Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2013-00560
Date Issued: 09/25/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S 25/201 1601
Jurisdiction: Tigard
Site address: 7340 SW HERMOSO WAY
Project: LYMAN Subdivision: HERMOSO PARK Lot: 13
Project Description: Furnace installation with gas piping.
Contractor: OWNER Owner: LYMAN, KYLE M
PO BOX 231026
TIGARD, OR 97281
PHONE:
PHONE:
FAX:
FEES
Specifics: • Description Date Amount
Mechanical Permit-RES 09/25/2013 $90.00
Type of Use: SF 12%State Surcharge-Mechanical 09/25/2013 $10.80
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued ByL -•• ittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
Received
City of Tigard � � Date/By: q . l jkN Permit No.
• q 13125 SW Hall Blvd.,Tigard,OR 97223 _
9 Plan Review
Phone: 503.718.2439 Fax: 503.598; �, \r3
Other Permit:Date/By:
1"tG A R D Inspection Line: 503.639.4175 ` `�,� Date Ready/By: luris: 01 See Page 2 for
Internet: www.tigard-or.gov S`Q �'- �� Notified/Method: Supplemental Information
TYP OF WOR Ai. COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
•
Mechanical permit fees*are based on the value of the work
❑New construction ddition/alteratioz `y ment performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 11 Other:
• mechanical materials,equipment,labor,overhead,and profit.
. Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT:/SYSTEMS FEES*
Ed 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
y �� ��/ Air conditioning 46.75
Job site address: p / �,1<�- f 0 /7 - Furnace 100,000 BTU(ducts/vents) f 46.75
City/State/ZIP: 77-6...0... .0- 6� 9?-2.27V Furnace.100,000+BTU(ducts/vents) 54.91- —
��.,`� � Heat pump 61.06
Suite/bldg./apt.no.: Project name: /'<7K t Ly1' arm'— Duct work 23.32
Cross street/directions to job site: 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
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
--DESCRIPTION OF WORK Gas fireplace/insert 33.39
- Flue vent for water heater or gas
,_. s7 /7 O 'P 4 ,� �orQ fireplace 23.32
�% X /j Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
.1a—PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: A,-.4-z.-. L . - Range hood/other kitchen
/ equipment 33.39
Address: ?--..... .es Xis' ��y,,,�5 a, %/ Clothes dryer exhaust 33.39
City/State/ZIP: 7' a d2 9, ..„,.2....r. Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(5-2V) 7 'S'S-... 7 Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ID CONTACT PERSON Other: 23.32
- Fuel piping:
Business name: lr� ,,,,k f r4/A t— $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc. / /1/, Is
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: C JA/T—r- Other:
MECHANICAL PERMIT FEES*
Address:
Subtotal � /.5—City/State/ZIP: Minimum permit fee($90.00) O,t o
Phone:( ) Fax: Plan review(25%of permit fee) —
( ) State surcharge(12%of permit fee) /J_g..0
CCB lic.: TOTAL PERMIT FEE /U0.36
This permit application expires if a permit is not obtained within 180
— days after it has been accepted as complete.
Authorized signal * Fee methodology set by Tri-County Building Industry Service Board
Print name: ��,Cf/6� Zr/0J/�7►/ Date: 0iDj3
I:Building\Permits MEC_PermitApp_0401 I 3.doc 440-4617T(I I/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.
:\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
lice sed 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.
/gt,e-e-
Print Name of Permit Applicant
Si. .• i ei mit Applicant Date
Permit#: 9•6 I —4105-4,0
Address: _73L40 514 eet, vde"-7
A)di..e( C11e q7 943
kit*.414
Issued by: Q.T_ Date: 4/o2 S/j
This Copy for Permit Offices