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Permit RI CITY OF TIGARD MECHANICAL PERMIT 111 . _, COMMUNITY DEVELOPMENT Permit #: MEC2013 -00071 T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/31/2013 Parcel: 2S103BA00104 Jurisdiction: Tigard Site address: 11890 SW ANN ST Project: Hutchison Subdivision: LERON HEIGHTS Lot: 4 Project Description: (1) tankless water heater and (1) flue /vent replacement Contractor: OWNER Owner: HUTCHISON, PERRY C 11890 SW ANN ST TIGARD, OR 97223 PHONE: PHONE: 503 - 590 -3023 FAX: FEES Specifics: Description Date Amount Water Heater 01/31/2013 $23.32 Type of Use: SF Chimney /Liner /FlueNent 01/31/2013 $23.32 Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 01/31/2013 $10.80 Occupancy Grp: Minimum Fee Adjustment - Mechanical 01/31/2013 $43.36 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. Issued By: /90A 4 lam- C e. 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 FOR OFFICE USE ONLY Received REC , City of Tigard Date/By: 1 /1 3 sr PermitNo.:u a©i3 _ 000-1 III . ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 4 i n,N 3 1 2013 Date/By: Other Permit: TI G A R D Inspection Line: 503.639 Date Ready/By: lin El See Page 2 for Internet: www.tigard - or.gov CITY OFTIGARD Notified/Method: Supplemental Information 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* A l - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: / / g S[,t, i h t ' Air conditioning Job site address: l J c (requires site plan showing placement) 46.75 City /State /ZIP: / [� 1- `� % �} 7 � Furnace 100,000 BTU (ducts/vents) 46.75 �l �T / r 2 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: / Z/ 7' 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 2 rim* , " v7 L 5 / y-� 7 - 0 Gas fireplacrt 33.39 fy` � J t ' / d-c / ��� g � Flue vent for water heater or gas r , 9 ,// ?--�� . (_(_ = ��a, -r!� / (� vi/" 6, fireplace 23.32 W / 1 / v 6 ( '7 �/ \ Log lighter (gas) 23.32 / ��9 - 1A ") Wood/pellet stove 33.39 Wood fireplace /insert 23.32 JROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent / 23.32 Other: 23.32 Name: A �1RY /.4-1/17—C#775?)/(j Environmental exhaust and ventilation: Address: // 596, S U ,*/ ' vo) � 5 Range hood/other kitchen ` equipment 33.39 City/State /ZIP: 1 C K 7 7 2_z3 Clothes dryer exhaust 33.39 � 576:7- OZ F ax: Single -duct exhaust (bathrooms, Phone: ( 3 3 ( ) 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 E -mail: Fireplace Range CONTRACTOR Barbecue Business name: Clothes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* City/State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) TOTAL PERMIT FEE to-0 Sa) Authorized signature This permit application expires if a permit is not obtained within 180 2 - days after it has been accepted as complete. Print name: �% ,� ti �G�jl{ /s�7�� Date: J ? J Q/ * Fee methodology set by Tri-County Building Industry Service Board I:\ Building \Permits\MEC- PennitApp.doc 03 /07/12 440 - 46171(11 /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- PermitApp.doc 03/07/12 2 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 K , 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. nY. /1 >fr G ' c7 tI Print Name Permit Applicant :a ice— �ii /c3)/2-113 Signatur- : - ermit Applicant Date Permit #: e46C 02013 — 0 00 1 1 Address: I�� +vi!° qh s• Issued by: ( Date: I ( 31 This Copy for Permit Offices s��. Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 11890 SW ANN ST, TIGARD, OR, 97223 Residential - Mechanical 615 Mechanical rough-in 02/25/2013 00:00 MEC2013-00071 FAIL Bosch 330 PN-N Gas line to be sized and pressure tested Plumbing permit needed Violation Summary: Inspector Contractor