Permit C ITY OF TIGARD MECHANICAL PERMIT
'
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00508
' rtenxp 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/14/2008
PARCEL: 2 S 115AA -01800
SITE ADDRESS: 10873 SW DOVER CT ZONING: R -2
SUBDIVISION: DOVER LANDING LOT: 021 JURISDICTION: TIG
PROJECT: POTTER
Project Description: Removing and replacing furnace and venting.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: 1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
FRANK POTTER Description Date Amount
10873 SW DOVER CT
TIGARD, OR 97224 [MECH] Permit Fee 10/14/20C $72.50
[TAX] 12% State Surch 10/14/20C $8.70
Total $81.20
Phone: 503 - 970 -7019
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact #:
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �j y / y Permittee Signature: );7‹:z— Q i,� /� Ly'G�S
Ca 9.4175 by 7:00 a.m. for inspections that business day.
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.
.A. , �fS : 74 4-- 1 ,H( Y e ate 1 q � p1
Mechanical Permit Application „ "' x F 'OR OFFI ONLY f , �'
•:
'� 51 . +i'. -. xs- x�t ,:,.rte rt"� ��.;d
City of Tigard ` , i ed
� Re De e civy r ,�
Received
V ��, "J ' ennuNo.
13125 SW Hall Blvd., Tigard, OR 97223 ,
' ' _ Phone: 503.639.4171 Fax: 503.598.19. to V, 1, Plan Review
Date/By: Other Permit:
/B Date Ready/By: Juris:
T:1 G A' R Inspection 503.63975 D p Line: .41 � �`' ^���
Internet: Line. Bard- or..41 � �'" 1 y y See Page 2 for
1 Notified/Method: Supplemental upplemental Information
TYPE OF WORK � o wat _ COMMERCIAL FEE SCHEDULE = USE CHECKLIST
❑ New construction ❑Addition /alteration Mechanical permit fees* are based on the value of the work
` performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: ON \\ . mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION_ • Value: $
RESIDENTIAL, EQUIPMENT'/ SYSTEMS FEES*
1- 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
Job site address v Air conditioning or heat pump
/0 ' 5 - le/ /n J _. c7 (requires site plan showing placement) 14.00 .
City /State /"ZIP: G} Fumace 100,000 BTU (ducts /vents) / 14.00 /‘(
r:--'6.-,2--, � 7 '�< v Fumace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg./apt. no.: Project name:
/ Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Flue /vent for any of above / 6.80 6.6:d
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
7 - GC /7Z‘) �� , = U,
/ / xi" G ` Flue vent for water heater or gas
✓1 fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
❑ PROPERTY OWNER r. ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: j -79,,/ ( 7 � /L y Environmental exhaust and ventilation
/ v I Range hood/other kitchen
Address:
/0 77 t _S- � /9th/ - G T equipment 10.00
City /State /ZIP: 7— `6._/, wit , 47 7o y Clothes dryer exhaust 10.00
f Single -duct exhaust (bathrooms,
Phone:-(3 3) y261_ 7o /f f Fax: ( ) toilet compartments, utility rooms) 6.80
❑. APPLICANT ❑ CONTACT PERSON • Attic /crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: s , /7� /1 1-- 4.1 1----
d z/� $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( )
Fax:: ( ) Water heater
Fireplace
E -mail: Range
. CONTRACTOR • Barbecue
Clothes dryer (gas)
Business name: s-VL
(�0�L Other:
Address: MECHANICAL PERMIT FEES* .
City /State /ZIP: Subtotal _
Minimum permit fee ($72.50) 4 5 C)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB Iic.: State surcharge (12% of permit fee) 7D
TOTAL PERMIT FEE )
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: / j Date: U — 4,,,_ / * Fee methodology set by Tri- County Building Industry Service Board
1:\Buildineermits\MEC- PermitApp.doc 01/19/0 440 -4617T (11 /02 /COM!WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule: r
Total Valuation:. `; Permit Feei
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including •
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1:\ Building \Permits \MEC- PermitApp.doc 01/19/07 2
Information Notice to Property Owners About
Construction Responsibilities Statement
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 701.055 (4)]
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 and complete the following statement:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
1 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 contract with a
contractor who is licensed with the CCB and will immediately notify the office issuing this building
permit of the name of the contractor.
I have read and understand the Information Notice to Property Owners about Construction
Responsibilities contained on these two pages and I hereby certify that the information checked and
completed above is correct and accurate.
l ig , #1 1 ih ,e) / �[ ,
Print name of permit applicant Signature of permit applicant
S> / ,fie;
Date
Permit #: P cx) _r,r) E v
This form is supplied to building /�
permit offices by the Oregon % ' 4 , . Address: /0$73 � -. 1Jd(/t � r ( /'`'
Construction Contractors Board �s,._.
as required by ORS 701.055 (6) '• / �� ' / d� Quo 'i'
iti9"
Issued by: G5. 7 Date: Wil(AE
This copy to issuing permit office