace. checklist Multi - family ❑ Master builder E] Other: Descr iption I Qty. L Ea, i Total JOB SITE INFORMATION AND LOCATION Healing /cooling: Air conditioning t Job site address: i 1 gS 5 t.a3 W i l oIw Op 4,1 , S4 r •, } - I (requires site plan slow v .16.75 { -6,, „r, l ' -)T - I Furnace 100.000 War (ductseventsl _ _ 46.75 City/States "LIP: A " a a 1 Furnace 100.000+ BTU (li 54 Suite.blde. /apt. no.: Project name: 1 Heat pwrlp (requires site plan :lowing placement) ' 1 61.06 1 Cross street/directions to job site: Duct work f 23.32 Hydron le hot water system j 23.32 1 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 1 Subdivision: _ I 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 i 23.32 Gus fireplace /insert — r 33.39 Flue vent for water heater or gas R`. _1 M.-r i� fireplace 23.32 WI (r `r Log lighter (gas) ' 2132 , Wood/pellet stove 33.39 Wood fireplace/insert 23.32 ❑ PROPERTY OWNER I ❑ TENANT Chimney /linedflue/vent 23.32 Other: 23.32 Name: l 13 C 1 Pr to r K ' e ( , Environmental' exhaust and ventilation: Address: t t / 2 51e) (j 1 ( at,y�OC} C Y J ,Q -'l' an3 hood/other kitchen D ► equipment 33.39 CityiState/ZIP: rd © `' 7 1 aa Clothes dryer exhaust ! 33.39 Single -duct exhaust (bathrooms, I ; 1 Phone: ( ) ? Fax: ( 1 toilet compartments. utility moms) 1 23.32 ❑ APPLICANT 0 CONTACT PERSON Anic /crawlepace farts f 1 23.32 Business name: SC_.4 dQ ,�, av � Other: J I 23.32 ; _ Fact piping: Contact name: t e --'j SA•CP , r 51 4.15 for first four; 34.03 for each additional I-- Address: a / ) (01 /V 1 1' { ct.\S �-14,n Gast City/State . /J_IP: (t ] FF� ;� 1 _s.P_� V f�T' 4 1^U dJ 11 ( � 3 a � Wall /str,RenderUunil heater Phone: Gp Fax :: ) t U 3 1 � a � - � 0 � �] 11 � �3 OZ.g � � �01 � 0 Water hearer I Firtylnce E E>ru i ce ( Gcc SC4 - C5'' Range I CONTRACTOR Barbecue Business name: �cc S C4 A .& R d Clothes dryer (gas) t ` �" Other. Address: 1 E. . c o �� S +e MECHANICAL PERMIT FEES" Cif 3/ tate S/l.IP: Ctl�a� - I Subtotal 1 gi,40 1�- y r vl� c . Phone: ( 3) al - ''12(3 • Fax: b•03) as f- (? 0 i Minimum permit foe ($40.(70) 1 ! Tail review (25% of permit fee) 4 CCR lee.. 1 gt`).S 37 �\ t 4 i Stale surcharge (12% ufpermit feel / �/� I TOTAL PERMIT FETE, ICO, $40 a/ This permit application expires If a permit Is not oltesinett within 180 Authorized signature ` days after it hos been accepted as complete ` pli` Fcc methodology ;rr by fn -downy lirtilding Industry Servicro AnarJ I Print name. Arne l / • witltev ! Date: t•�n, , Ii„r\PerniIsiMTC.- PemvtAoa doe 03107/12 110 - 77(1 I1024S1.WwE111