Permit ® CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2013-00689
Ti GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/14/2013
Parcel: 2S 103DA05900
Jurisdiction: Tigard
Site address: 10590 SW COOK LN
Project: FOSTER Subdivision: FANTASY HILL Lot: 13
Project Description: (1)bathroom exhaust fan and duct work for bathroom addition. Structural permit not required.
Contractor: SCOTT FOSTER Owner: FOSTER, SCOTT A&LORRI K
10590 SW COOK LANE 10590 SW COOK LN
TIGARD, OR 97223 TIGARD,OR 97223
PHONE: 503-989-3826 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Duct Work 11/14/2013 $23.32
Type of Use: SF Single Duct Exhaust(Bathrooms,Toilet, 11/14/2013 $23.32
Class of Work: ALT Type of Const: Utility Rooms)
Occupancy Grp: 12%State Surcharge-Mechanical 11/14/2013 $10.80
Stories: Minimum Fee Adjustment-Mechanical 11/14/2013 $43.36
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: -- •,ittee Signature: ,52L'
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FoR OFFICE USE ONLY
City of Tigard Received 1
Date/By: ! / 1 Permit No.: pia - I
° 13125 SW Hall Blvd.,Tigard,OR 9722
"' Plan Review
1111 C Phone: 503.718.2439 Fax: 503.598.191 Other Permit.
Inspection Line: 503.639.4175 ' Et Date/By: ,-.1.4,
0�13�
T PG A k D Z Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov A 2013 Notified/Method: Supplemental Information
NOV 4
TYPE OF WORD p�TIGAAD COMMERCIAL FEE* SCHEDULE - USE•CHECKLIST
Mechanical permit fees'are based on the value of the work
❑New construction Addition/alterat'
��1ti' (� 11i performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: Dv mechanical materials,equipment,labor,overhead,and profit
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES"
rieland 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑ ulti-family 0 Master builder ❑Other: Description I Qty. I Ea. I Total
- .'"JOB"SITE INFORMAilON AND LOCATION Heating/cooling:
I�S�i (] S � Air conditioning 46.75
Job site address: (OO. L�Fr.1e Fumace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: -/ 6 A-to 04( 5' 7 Z 1-3 Fumace 100,000+BTU(ducts/vents) 54.91
/ n - Heat pump 61.06
Suite/bldg./apt.no.: Project name: Q It'rFloco-� • /'*'A 0,n t Duct work 1 23.32 )-3-)k
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
1 NSTAz L v r'-7-- t,was p. p-& PO ST e a s y fireplace 23.32
Log lighter(gas) 23.32
Pti 0 ✓E. Du eT /N QOC 2 Wood/pellet stove 33.39
(..►� KC` 6 1 s-t✓(Z • Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: i O7T 1'Jc7-e5./Z__ Range hood/other kitchen
equipment 33.39
Address: t 0 Sy 0 5 Gt. c u-D( _fr, Clothes dryer exhaust 33.39
City/State/ZIP: T 1 o 4-q D 2 97170 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) I 23.32 2-3_3,Z
Phone:(..q5 ) 5&q 3k Z 6 Fax:( ) Attic/crawlspace fans 23.32
. • ❑'"APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: v--
[ Fuel piping:
/9/►lR .ri 5 `l d( _ $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)
•
Other:
Business name: 540.,,e, a S .
C( /t!✓Q— MECHANICAL PERMIT�FEES' .
Address: Subtotal
City/State/ZIP:
Minimum permit fee($90.00) 80.00
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) p S'p
CCB lie.: TOTAL PERMIT FEE /(%)'aQ
his permit application expires if a permit is not obtained within ISO
f days after it has been accepted as complete.
Authorized siggature: •!:•/ *T.Fee methodology set bye
y Tri-County Building Industry Service Board
Print name: O 071-- ,`QSr_i Date: i ] l / /3
I:\Building\Permits\MEC_PermitApp_040 it 3.doc 440-461 (I1/0 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.
I:\Buildineermits\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.
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.
Sc OTT CO;-f .
Print of Permit Applicant
...;
1111417
Signature o ermi pplicant Date
Permit#: 19//)/4200- 00 ifol,S7C-490J7-606&9
Address: lr35--QQ St../ ( 1C Lrti" r, .
ae 7,i
Issued by: 4.J• Date: /// //.) f " •
This Copy for Permit Offices