Permit CITY OF TIGARD MECHANICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: MEC2015-00178
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/01/2015
Parcel: 2S103DC06400
Jurisdiction: Tigard
Site address: 11220 SW FAIRHAVEN ST
Project: Wolf Subdivision: EXODUS Lot: 5
Project Description: Convert existing bedroom into master suite bath,adding(1)clothes dryer exhaust,(1)vent fan&gas piping for
clothes dryer.
Contractor: OWNER Owner: WOLF, DEAN 0
DEAN WOLF MATAYA, LINDA
11220 SW FAIRHAVEN ST 11220 SW FAIRHAVEN ST
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-267-8840 PHONE: 503-267-8840
FAX:
FEES
Specifics: Description Date Amount
Clothes Dryer Exhaust 04/01/2015 $33.39
Type of Use: SF Single Duct Exhaust(Bathrooms,Toilet, 04/01/2015 $23.32
Class of Work: ALT Type of Const: Utility Rooms)
Occupancy Grp: Fuel Piping 04/01/2015 $14.15
Stories:
Minimum Fee Adjustment-Mechanical 04/01/2015 $19.14
12%State Surcharge-Mechanical 04/01/2015 $10.80
(manual)
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direc estio OUNC by calling 503.232.1987 or 1.800.332.2344.
v v
lssu d By: / / Permittee Signature: AC a_„.tc
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard R0C0By: Permit No.:
DateB �e� eLam/5-7.(zy 7g
13125 SW Hall Blvd.,Tigard,ORRE C E I V ED Plan Review
: I Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Date/By:
II(.A R a Inspection Line: 503.639.4175 APR 1 2015 Date Ready/By: Juris. ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPEEMIE19114G DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction 'Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
T and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family El Master builder ❑Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 1 (22 D s lj Fa t r Ina v h S.t'- Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: 'Tr 9-T223 Furnace 100,000+BTU(ducts/vents) 54.91
3f
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
�" Residential boiler(radiator or
Goat-ek. i (I 51-1k 1 FOI t f YN a V e n hydronic) 23.32
J Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: E-%o el U S Lot no.: 5 Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
e c.t1 ve -e a,LIrsr,1'19 la. .a rO qtr► -b fireplace 23.32
Log (gas) 23.32 a s ref- 13 c. s V 1 fi€ Wood/pellet stove
33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
1 ROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: 1Q ea n W o ic. Range hood/other kitchen
equipment 33.39
Address: Clothes dryer exhaust I . 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) t 23.32
Phone:(So3) 261 . g$40 Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Address:
Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax: :( )
Fireplace
Range
E-mail:
Barbecue
CONTRACTOR Clothes dryer(gas) / g q.15-
Q l.V 0 E 72-- Other:
Business name: MECHANICAL PERMIT FEES*
Address: Subtotal Q
Minimum permit fee($90.00) 74'te-
City/State/ZIP: Plan review(25%ofpermit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee) /4•g8
CCB lic.: TOTAL PERMIT FEE /a'.1'
This permit application expires if a permit is not obtained within 180
J days after it has been accepted as complete.
Authorized signature: Oe..-a4,-- We /f� " Fee methodology set by Tri-County Building Industry Service Board
Print name: PQ 10 t )O( f ((ff Date: ff/j/5—
1.\Building\P its\MEC_PermitApp_040113.doe 440-617r(11/02/COMIWEB)
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.
I:\Building\Permits\MEC_PermitApp_040113.doc 2
Property Owner Statement
Regarding Construction Responsibilities
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 701.325 (2))
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:
XI own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
7 I will inform 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 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.
Dec>` n LJ i=
Print Name of Permit Applicant
1 - l - fS
Signature of Permit Applicant Date
Permit#: Itj!r'S—1-c?!
OF■
s �
Address: /./;,.9c,'' C%ji/_frf 1/Zikj
/Grim, c,� i7e �7 �: • : ar�rvE::
Issued ,i-- lr'i: Date: 'WO/
This Copy for Permit Offices
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11220 SW FAIRHAVEN ST, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2015-00178
David Young
Violation Summary:
Inspector Contractor