Permit •
F f �� CITY OF TIGARD
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00729
DATE ISSUED: 12/17/2007
T�GnRD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S103BB - 07000
SITE ADDRESS: 12185 SW WALNUT ST ZONING: R - 4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: BOLEN
Project Description: Replace gas furnace.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 . VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
RICHARD BOLEN Description Date Amount
12185 SW WALNUT ST
TIGARD, OR 97223 [MECH] Permit Fee 12/17/20C $72.50
[TAX] 8% State Surchare 12/17/20C $5.80
Total $78.30
Phone: 503- 367 -7118
Contractor:
SERVICE NOW OF OREGON INC
621 SE 7TH
PORTLAND, OR 97214 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 445 -2440
FAX 503- 445 -2443
Reg #: LIC 161582
This permit is issued subject to the regulations contained in the Tigard Munidpal Code, State of Ore. Specialty Codes and all other applicable laws.
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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center.
Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503.246.6699 or 1.800.332.2344.
I -sued By: t •� _� �/_. Permittee Signat� , ` ` � j 1
Call 503.639.4175 by 7:00 a.m for inspections the business day.
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 irgopr.:: e . , ° F ' , 14,:; m 4 ,�
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f 8 y City of Tigard ' . Received
" 13125 SW Hall Blvd., Tigard, OR 7 '.` >� �Q� DatuBy. / b 7 Permit No.. / y 1 �/'�9
Phone: 503.639.4171 Fax: 503. . l Plan Review /
1 DateiBy: Other Permit
: In ection Line: 503.639.4175 ` Tc�
Rd
JIGARD' p C .a D ! � upplemental SeePage2for
Internet: unvw.tigard or.gov Q `� }� �
`�v V� ��; � Not Notified/Method: �` S Information
TYPE OF WWA. �` ! i COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction ® Addition/alteration/replacement
❑ Demolition performed. Indicate the value (rounded to the nearest dollar) of all
❑Other: . mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
Commercial/industrial RESIDENTIAL EQUIPMENT /SYSTEMS FEES"
® 1- and 2- family dwelling ❑ Commercia
❑ Accessory building
❑ Multi-family El Master builder For special information use checklist.
❑O ther: Description t .
Q y 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating /cooling •
Job site address: 12185 sw walnut st Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: Tigard Or 97223 Furnace 100,000 BTU (ducts/vents) 1 1400 14.00
Suite/bldg./apt. no.: Project name: Bolen Furnace 100.000+ BTU (durls/vents) 17.90
Gas heat pump L 14.00
Cross streetldireciions to job site: Duct work 14.00 _
- Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
- Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. _ 10.00
Subdivision: Lot Flue/vent for any of above 10.00
Other: 10.00
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00 j
Gas furnace replacement Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Loe lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplaceiinsert 10.00
® PROPERTY OWNER I ❑ TENANT Chimney liner /flueNent 10.00
Other: 10.00
_Name: Richard Bolen
Environmental exhaust and ventilation
Address: 12185 SW Walnut st Range hood /other kitchen
equipment 10.00
City/State/ZIP: Tigard Or 97223 Clothes dryer exhaust 10.00
Phone: (503)367-7118 Fax: Single -duct exhaust (bathrooms,
( ) toilet compartments, utility rooms) 6.80 _
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name: Service Now Inc. Other: 10.00
Fuel piping
Contact name: Kurt $5.40 for first four; $1.00 for each additional
Address: 621 se 7 aye Fumace, etc.
—
Gas heat pump
City /State/ZIP: Portland OR 97214 Wall /suspended /unithealer
Phone: (503) 445 -2440 Fax: : (503) 445 -2443 Water heater 1
E-mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: Service Now Inc. Clothes dryer (gas)
Address:
Other:
MECHANICAL PERMIT FEES"
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee (572.5D) 7A. 5v
Plan review (25% of permit fee) -B
CCB lic.: 161582 State surcharge (8% of permit fee) .. $0
TOTAL PERMIT FEE 7 .30
Authorized signature: / This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Kurt W eficld Date: 12/13/07 I ' Fee methodology set by Tri- County Building; Industry Service Board
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MF_t:7007- 00771
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: IA1117/:)007
Phone: (503) 639 -4171 a a,., 4 I j
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/° i200f3 TIME: 7:02AM PAGE: 74
SITE ADDRESS: 12113'' SW WAL NUT ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: B ;OLEN
DESCRIPTION: Replace T.:s furnace.
OWNER: BOLEN, RICHARD:) PHONE #: 503.367 -7118
CONTRACTOR: SERVICE NOW OF OREGON INC PHONE #: x.03- 445.2440
Inspection Request Scheduled For: Date: 1/18/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 063432 -01 603 367 -7118 Y
Corrections /Comments /Instructions:
Cal t, ib-i
i PASS PARTIAL APPROVAL ❑ CANCEL NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
�M_i V `` A---- ��
Inspector: �v. lA---- Date: J ' 1 Phone #: (503) 718-