Permit W CITY OF TIGARD MECHANICAL PERMIT
`� '1 COMMUNITY DEVELOPMENT Permit #: MEC2011 00165
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2011
Parcel: 25111 DD10900
Jurisdiction: Tigard
Site address: 8650 SW STRATFORD CT
Project: AKAGI Subdivision: CHESSMAN DOWNS Lot: 35
Project Description: Replacing gas water heater.
Contractor: OWNER Owner: AKAGI, RANDOLPH S AND
TOMIYE T
8650 SW STRATFORD CT
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Specifics: Description Date Amount
Water Heater 04/15/2011 $23.32
Type of Use: SF 12% State Surcharge - Mechanical 04/15/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/15/2011 $66.68
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 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 O NC by calling 503.232.1987 or 1.800.332.2344.
11 ■11111ft i►
Issued By d110 — _� � •• .` Permit ee Signature: �� i x
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 �)� I O1( (►11.1(I I ,I.OyI.1 --- City of Tigard Date/By: Received 5 // Permit No.: -7; —
13125 SW Hall Blvd., Tigard, OR 97223 ,1O '�1 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 GJ
Other Permit:
1, D ate / By:
I I t i A R D Inspection Line: 503.639.4175 0 AA ( 1, t.‘`" L .% Ready/By: ® See Page 2 for
Internet: www.tigard- or.gov O � ' N ` `1N otified/Method: Supplemental Information
TYPE OF WORK ,\1 COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
® Mechanical permit fees* are based on the value of the work
❑ New construction p Addition/alteration /replacement 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*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: O ( , 6 -- U S L.)- S tRp.TF_ L1- (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City /State /ZIP: -- t . :(7 , 14(2_, 0 Oa_ o '1 IA-4 Furnace 100,000+ BTU (ducts /vents) 54.91
,
Suite/bldg. /apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
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
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater / 23.32
.n- Gas fireplace 33.39
ru. l (vtAr S t.,.J `C it-- 1- C'>`12_ Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) - 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
PROPERTY OWNER I ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: R A-1-4.01 /�tL(� -(� Environmental exhaust and ventilation:
Address: Range hood/other kitchen
`? (ttM�- /LS J L' JJ L equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
( �3)
Phone: C % - c\8 L . F ax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: //�� piping:
`^ u-S Ct � I/Ir�_ Fuel 1 m
Contact name: S14.15 for first four; $4.03 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
Business name:
Clothes dryer (gas)
Other:
Address: 6 t _ A) MECHANICAL PERMIT FEES*
City/State /ZIP: t/``� J Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: State surcharge (12% of permit fee) TO , VD
TOTAL PERMIT FEE r DO , 5( 6
Authorized si afore: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: hIAV LP e k E . 1 Date: l 5 / t ` • Fee methodology set by Tri -County Building Industry Service Board
I:\ Building \Pennits\MEC- PermitApp.doc Op /09/10 440 -4617T (11 /02 /COM/WEB) ,
I
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.
C\ Building \Permits\MEC - PermitApp.doc 09/09/10 2
a
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction
ermit a applicants who are not licensed '
9 4 permit Pp ce 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:
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.
fi
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.
fZeN NoC w } 1 S 1/ tom - ✓\ t:
Print Name of Permit Applicant
Signature of Permit Applicant Date
Permit #: f at? t t — LX-)k (05 e
Address: 5 5R-d- . .; �'` .
Issued by: J Date: `r/ S A
This Copy for Permit Offices