Permit CITY T I GAR D MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 -00424
r l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/28/2006
PARCEL: 2S 104AA -90162
SITE ADDRESS: 12658 SW KAREN ST 16 ZONING: R -12
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUMS LOT: 016 JURISDICTION: TIG
Project Description: Apt. 16 & 17 dryer vents.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: MF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R1 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
GAS OUTLETS:
> 10000 cfm:
Owner: FEES
MOZINSKI, STEVEN P Description Date Amount
ZAKOCS, EDWARD JR
PO BOX 189 [MECH] Permit Fee 8/28/200E $72.50
YAMHILL, OR 97148 [TAX] 8% State Surcha 8/28/200€ $5.80
Total $78.30
Phone: 503- 662 -0240
Contractor:
RELIABLE HOMES IMPROVEMENT
PO BOX 230815
PORTLAND, OR 97281 REQUIRED ITEMS AND REPORTS
Contact #: FAX na
Reg #: LIC 48634
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.
/ /
Issued By:
4,,,L,„„8„,,,,,
Permittee Signature? , ' /
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business d • 7
This permit card shall be kept in a conspicuous place on the job site until comp) -- : of the project.
Approved plans are required on the job site at the tine of each inspection.
t
Mecha lical Permit Application FOR OFFICE USE ONLY . ,
Ci of Ti and Received / f / I
`J g Date/By: =� 1 , - ►;r tee° a A tha
13125 SW Hall Blvd., Tigard, OR 97223
0 Plan Rev,. • Other Permit:
. Phone: 503.639.4171 Fax: 503.598.1960 Date /By.
T I AR D Inspection Line: 503.639 Date Ready/13y: lel ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
- Pull - 00710
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
0 New construction El Addition /alteration/replacement • Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
„ RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ - family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
ulti family El Master builder ❑ Other: Description I Qty. I Ea. Total
" ; = EINFORMATION' AND ;LOCATION Aid i1 tip 17 Heating /cooling
Job site address: ��,tt" n p Air conditioning or heat pump
� (.(� �PT� �J✓ �ie /`— (requires site plan showing placement) 14.00
City /State /ZIP: p,, Furnace 100,000 BTU ( ducts/vents) 14.00
T� V C/ / 7 Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: j h z/I p 7 pstLQ- Gas heat pump 14.00
Cross street /directions 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: I Lot no.: 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
. Gas fireplace 10.00
-Zi/.5: .(.1, f, 0 )21y(2 (,( -,,a • Flue vent for water heater or gas
,{, 7t- fireplace 10.00
%T� L ,l 7 Log lighter (gas) 10.00
. l/ Wood /pellet stove 10.00
Wood fireplace /insert 10.00
' _ ''C :O ,WNE R [ , - , 0 TENANT Chimney /liner /flue/vent 10.00
Other: 10.00
Name: 6/) 1 L/i edeiy,0 ,,, Environmental exhaust and ventilation
Address: 7 �- " Range hood/other kitchen
fr 1- ' l/ / equipment 10.00
City /State /ZIP: c"4-4.47,
c/ t Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (& -•-k) Fax: ( ) toilet compartments, utility rooms) 6.80
15-- APPLICANT' ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name: r _, 6i 3L >J/ Ow xm-_ 'Z,,,- /1 iv-.ei --/ - Fuel piping
• Contact name: �� . / 7 /� �,0 $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: 7i C.) t, /dam 1'
.136 S'
»� Gas heat pump
City /State /ZIP: ? D R17.- y) € t.- 7 as // Wall /suspended/unit heater
O Phone: (6d3) (47 _aa,Li V Fax:: ( )
Water heater
0 V Fireplace
'E -mail:
Range
- , CONTRACTOR , - .. ' Barbecue
!
Business name: Re Clothes dryer (gas)
Other:
Address: p i. 14.�J / �„„�� �, D J &0 a3 U CGS - ' �" MECHANICAL PERM[T'FEES* -.: ' .
.City /State/ZIP: p / Subtotal
Phone: // O Fax: ( ) Minimum permit fee ($72.50)
�J ) tigl(" ,a 7 Plan review (25% of permit fee)
CCB lic.: tl2C217 S7aq �fr State surcharge (8% of permit fee)
TOTAL PERMIT FEE 7)11 Sp
S
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. '3-1--P Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
t:\ Building \Permits \MEC- PermitApp.doc 04 /06/06 4404617T (1 I /02/COM/WEB)
•
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: - ` - Permit. Fee: ,
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
•
for each additional $100.00 or
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
• fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
•
1:\Building\Permits\MEC- PermitApp.doc 12/30/05 2
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2006-00424
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8128/2006
Phone: (503) 639-4171 AA
,.., Wi
Inspection Requests (24 Hrs.): (503) 639-4175 — l t
INSPECTION WORKSHEET FOR DATE: 81 TIME: 7:041W PAGE: 20
SITE ADDRESS: 12658 SW KAREN ST 16 CLASS OF WORK:
SUBDIVISION: BEL , ili 6 _ * ' CONDOMINIUM LOT #: 016 TYPE OF USE:
PROJECT ■. ' • : *ELLWOOD TERRACE C OMINIUMS
DES 'IPTION: Apt. 16 &17 dryer vents.
,..„.
OW' .-. kJ 0 INS' asr.-.0 PHONE #: 503-662-0240
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 8/30/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
625 Duct work 035799-01 503-481-0240 V
Or ke:cl-k- RUA-(_—_ 6'0-AKT-
Corrections/Comments/Instructions:
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-.- PASS * n PARTIAL APPROVAL I. CANCEL I I NO ACCESS
I I FAIL E C LL FOR INSPECTION n ADDI IONAL FEES ASSESSED
Inspector: Of Date: : 0 e k Phone #: (503) 718-
. .