Permit i.
f -4 CITY OF' T IGARD MECHANICAL PERMIT
' , COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00416
TIGARD DATE ISSUED: 8/11/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S134AC 04200
SITE ADDRESS: 11068 SW BLACK DIAMOND WAY ZONING: R - 4.5
SUBDIVISION: HART'S LANDING LOT: 013 JURISDICTION: TIG
PROJECT: KERSHNER
Project Description: Replace ductwork.
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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
REPAIR
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Owner: FEES
JEFF & BETH KERSHNER Description Date Amount
11068 SW BLACK DIAMOND WAY
TIGARD, OR 97223 [MECH] Permit Fee 8/11/200E $72.50
[TAX] 12% State Surchai 8/11/200E $8.70
Phone: 503- 684 -6595
Total $81.20
Contractor:
THERMAL FLO
7236 SW DURHAM RD. STE 100
PORTLAND, OR 97224 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 670 -8343
FAX 503- 670 -9064
Reg #: LIC 151847
This permit is issued subject to the regulations contained in the Tigard Municipal 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
Issued = ` �j J �L �� i / Permitt Si•nat I_ _ _ice /r ' (d
r
Call 503.639.4175 by 7:00 a.m. for inspections t . business a y.
This permit card shall be kept in a conspicuous place on the jo• site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
1 ,G/ 14/2008/MON 08:42 AM THERMAL FLO FAX No, 5036709064 P. 002
�. .
1VIechanical Permit A, I i.catie 111 Received . ' FOR OFFICE USE OINL1' • .
City of't i� rd 1 - , D etelBy f OS 4K . ermitNo.: Mgzaoog. od /
n 131 SW Hflll Blvd., Tigai ., ti • 97223 Plan Review
' - . • Phone: 503.639.417) Pax: 503.59. 0 2OQ . Date/By. ' Other Permit:
TIGARI3
Inspection Line x03.639.4175 Date Ready/By:
l e El See Page 2 for
' Internet 1,tiryvw.tigard or.gov p� ( F �C ��� Notified/Method: / 'L Supplemental Information
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performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
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Air conditioning or beat pump
Job site address: 1 , o 0 e2.4'712 ., W ' (requires site plan showing placement) 14.00
City /State/ZIP: 7//4r P 0,q tj� 2 °Z . . Furnace 100,000 STU (duct3/vents) 14.00
`/mil /11211,0-1.,.. Gas heat 14.00 / ea 1 DI1 :000+ BTU (t{ucfsh ent3) 17.00 N
Suite/bldg./apt. no.. Project name: . � as
Gas pump /
Cross street/directions to job site: Duct work _ 10.00
. Flydronic hot water system 1 4.00
Residential boiler (radiator or
12/n - J bo� o �J - 7- hydronic) 14.00
L/ / /Gib UL /I " [ Unit heaters (fuel -type, not electric),
• in -wall, in -duct, suspended, etc. 14.00
Subdivision: I Lot no.:
Flue /vent for any of above 6.80
_ - Other: I 10.00 •
Tax map /parcel no - Other fuel applianccs _
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Wood /pellet stove 10.00
. Wood fireplace /insert 10.00
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Address: equipment 10.00
City /State /ZIP: LZ/J2 ' �� 67.5i . � �. /e. . Clothes dryer exhaust 10.00
��,� ���_ . 11 J t ins tcomp r t ents(ua h
Ptiane: Fax: ( ) toilet compartments, utility rooms) 6.80
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Business name: Fuel piping
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Contact name: n IY 1 J $5.40 for frstfour $1.00 for each additional
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Phone: ( ) • F ax; ; ( ) Water heater .
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City /Slate /ZIP' Optl��, ,� 477 ' i Subtotal t L3L
Phone: ili9� , 0 4 ,¢t ' )1,V ' Q ' Minimum permit fee (5 bt o tal ILOZ,
Platt review (25% of permit fee)
CCB lie.: /big State surcharge (12% of permit fee) 4 , , 00i
•
TOTAL FERMI' FEE A . 20
f this permit nppticafinn expires if n permit is not obtained within 180
Authorized signatur: / / /
(lays after it has been accepted n3 Cnmpick.
Print name: 7 - / ,,4 / Date: • " Fee methodology set by Tri- County Building Indust:) Service Board
CITY OF TIGARD t ' , ' �1
BUILDING DIVISION i ‘ v PERMIT #: MEC2008 -00416
13125 SW Hall Blvd., Tigard, OR 97223 < DATE ISSUED: 8/11/2000
Phone: (503) 639 -4171 u7 riii�Qf�l
Inspection Requests (24 Hrs.): (503) 639 -4175 ��' ` 2 ‘C
INSPECTION WORKSHEET FOR DATE: 9124/2008 TI • 7 :00AM PAGE: 26
SITE ADDRESS: 11068 SW BLACK DIAMOND WAY CLASS OF WORK:
SUBDIVISION: HART'S LANDING LOT #: 01 i TYPE OF USE:
PROJECT NAME: KERSHNER
DESCRIPTION: Replace ductwork.
OWNER: a
PHONE #: r
KERSHNER. JEFF & BETH
03 ro8� 0585
CONTRACTOR: THERMAL FLO PHONE #: 503-670-8343
Inspection Request Scheduled For: Date: 2 �� X000 Pour Time: CV VU
Code # Inspection Description Confirm # Contact # Mes ge "
699 Mechanical final 076848 -01 503-670-8343 Y ,; .
Corrections /Comments /Instructions:
. ,\
(../ .• I
P S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
144 Inspector: (I e.--■ --- Date . : q �
�/ Phone #: (503) 718 - y
j .
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