Permit 4 d , 7';,:q CITY OF TIGARD
',, MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00353
T[GA[tD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
DATE ISSUED: 7/7/2008
PARCEL: 2S114BC -04500
SITE ADDRESS: 10496 SW BONANZA WAY ZONING: R -7
SUBDIVISION: RIVERVIEW ESTATES NO. 2 LOT: 082 JURISDICTION: TIG
PROJECT: DIXON
Project Description: Extending gas line for furnace, water heater and barbecue.
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:
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: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 3
> 10000 cfm:
Owner: FEES
KENNETH & KIMBERLEE DIXON Description Date Amount
10496 SW BONANZA WAY
TIGARD, OR 97224 [MECH] Permit Fee 7/712008 $72.50
[TAX] 12% State Surch 7/7/2008 $8.70
Total $81.20
Phone: 503- 624 -5609
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.
• 0411p � • a
Issued By: ` - Permittee Signature: j
.
Call - ` .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.
I - „
� � ,� ro1�ol�H lc l � ' � H c)�t� i �
M echanical Permit Application � '
Received
7ii . ". City of Tigard
13125 SW Hall Blvd., Tigard, OR 9722,. Plan Review - 7 - 4 Permit No.: /� , 4 .; .....c, s 1
i C - Phone: 503.639.4171 Fax: 503.5' Aryl,
Al
C F j DateBy: i
JIG n R1b; Inspection Line: 503.639.4175 A `1" *. r Date Ready /By: ® See Page 2 for
s Internet: www.tigard or.gov ® ` �y Notified/Method: /� Supplemental Information
TYPE OF WORT .4 Q � , \ COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
rr�� Mechanical permit fees* are based on the value of the work
El New construction ®Addition/alterah6rl[�rement performed. Indicate the value (rounded to the nearest dollar) of all
El Demolition ❑Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ 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 or heat pump
Job site address: 10496 SW Bonanza Way (requires site plan showing placement) 14.00
City /State /ZIP: Tigard, OR 97224 Furnace 100,000 BTU ( ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Dixon Kitchen Gas heat pump 14.00
Cross street/directions to job site: SW corner of Riverwood and Bonanza Way 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
Subdivision: Riverview Estates Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Extend gas line from furnace/water heater to kitchen for gas cooktop. Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue/vent 10.00
® PROPERTY OWNER ❑ TENANT Other: 10.00
Name: Ken Dixon Environmental exhaust and ventilation
Range hood other kitchen
Address: 10496 SW Bonanza Way equipment 10.00
City /State /ZIP: Tigard, OR 97224 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (503)624 -5609 Fax: (503)620 -6825 toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: C_ - ac e...ett Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address:
Gas heat pump
City /State /ZIP: Wall/suspended/unit heater
Fax: Water heater C
Phone: ( ) ( )
Fireplace
E -mail: Range
7
CONTRACTOR Barbecue 1
Clothes dryer (gas)
Business name: e 1
k.JATr.i( Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal 7d, .57:7
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) e; 70
TOTAL PERMIT FEE 5( Q
Authorized signature: T his permit application expires if a permit is not obtained within 180
$n days after it has been accepted as complete.
Print name: `1 (`A) 0 ()(fP - Date: 7/? t * Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Permits'MEC- PermitApp. 01/19/07 440- 4617T(1 l /02/COM/WEB)
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
10 71 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
I will be performing work on property I own; a residence that I reside in or a residence that 1 will
reside in. If I hire subcontractors, t will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general; contractor, ;Iwi11 contract` with a
who is licensed with the CCB and will immediately notify`the: office issuing this building'
permit of the name of the contractor.
I ha'vc 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.
Print, name of permit applicant :; Signature of permit applicant
7 � �� c)
Date
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Permit #:FLLdc r'vo386 f do0E ("Wet()
This form is supplied to building of �U�`�� ��) �c:�'lJ�i/Za
permit offices by the Oregon Address: 1 7
Q:Fuu" •4N /
Construction Contractors Board, 'N . ■' =d:
as required by ORS 701.055 (6)
Issued by: % Date: 7/7
This copy to issuing permit office
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2008-00353
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/712008
Phone: (503) 639-4171 i A,
,
Inspection Requests (24 Hrs.): (503) 639-4175 4i1
INSPECTION WORKSHEET FOR DATE: 8/25/2008 TIME: 7:00AM PAGE: 24
SITE ADDRESS: 10496 SW BONANZA WAY CLASS OF WORK:
SUBDIVISION: RIVERVIEW ESTATES NO. 2 LOT #: 082 TYPE OF USE:
PROJECT NAME: DIXON
DESCRIPTION: Ex lending gas line for furnace, water heater and barbecue.
OWNER: DIXON, KENNETH & KIME3ERLEE PHONE #: 504624-5609
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 8/25/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
6 tO Gas line 074588-01 150-362-4560
Corrections/Comments/ Instructions:
Loe C.C5SV he( e • 2 '3 135'1 r
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•
- PASS 1 PARTIAL APPROVAL CANCEL NO ACCESS
n FAIL pi CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: go Date: c Phone #: (503)