Permit CITY OF TIGARD MECHANICAL PERMIT
g • - COMMUNITY DEVELOPMENT Permlt9: MEC2013 -00321
111
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2013
Parcel: 2S110BB02600
Jurisdiction: Tigard
Site address: 12286 SW CHANDLER DR
Project: Ehlert Subdivision: ARLINGTON RIDGE Lot: 3
Project Description: Replace furnace and add NC. Placement of NC or heat pump units must comply with the manufacturer's
clearance requirements.
Contractor: JAMES EHLERT Owner: EHLERT, JAMES L & DENISE M
12286 SW CHANDLER DR 12286 SW CHANDLER_ DR
TIGARD, OR 97224 TIGARD, OR 97224 ' .
.• ....,,, .t: ... 1 :7
PHONE: PHONE: T , • i"11:' -..rr
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 06/11/2013 $46.75
Type of Use: SF Fumaces < 100K BTU 06/11/2013 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 06/11/2013 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types: -
Gas Pressure:
• Total $104.72
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: 0.4-..------
/ Call 503.639.4175 by 7:00 a.m. for the next available Inspecti '
A--/ ------
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 // role OFFICE USE ONLY
City of Tigard Rece/Bived Q /
III 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
e Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T l G A R D Inspection Line: 503.639 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 776C Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction )2 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*
�fC l- 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 Heating/cooling:
Air conditioning 46.75
Job site address: 1-. S v. v...) C1 vl `D Z Furnace 100,000 BTU (ducts/vents) X 46.75
City /State /ZIP: q pv.1.- e) (L ct i 2-2-4 Furnace 100,000+ BTU ( ducts/vents) 54.91
.041—. / Heat pump 61.06
Suite/bldg. /apt. no.: Project name: 1.,kV A.e__ Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
S Residential boiler (radiator or
elk-AA-0M .4-- 7-..-1 I � J hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue /vent for any of above 23.32
Other: 23.32
Subdivision: kyZ,(,I LiL� f pN.,2 V_ li a C.�Y Lot no.: Other fuel appliances:
Tax map /parcel no.: Water heater ' 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
/A
� _ Flue vent for water heater or gas
!� iS NAIL Cen pr(LoN.) fireplace 23.32
N �� r/✓� Log lighter (gas) 23.32
Wood/pellet stove 33.39
( -( A FOIL 1AI2 CPI- O 17200 Wood fireplace /insert 23.32
Chimney/liner /flue /vent 23.32
cg- PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: f f E 0 Range hood/other kitchen
Address: \ ZZ1`p 5 W C t ' 144a x i, 7 i Clothes dryer 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: l7 h p..t> D 2 9 Z Z2--1f Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
Phone: (50 5) EL - 7 3C,5 Fax: ( ) /1//1 Attic/crawlspace fans 23.32
❑ APPLICANT �/ ❑ CONTACT PERSON Other: 23.32
Business name: ��4j ` Fuel piping:
I _' _ "�-- $14.15 for first four; $4.03 for each additional
Contact name: Furnace, etc.
Address:
Gas heat pump
Wall /suspended/unit heater
City/State /ZIP: Water heater
Phone: ( ) Fax: : ( ) Fireplace
Range
E -mail:
Barbecue
CONTRACTOR Clothes dryer (gas)
Business name: fij, µ, oL� Other:
MECHANICAL PERMIT FEES*
Address:
Subtotal
City/State /ZIP: Minimum permit fee ($90.00)
Plan review (25% of permit fee)
Phone: ( ) Fax: ( )
State surcharge (12% of permit fee)
CCB lic.: TOTAL PERMIT FEE zip y, 72.,..
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
,,...-1...
Authorized signature: ,, ---
• Fee methodology set by Tri County Building Industry Service Board
Print name: J AM, (_ ILL -� I Date: Cot (L to 3
1:\Building\PermiMlEC PermitApp 0401I3.doe 440- 4617T (II /07JCOM/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.
L\Building\Permits MEC_PermitApp_040113.doc 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
ftr 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.
J I1/4/&-e.5 Eb [. E '1
Print Name of Permit Applicant
,,,, I(Itfr---- 4 /I( A3
Sigr of Permit Applicant Date
Permit #: / -- 9 3 ,a/
Address: /.202. F6 S4) C14 1_ 472...__ ��'•.:., ';r >: .
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Issued by: - Date: 4 //� // 3 f:
This Copy for Permit Offices