Permit {
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00582
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/08/2012
Parcel: 2S112CD12100
Jurisdiction: Tigard
Site address: 15996 SW 77TH TER
Project: Stevenson Subdivision: HAMBACH GROVE Lot: 19
Project Description: (1) range hood installation
Contractor: MODERN PLUMBING Owner: STEVENSON, SARA R
11120 SW INDUSTRIAL WAY 15996 SW 77TH TER
• TUALATIN, OR 97062 TIGARD, OR 97224
•
• PHONE: 503 - 691 -6166 PHONE:
•
FAX: 503 - 691 -6771
FEES •
Specifics: Description Date Amount
Range Hood /Other Kitchen 11/08/2012 $33.39
Type of Use: SF 12% State Surcharge - Mechanical 11/08/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/08/2012 $56.61
Occupancy Grp:
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
•
Issued By: Permittee Signature: oN 4pP , . 4r
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.
4ylNov. 7. 2012e 4:56P iitModern Plumb'n No. 7912 P. 1
City of Tigard R E IV
( (- S{ Permit No.` a p l a' OD�f�►
� 13L25 SW Hell Bivd., Tigard, OR 9722) � y- ■
' M Phone: 5033182439 Fax: 503.598.1960 Q Rev 10W Other Permit:
TIGA[tD Inspection Line: 503.639.4175 NOV 0 8 2UI pu
Internet: www.ligard- or.gov edrMat d - : - -1 / _ SSu p Inf
CITY OF T
TYPE OF WO' 7.'1 1' l' T 6 COMMERCIAL ME' SCREriYJT.E - ' USECRJBCI{TIST .
1:1 New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
F performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition i n Other: mechanical materials, equipment, labor, overhead, andyrofil.
• , CATEGORY : OF CONSTRUCTION Value: 5
Description dwelling RESIDENTIAL EQUIPMENT /SYSTEMS FEES* • .
and 2-family g ❑ Commercial/industrial ❑ Accessory buildin
❑ Multi family ❑ Master builder 1:1 Other: building For apednl Ramadan use checklist � I Qty. 1 I Total
' JOB SITE INFORMATION[ AND LOCATION Heating/cooling:
ti Air conditioning
Job site address: ' 5` C' t u 1 � 1-1 Thr ra. c (requires site plan showing placement) 46.75
City /State/ZIP: ')r u 0.reL O 9-7 Di Furnace 100,000 BTU (atrecs/venls) 54.91
Suilc/bldglapt no.:
Furnace PU p 00 ' 000+BTU(duttslvenla) 54.91
I Project name: S e U e 4. try, (requires site plan showing placement) 61.06 _
Cross streel/directions to job site: Duct work 23.32
HXdronic hot water system 23.32
( X le- ( / 0 G 1 Residential boiler (radiator or
hydronic) 23.32
Unit beaters (fuel -type, not electric),
in wall, in -duct, suspended. etc. 46.75
Subdivision: I 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
,Q ,�1 Gas fireplace 33.39
R Yom.4 ` �60 el i S 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
1:1 PROPERTY OWNER I Chimney/liner/flue/vent 23.32 •. '❑
Other: 23.32
Name: Environmental exhaust and ventilation;
Address: Range hood/other kitchen
equipment ( 33.39 33.1et
City/State/ZIP: Clothes dryer exhaust 33.39
Phone: ( ) I Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
r APPLICANT .0 CONTAGr•iPERSO■ . Attic/crawispace fans 2332
Business name: Other: 23.32
- Fuel pipin -
Contact name: S14.15 for first four; $4.03 for each a dditional
-
Address: Furnace, etc,
- Gas heatpump
City /Slate/ZIP: Wallsuspended/unitheater
Phone: ( ) l Fax :: ( ) Water heater
E -mail: l - Fireplace
Range
. • I. CONTRACTOR ' • ' . •
~ Btsiness name: Y V l0 1 0-.45' BI01� hcs (Res)
Address: 1 11 ) 0 51 U��-1r (3 ,5„, el - ' l_f?GiiANICAI,_PE
plT .FEES!,.
City /State/LIP: __ . _ n 41 A Q j 0 6 Subtotal 3 3.3tj
Phone: ( S11 7 ) 6 Cp16 I Fax:SD I I "�,, / Minimum pemtltfee
rmitfe ei O.to
_l 1 Plan review (25% of permit fee)
CCB 1k.: :3 1 q cite State surcha
rge (l2 %orpermit fee) l 0_$0
k �/ /1 TOTAL PERMIT FEE /001 00
Authorized signature: r r / ' .t .. -45-4-4-° This permit applteallon expires If a permit 4 not obtained within 180
r days after ti has been accepted as complete.
Print nameA k D ate: r7 • Fee methodology set by Tri- County Building Industry Service Board
I:LB„IIdb.lP .,,,A¢C -p . App.doc 04/09/10 440-16 0 IAWCOMIWEB)