Permit CITY OF TIGARD MECHANICAL PERMIT
` ° l ' COMMUNITY DEVELOPMENT Permit #: MEC2011 00446
Date Issued: 10/12/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 1S133DD13800
Jurisdiction: Tigard
Site address: 11952 SW 127TH PL
Project: SCHMITT Subdivision:'ILLAGE AT SUMMER LAKE PARK NO Lot: 175
Project Description: (1) vent fan for bathroom remodel
Contractor: SQUARE DEAL REMODELING CO INC Owner: SCHMITT, LORI KAY
8603 SE STARK ST 11952 SW 127TH PL
PORTLAND, OR 97216 TIGARD, OR 97223
PHONE: 503 - 254 -4156 PHONE
FAX 503 - 254 -4206
FEES
Specifics: Description Date Amount
Single Duct Exhaust (Bathrooms, Toilet, 10/12/2011 $23 32
Type of Use: SF Utility Rooms)
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 10/12/2011 $10 80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 10/12/2011 $66 68
Stories:
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 q ions to UNC by calling 503 232 1987 or 1.800 332 2344.
Issue By: Permittee Signatu.
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.
A Mt
Mechanical Permit Application ® FOR OFFICE USE ONLY
Permit No
Received -
ritea7d�
III City of Tigard DaDate/By �� � -no y.
" 13125 SW Hall Blvd., Tigard, OR 97223 ` Plan Review
"��� Other Permit
_' Phone 503 718.2439 Fax: 503.598.19 rL0\ Date /By Si .... '( :;)e)
TIGARD Inspection Line: 503.639.4175 , O Date Ready /By loos RI See Page 2 for
\
Internet: www.tigard- or.gov r te , *otified /Method. Supplemental Information
OC
TYPE OF WORK ® COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
040' Mechanical permit fees* are based on the value of the work
❑ New construction Addition /alteration/repl performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, e, labor, over' -ad, � d profit
Value: $ 4t
CATEGORY OF CONSTRUCTION RESIDENTIAL P MENT /SYSTEM S*
51 and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. I Ea Total
JOB SITE INFORMATION AND LOCATION Heating cooling:
i Air conditioning
Job site address: l l (IS G/ uj l i ' (�i , (iequues site plan showing placement) 46.75
1 �C p Furnace 100,000 BTU (ducts /vents) 46 75
City/State /ZIP: — 1 — ° 1 1 Q er Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: l . `� li� Heat pump
! J f L{� uLL' (iequues 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
7c —
Other 23.32
Tax map /parcel no.: V i t ( kf, t rn-er Lc V Other fuel appliances:
- DESCRIPTION OF WORK - Water heater 23 32
Gas fireplace 33.39
• 4A • ._ — _ • ' �,� ' W4 - . . Flue vent for water heater or gas
y fireplace - 23 32
irpl', "a 1 , � -tii'i u-I i 4e,a) - lA it -CAA, Log lighter (gas) 23.32 -
V p 4 P 4(-f' e4" j b Wood /pellet stove • 33 39
Wood fireplace /insert 23 32
-- A PROPERTY OWNER . ❑ TENANT Chimney /liner /flue /vent 23.32
Other 23.32
Name: rii Environmental exhaust and ventilation:
Address: y 7 / Range hood /other kitchen
j l y.5--z__ S(r� ( A lac-e.- equipment 33 39
City /State /ZIP: O _A,, g,�-Z'? Clothes dryer exhaust 33 39
/ " - Single -duct exhaust (bathrooms,
Phone: ( J C 5 , ''
�) �l .� J � � � Fax: ( t .�-- toilet compartments, utility rooms) 23.32 2.3, 52_
CZ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23 32
Business name: /� - f t. Other. 23 32
S � —�(`P .----,40,...., ` �{ t r,� �(f en Fuel piping:
Contact name: 6 -d ng ,, f a $14.15 for first four; $4.03 for each additional
Address: C 3 SF <4 K Furnace, etc
n (Cx� Gas heat pump
City /State /ZIP: T ( 34,00 ' CJ evil- 77Z-30 - Wall /suspended /unit heater
Phone: (5'03) j5 _ 1.,✓ / FA:: (S03) s .- e i0t, Water heater _
f 11 if' Fireplace
E-mail: p 4 vvi e S so: 4.0 d tea( e- r i4 .., f vte C-- t- Range
CONTRACTOR Barbecue - •
Business name: g. 46 LA .2- - )w-a. ( ,c1,1,-.(,' Cl Clothes dryer (gas) - - - -
o
Address: g f. 03 5 C � -t' a ��[ MECHANICAL PERMIT FEES* •
City /State /ZIP: — t1 �p0 °{ Subt z—
1. g
Phone: (�d3) 0 � ,[f SL Fax zg L� /� Minimum permit fee ($9000) � Q90:00 Plan review (25% of permit fee) ..------- CCB lie.: 7 g / g�' I /I 7 t "' I/ 6 State surcharge (12% of permit fee) /C SO
(
/ TOTAL PERMIT FEE
Authorized signature: ,,
ature: T his permit application expires if a permit is not obtained w in 180
r e r days after it has been accepted as complete.
Print name: e:41� .44 /0,, , -ti Mi / (, - i * Fee methodology set by Tn- County Building Industry �c Boar f1
D V
1 \Building\PermitsWIEC- PermitApp doc 09/09/10 440 -4617T (11 /02/COM/WEB) _'