Permit CITY OF TIGARD MECHANICAL PERMIT
2 , COMMUNITY DEVELOPMENT Permit#: MEC2015-00076
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/12/2015
Parcel: 2S109AB07200
Jurisdiction: Tigard
Site address: 13115 SW ST JAMES LN
Project: Walker Subdivision: RAVEN RIDGE Lot: 1
Project Description: Modify duct work and install(1)vent fan for bath remodel.
Contractor: OWNER Owner: WALKER,TIMOTHY E& LORINA B
TIM WALKER 13115 SW ST JAMES LN
13115 SW ST JAMES LN TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 503-880-7132 PHONE: 503-880-7132
FAX:
FEES
Specifics: Description Date Amount
Duct Work 02/12/2015 $23.32
Type of Use: SF Single Duct Exhaust(Bathrooms,Toilet, 02/12/2015 $23.32
Class of Work: ALT Type of Const: Utility Rooms)
Occupancy Grp: 12%State Surcharge-Mechanical 02/12/2015 $10.80
Stories: Minimum Fee Adjustment-Mechanical 02/12/2015 $43.36
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law, All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Per mittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
III Received
City of Tigard Pcnnit No.
Date/By: //e"/i 5- /l f�o2LX S two!So
't 13125 SW Hall Blvd.,Tigard,OR
Plan Review
Phone: 503.718.2439 Fax: 503.5C/ �� Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 �� DateReadyBy: luris 10 See Page 2 for
Internet: www.tigard-or.gov FEB 2015 Notified/Method: �-�l Supplemental Information
TYPE OF�I ° D v!S BO
ON COMMERCL4L FEE* SCHEDULE - USE CHECKLIST
Q11',.D,NG Mechanical permit fees*are based on the value of the work
❑ New construction ig Addition/3KbtdBtVreplacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
I-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 31 S S l.J .S T'SAMES C-0 Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: Ti 4 a4 0 a 2 ' ''22 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: 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
fireplace 23.32
11/4-1-14 1'�p D6 EL Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: 7l✓I�I (A)AiIC ;t Range hood/other kitchen
I V� equipment 33.39
Address: ^
3115 s�✓ -t ( 7 lil(-> Clothes dryer exhaust 33.39
City/State/ZIP: -fl 4 A� 0 £I?Z24 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) I 23.32
Phone:(Cdj )fJ&O. 7 13 Z Fax:(50D)ELI -(4_4-Cc L Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Fuel piping:
Business name:
$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
CON TOR Clothes dryer(gas) .
Other:
Business name. ow/VC/ MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP:
Minimum permit fee($90.00) q0,CC)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) (C.>>O
CCB lie.: TOTAL PERMIT FEE /00.$O
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board
Print name: �.,)/�_ Date: _ /I I is
1.1Buildin Fermi ts 1MEC_P rmitA pp_040113.doc 440-461/T 11/0
2/COM/WEB
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:
1 1 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.
N. or
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.
Ii VA ID PLL
Print Name of Permit Applicant
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Si 2natur-�f Permit Applicant Da e
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Permit#: /IfC &/5- CGC7(.e /a-0-c/5�L;C`I3
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Address: 1 31 r 6 d� 171 evi5 L--(1) ~'( t
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Issued by: ` /J/.i Date F1
This Copy for Permit Offices