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Permit (63) CITY OF TIGARD MECHANICAL PERMIT F il; '< COMMUNITY DEVELOPMENT Permit#: MEC2017 00875 Date Issued: 11/06/2017 -F r.c3ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S 134 DA05600 Jurisdiction: Tigard Site address: 11343 SW 105TH PL Project: GANTNER Subdivision: NODAK Lot: 4 Project Description: Gas line for range and barbecue. Contractor: OWNER Owner: GANTNER, ERIC C ERIC GANTNER 11343 SW 105TH PL 11343 SW 105TH PL TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 971-563-0650 PHONE: FAX: FEES Specifics: Description Date Amount Fuel Piping 11/06/2017 $14.15 Type of Use: SF 12%State Surcharge-Mechanical 11/06/2017 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 11/06/2017 $75.85 Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas 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 ..• of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rul i,s adopt-d . the • -.on Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-)* 0. y (ibtain . r.py of t es or direct questions to OUNC by calling 5 .1987 or 1.800.332.2344. / Issued By: -, /. Permittee Signature: 'Ilk 1 A Call 503.639.4175 by 7:00 a.m.for the next available ins ction d. e. II Or '1111161 This permit card shall be kept in a conspicuous place on the job site until complet on of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE USE("II City of Tigard Received g Date/By: 7 Permit No.: - ,.,....,e' •- 13125 SW Hall Blvd.,Tigard,OR 97223 . W.� fl FJ i Plan Review Phone: 503.718.2439 Fax: 503.598.196 '" '� Other Permit: Inspection Line: 503.639.4175 `�" "�'' '' Date/By: T I C A R D Date Ready/By: H See Page 2 for Internet: www.tigard-or.gov Y R�o v 6 7017 Notified/Method: Supplemental Information V — TYPE OF WOOQE 1iGA COMMERCIAL FEE*SCHEDULE —':USE CH CKLIST i ( l t ° ��,/"w° $°t�'r*t e**1 Mechanical permit fees*are based on the value of the work ❑New construction 0 Addition/alters �+ �cemdrrt " performed.Indicate the value(rounded to the nearest dollar)of all 0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONSTRUCTION: *RESIDENTIAL EQUIPMENT/SYSTEMS FEES* ❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION:AND LOCATION a;,. Heating cooling: Job site address: L4'� SLC) j Air conditioning 46.75 `Q'�Vb —P( Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: ;(t , Q--']'7 Furnace 100,000+BTU(ducts/vents) 54.91 } t l Heat pump 61.06 Suite/bldg./apt.no.: Project name: `F „"� 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 4 .e: -' '-a '. �, , a- AESCRO"TION Vkr Gas fireplace/insert 33.39 Flue vent for water heater or gas fireplace �S (ll�?Q 4._ fireplace 23.32 Log lighter(gas) 23.32 ,.. 6`"x Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 '16', 0 PROPERTY OWNER '''0 TENANT Environmental exhaust and ventilation: Name: .eA c f--i t2 Range hood/other kitchen equipment 33.39 Address: 1'4'2-) S 1 (J5 --i)LrC\ ' Clothes dryer exhaust 33.39 City/State/ZIP: '4i ©� i� Single-duct exhaust(bathrooms, ( ` ' toilet compartments,utility rooms) 23.32 Phone:(q7 I ) 5L6)-- o Fax:( ) Attic/crawlspace fans 23.32 0 APPLiC'ANT .' 0 cONTA ' PERSON Other: 23.32 Business name: Me, Fuel piping: ,- ' `�_ 4-4' $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 i ' ,. CONTRACTOR 's` Clothes dryer(gas) Business name: Other: 04/"A...1--- a. MECHANICAL PERMITFEES* Address: Subtotal /if.' I> City/State/ZIP: Minimum permitifee($90.00) 4 '''.-e• Plan review(25%of permit fee) Phone:( ) Fax:( ) State surcharge(12%of permit fee) __._ CCB lic.: TOTAL PERMIT FEE (j �, This permit application expires if a permit is not obtained withi%180 days after it has been accepted as complete. Autho -a gnature: , * Fee methodology set by Tri-County Building Industry Service Board Print e: ► .o•�, 1 Date: /Ib f 7 I:\Building\Permits\MEC_PennitA.,._041 13.doc t ,1` i 4J 440-461 (11/0/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Total ValuationPermit Pepe $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:\Building\Permits\MEC_PermitApp_040113.doc 2 VOID . , v City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT �? 7--� h ///&/ a Request for Permit t Action .c� TIGARD 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPennits@tigard-or.gov FROM: ❑ Owner F ] Applicant ' I Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business orindividual) TYCO Integrated Security Mailing Address: 6305 SW Rosewood St. City/State/Zip: Lake Oswego,OR. 97035 Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ® CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). UINVOICE FOR FEES DUE(attach case fee schedule and provide explanation below). REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: ELR2016-00086 Site Address or Parcel#: 7320 SW HUNZIKER RD,Suite 300 Tigar,OR. 97223 Project Name: Eagle Home Mortgage 108328637-01 Subdivision Name: Lot#: EXPLANATION: Please Void this permit the Work is being performed under new permit. Signature: Date: • Print Name: Tjy 11-6-17 Helms --- Refund Policy 1 I. The city's Community Development Director,Building Official or City Engineer may authorize the refund of • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. MI refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. 1 FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date 7 6 /7 By for gyp' Refund Processed: Date eJ/.4 B, Invoice Processed: Date By Permit Canceled: Date //�4j//7 B 7 . arcel Tag Added: Date By I:\Building\Forms\RegPcrmitAction_ 23 clot