Permit CITY OF TIGARD
MECHANICAL PERMIT
= COMMUNITY DEVELOPMENT Permit #: MEC2012 -00588
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/13/2012
Parcel: 2S112CA03400
Jurisdiction: Tigard
Site address: 15270 SW 79TH AVE
Project: Trevor Subdivision: DURHAM ACRES Lot: 30
Project Description: Installation of gas furnace and gas insert, venting for furnace and gas insert, gas piping for furnace, water heater,
insert and barbecue.
12/19/12 REPRINT Adding mechanical contractor for gas line work only
Contractor: OWNER Owner: BRETT TREVOR
15270 SW 79TH AVE
TIGARD, OR 97224
PHONE: PHONE: 541 - 350 -0383
FAX:
FEES
Specifics: Description Date Amount
Fumaces < 100K BTU 11/13/2012 $46.75
Type of Use: SF Gas Fireplace 11/13/2012 $33.39
Class of Work: ALT Type of Const: Flue Vent for Water Heater or Gas 11/13/2012 $46.64
Occupancy Grp: Fireplace
Stories: Fuel Piping 11/13/2012 $14.15
12% State Surcharge - Mechanical 11/13/2012 $16.91
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $157.84
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: 52lit Aity Permittee Signature: 6,0 tt ppo CA77 0 ki
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
!E COMMUNITY DEVELOPMENT Permit #: MEC2012 -00588
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/13/2012
Parcel: 2S112CA03400
Jurisdiction: Tigard
Site address: 15270 SW 79TH AVE
Project: Trevor Subdivision: DURHAM ACRES Lot: 30
Project Description: Installation of gas furnace and gas insert, venting for furnace and gas insert, gas piping for furnace, water heater,
insert and barbecue.
12/19/12 REPRINT Adding mechanical contractor for gas line work only 3/26/13 REPRINT Adding (1) single -duct efS f
Contractor: OWNER Owner: BRETT TREVOR
15270 SW 79TH AVE
TIGARD, OR 97224
•
PHONE: PHONE: 541- 350 -0383
FAX:
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/13/2012 $46.75
Type of Use: SF Gas Fireplace 11/13/2012 $33.39 •
Class of Work: ALT Type of Const: Flue Vent for Water Heater or Gas 11/13/2012 $46.64
Occupancy Grp: Fireplace
Stories: Fuel Piping 11/13/2012 $14.15
12% State Surcharge - Mechanical 11/13/2012 $16.91
Single Duct Exhaust (Bathrooms, Toilet, 03/26/2013 $23.32
Utility Rooms) •
12% State Surcharge - Mechanical 03/26/2013 $2.80
Fuel
Fuel Types: Natural Gas
Gas Pressure:
• Total $183.96
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: { J,/4 / Pernittee Signature: [ Op 7 C 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 -00588
•
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/13/2012
Parcel: 2S112CA03400
Jurisdiction: Tigard
Site address: 15270 SW 79TH AVE
Project: Trevor Subdivision: DURHAM ACRES Lot: 30
Project Description: Installation of gas furnace and gas insert, venting for furnace and gas insert, gas piping for furnace, water heater,
insert and barbecue.
•
Contractor: OWNER Owner: BRETT TREVOR
15270 SW 79TH AVE
TIGARD, OR 97224
PHONE: PHONE: 541 - 350 -0383
FAX:
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/13/2012 $46.75
Type of Use: SF Gas Fireplace 11/13/2012 $33.39
Class of Work: ALT Type of Const: Flue Vent for Water Heater or Gas 11/13/2012 $46.64
Occupancy Grp: Fireplace
Stories: Fuel Piping 11/13/2012 $14.15
12% State Surcharge - Mechanical 11/13/2012 $16.91
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $157.84
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 : 'cation Ce Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir t questions to OUNC • • •g 503.232.1987 or 1.800.332.2344.
Issue. By: e, d r. el �i / , 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 1 FOR OFFICE USE ONLY
Received `� / IUC� 4,0/a-6
q City of Tigard Received 3/ Permit No.: ?�
13125 SW Hall Blvd., Tigard, OR 97223 MAR 26 2013 Plan Review
II Phone: 503.718.2439 Fax: 503.598.1960 D Other Permit:
TIGARD
Inspection Line: 503.639 CITY OF TIGARD Date Ready /By: kris: ® See Page 2 for
Internet: www.tigard or.gov BUILDING DIVISION Notified/Method: /(,,, Supplemental Information
TYPE OF WORK COMMERCIAL FEE ", 7 S E
CHDULE • = 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 Heatiog/cooling:
Air conditioning
Job site address: 15270 SW 79 Ave (requires site plan showing placement) 46.75
City/State /ZIP: Tigard, OR 97224 Fumace 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: 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 23.32 '
Please Gas fireplace /insert - 33.39
lease add to MEC2012 -00588
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
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 1 23.32 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: Fumace, etc.
Gas heat pump
City/State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail: Fireplace
Range
' CONTRACTOR Barbecue
Business name:
Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State /"ZIP: Subtotal 23.32
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) 2.80
TOTAL PERMIT FEE 26.12
• / � 1 n This permit application expires if a permit is not obtained within 180
Authorized signature: it 2 days after it has been accepted as complete.
Print name: s.J r e' Trevc9r Date: . 3 — 2_ ---'3 ' Fee methodology set by Tri- County Building Industry Service Board
I: \ Building \Permits\MEC- PermitApp.doc 03/07/12 440 -4617T (11 /02/COM/WEB)
•
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing per mits.
•
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.
Please check the appropriate box:
1 � • I own, res • in • or w • res • in the • completed structure and my general contractor is:
Name CCI3# Expiration Date
I will inform my general contractor that a II subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
X I will be performing work on property I own, a residence that I reside in, or a residence that I w ill
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.
r -CH Trtve
Print Name of Permit Applicant
I J5
Signature of Permit Applicant Date
Permit #: Xla' 0USS
� ,,2Dr 0O187
Address: (5 70 7? ,
1 DL R�a�� •�,,,.,,.t.'J
Issued by: Date: 36411.3 � 1
This Copy for Permit Offices
Mechanical Permit Application FOR OFFICE USE ONLY
•
City of Tigard Received / / _ /. 11114:. !Jr Permit No.: ge 40 58 p 8
- ° 13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639 Date Ready/13y: !uric: RI See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
' TYPE O F WORK . _ COMMERGI�IL ,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 -. 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 SI INFORMATION Heating/cooling:
= Air conditioning
Job site address: 15270 SW 79 Ave (requires site plan showing placement) 46.75
City /State /ZIP: Tigard, OR 97224 Furnace 100,000 BTU (ducts/vents) 1 46.75 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91 •
Suite/bldg. /apt. no.: Project name: Trevor House Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: 79 Ave and Thurston 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
bdivision: Lot no.: Flue /vent for any of above .4=0
Other: 23.32
x map /parcel no.: . Other fuel appliances:
' DESCRIPTION OF WORK : ' . Water heater _.__ __.__
astall gas furnace, gas fireplace, and gas hot water heater, and dependencies Gas fireplace /insert I 33.39 33.39
Flue vent for water heater or gas L� a /
fireplace
F
- 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: Brett Trevor Environmental exhaust and ventilation: _
Address: 15270 SW 79 Ave Range hood/other kitchen
equipment 33.39
City/State /ZIP: Tigard, OR 97224 Clothes dryer exhaust 33.39
Fax: Single -duct exhaust (bathrooms,
Phone:
(541)350-0383 ( ) toilet compartments, utility rooms) 23.32
M :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. I 14.15
Gas heat pump
City /State /ZIP: Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater I
Fireplace I
E -mail:
Range
CONTRACTOR Barbecue I
Business name: Homeowner installed, except for gas line Clothes dryer (gas)
Other:
Address: MECHANICAL PERMIT FEES*
City /State/ZIP: Subtotal I}f1 -
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) 13
Plan review (25% of permit fee)
t :CB lic.: State surcharge (12% of permit fee) 16.1 I .4944-
�i TOTAL PERMIT FEE 15'flialitbeft
m[hori2ed signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
'Tint name: Date: * Fee methodology set by Tri -County Building Industry Service Board
uilding \Permits\Mt/C- PermitApp.doc 03/07/12 4404617T (I I/02/COM/W1i13)
Property Owner Statement
•
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2)) .
This statement is required for residential building, electrical, mechanical, and plumbing per mits.
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.
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 a II 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 w ill
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.
relf Tr -ev'or
Print Name of Permit Applicant
)Q 3 - 1) _-
Signature of Permit Applicant Date
Permit #: Il FC ,gO /'- — DO 5 if
00 -4 4111P-
Address: /59.70 51.) 7 de-
� s
Issued by( n Date: ////5//1.-- trIc
This Copy for Permit Offices