Permit 1
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CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2015-00058
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/04/2015
Parcel: 1 S134CA01400
Jurisdiction: Tigard
Site address: 12045 SW SUMMER CREST DR
Project: VIGUS Subdivision: BURLWOOD Lot: 7
Project Description: Water heater replacement.
Contractor: OWNER Owner: VIGUS, DANNY L
DANNY VIGUS 12045 SW SUMMER CREST DR
12045 SW SUMMER CREST DR PORTLAND,OR 97223
TIGARD,OR 97223
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Water Heater 02/04/2015 $23.32
Type of Use: SF 12%State Surcharge-Mechanical 02/04/2015 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 02/04/2015 $66.68
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1 :1/.332.2344.
Issued By: Permittee Signature: �—
Aro
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
Received
City of Tigard y Permit No.:
• 13125 SW Hall lvd.,Tigard,OR 97223 Plan Review
: /2 �� f� Z/ ( — t, �
c1 - Phone: 503.718.2439 Fax: 503.598.1960 ���' Plan R
Date/By: Other Permit:
I I c,AR t) Inspection Line: 503.639.4175 *8) Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov O Notified/Method: Supplemental Information
TYPE OF WORK ` • vp COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
IA. �� v Mechanical permit fees*are based on the value of the work
❑New construction ❑Addition/alteration/repl � A�`5� performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: cl V`� mechanical materials,equipment,labor,overhead,andprofit.
��� Value:$
CATEGORY OF CONSTRUA RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: ,20q< ..<e„.,..<e„., 3-,,,,,,,,,,,,,,,, L p Q,o e.� r_ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: — Cte c( d i2 q ?.? Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: in)aT Et't L46„,4 i t=om 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 I 23.32 ..13 32 _
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
U/G ire— -- /�e.JP fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER l ❑ TENANT Other: _ 23.32
Environmental exhaust and ventilation:
Name: \ �� i Range hood/other kitchen
yi4 N*� �� 5 equipment 33.39
Address: ('Z co Li Sc,v sc,w,,,.,,o-r ell t°S L 1�J- Clothes dryer exhaust 33.39
City/State/ZIP:r- el(,-rC Q fe a72Z Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(G/7() - t OP g8S- Fax:( ) Attic/crawlspace fans 23.32 .
❑ APPLICANT ❑ CONTACT PERSON Other: _ 23.32
Fuel piping: _
Business name: _Q,-(cruz G t f G S611-t.._ $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: CS a hG v �/WAT�) Other:
MECHANICAL PERMIT FEES*
Address: Subtotal _.3 . 3,2
City/State/ZIP: Minimum permit fee($90.00) c.0-6/0
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) /p;tre _
CCB lic.: TOTAL PERMIT FEE /i ).Th
This permit application expires if a permit is not obtained within 180
___.,_ days after it has been accepted as complete.
Authorized Signatile: t — J * Fee methodology set by Tri-County Building Industry Service Board
Print name: `Q4,,,v` /1) S Date: W/�
I:\Building\PermitskMEC_PermitApp�J40113.do 440-46171(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.
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1:1Building\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 permits.
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 all 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 will
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.
/'c7v
Print Name of Permit Aiiplicant
Signaii re�f errtsit�Applicant Date
Permit#: /4"1kca�D I 5 -cu].
Address: i•ZeIL7(.S L.C.") &A/1111r-p-' (-/V-474. 4.7
Issued by: 6 7-- Date: db//S—
This Copy for Permit Offices