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Permit CITY OF TIGARDMECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit#: MEC2015-00829 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/15/2015 Parcel: 2S102CD02603 Jurisdiction: Tigard Site address: 9605 SW HILLVIEW CT Project: DOUGLASS Subdivision: TWALITY HILL Lot: 3 Project Description: Furnace replacement with fuel piping.1/25/16,REPRINTED to add fuel piping for gas range conversion and range hood. Contractor: OWNER Owner: DOUGLASS, MARTIN R 9605 SW HILLVIEW CT TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Specifics: Description Date Amount Furnaces< 100K BTU 12/15/2015 $46.75 Type of Use: SF Range Hood/Other Kitchen 01/25/2016 $33.39 Class of Work: ALT Type of Const: Fuel Piping 12/15/2015 $14.15 Occupancy Grp: 12%State Surcharge-Mechanical 01/25/2016 $11.31 Stories: Misc Administration Fee 01/25/2016 $45.00 Fuel Fuel Types: Gas Pressure: Total $150.60 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 B Permittee Signature• ti /�// �GGz–��✓ CJL—)–�� 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. CITY OF TIGARD MECHANICAL PERMIT g : COMMUNITY DEVELOPMENT Permit#: MEC2015-00829 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/15/2015 Parcel: 2S 102C D02603 Jurisdiction: Tigard Site address: 9605 SW HILLVIEW CT Project: DOUGLASS Subdivision: TWALITY HILL Lot: 3 Project Description: Furnace replacement with fuel piping. Contractor: OWNER Owner: DOUGLASS, MARTIN R 9605 SW HILLVIEW CT TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Specifics: Description Date Amount Fuel Piping 12/15/2015 $14.15 Type of Use: SF Minimum Fee Adjustment-Mechanical 12/15/2015 $29.10 Class of Work: ALT Type of Const: Furnaces< 100K BTU 12/15/2015 $46.75 Occupancy Grp: 12%State Surcharge-Mechanical 12/15/2015 $10.80 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 503.232.198 : . 2344. Issued By: r Permittee Signature:." - Call 03.639.4175 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 O Received ® ',� V IN • 13125 SW Hall Blvd.,Tigard,OR 97223 _ ` Date/B .• _ _ s V Plan Review Phone: 503.718.2439 Fax: 503.598.1960 ` Other Permit: Date/By: TI G A R D Inspection Line: 503.639.4175 ��C ` tJ�", Date Ready/By: See Page 2 for Internet: www.tigard-or.gov 1 J`, coA`o Notified/Method: SupplementalFM Information i F WO CIAL FEE* Mechanical permit tees*are based on the value of the work ❑ New construction 0 Addition/altera. ent performed.Indicate the value(rounded to the nearest dollar)of all ❑ Demolition 16.Qther: 3\N\ mechanical materials,equipment,labor,overhead,and profit. Value.S CATEGORVINWNSTRUellRESIDENTIAL EQUIPMENT/SYSTEMS FEES* V1...1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For information use checklist. ❑ Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning I }b'75 Job site address: Cil'( OS �: 7../Lit UPiCJt5 C I Furnace 100,000 BTU(ducts/vents) , 46.75 City/State/ZIP:'—"("-v as rcCr:'-fZ z 5 Furnace 100,000+BTU(ducts/vents) 54.91 _ Heat pump 61.06 Suite/bldg./apt.no.: Project name: S Duct work 23.32 Cross street/directions to job site: 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 Flue/vent for any of above 23.32 Other: 23.32 Subdivision: Lot no.: 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 -- LL_1,t_g__, greet& Gy fireplace 23.32 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 0 PROPERTY OWNER 0 `TENANTS 23.32 Environmental exhaust and ventilation: Name: ,•/a-('ZZ--1 Ki a0.--C Cf \,____, _c..—.5 Range hood/other kitchen equipment 33.39 Address: 76)0 5.— SCA_i 7GC CUL �We Cj Clothes dryer exhaust 33.39 City/State/ZIP: V `___ —k/ 07,--- 7` ZZ? Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( 4/ g05-g )4S Fax:( ) Attic/crawlspace fans 23.32 0 APPLICANT 0 CONTACT PERSON Other: 23.32 Business name: Fuel piping: 4 S C{L Je.,.._ $14.15 for first four;$4.03 for each additional _ Contact name: Furnace,etc. ( /if I Address: Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:( ) Fax::( ) Fireplace Range E-mail: Barbecue MEIMLCONTRACTOR Clothes dryer(gas) Other: Business name: 0iritik -r_ Address: Subtotal l - /5 City/State/ZIP: Minimum permit fee($90.00) C� , Plan review(25%of permit fee) — Phone:( ) Fax:( ) State surcharge(12%of permit fee) w- CCB lic.: TOTAL PERMIT FEE Authorized signature: a . elThis permit application expires if a permit Is not obtained withfo 180 days after it has been accepted as complete. ,X9-4--7 • Fee methodology set by Tri-County Building Industry Service Board Print name: ,474 71-ki !2 �.,,r vs/„. .. Date: / e e/3- <� (:'Building,Permits\MEC_PermitApp_040113.doc �-'�j 440-4617T(I /02/COM/WEB) 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\M EC_PennitApp_040I I3.doc 2 1 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 per mits. 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 a II 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 w ill 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. /4,47P--77 U fz- �S Print Name off Permit Applicant ez,./ 64..L., Signature of Permit Applicant Date Permit#: /fir-4 1 S— . F Address: 160, S4-/ fh 7,274 ale I-71-)3 �- 1;:�.�.;,E kid; Issued by: 6'✓ Date: 4p/S43 IL. • 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 9605 SW HILLVIEW CT, TIGARD, OR, 97223 Residential - Mechanical 699 Mechanical ﬁnal FAIL MEC2015-00829 David Young No electrical permit on ﬁle for furnace reconnect, no minor label posted on site in panels or on equipment. Provide electrical permit from city of Tigard as minor label not to be used after work is complete. Violation Summary: Inspector Contractor