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Permit CITY TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00512 TIGARD DATE ISSUED: 10/16/2008 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S104AA 11800 SITE ADDRESS: 12465 SW 129TH AVE ZONING: R -4.5 SUBDIVISION: BELLWOOD NO. 3 LOT: 137 JURISDICTION: TIG PROJECT: SELLMAN Project Description: Replace 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: 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 KIRK SELLMAN Description Date Amount 12465 SW 129TH AVE TIGARD, OR 97223 [MECH] Permit Fee 10/16/20( $72.50 [TAX] 12% State Surchai 10/16/20C $8.70 Phone: 503 - 590 -1963 Total $81.20 Contractor: TRI COUNTY TEMP CONTROL 13150 S. CLACKAMAS RIVER DR OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS • Contact #: PRI 503 -557 -2220 FAX 503 -557 -0919 Reg #: LIC 72623 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. Issu =d By: Permittee Sign- ture: • , ; ,c`i ' Call 503.639.4175 by 7:00 a.m. for inspections that,busine •ay. 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. 06T -16 - 2008 10:37A FROM: TO:5035981960 P.1 Mechanical Permit Application - i:oik oFFicE iISL UNI:i! City of Tigard �1 Received to b; Perm ;tNo.: �C i0: -tXSS/ , y 13125 SW Hall Blvd,, Tigard 972 �I CEg' FjD Plan Review Phone: 503.6394171 Fax: 503.59 Date/By Other Petmn, "• IG A RD Inspection Line: 503.639.4175 OCT 1 2008 Date Ready/By. Jr—' Page 2 for Internet: www,tigard- or,gov Notified/Method: / (fd Supplemental Informa TYPE OF ICY uF'IIGARD COMMERCIAL FEE* SCHEDULE - USE CHECKLIST RUMP © DIVISION ❑ New construction Addition /al Mbtt � 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: $ 1- and 2-family dwellin RESIDENTIAL EQUIPMENT !SYSTEMS FEES* y g ❑ Commerci ustrial ❑ Accessory budding 6 For special information use checklist. Multi - family ❑Master builder ❑ Other: Description Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling 124(u5 (a (2� NWT) Air conditioning or heat pump Job site address. "�ltl �J� U l I ��\J Ww/ (requires site plan showing placement) 14.00 City/State /ZIP: T►A rd (0 20 Furnace 100,000 BTU (duets/vents) ( 14.00 I Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work 10.00 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. 14,00 Flue /vent for any of above 6.80 Subdivision: Lot no.: Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 �n {^ l t Gas fireplace 1000 �tO (J Flue vent for water heater or gas _ fireplace 10.00 Log lighter (gas) 10.00 _ Wood /pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10 00 yi PROPERTY OWNER ❑ TENANT Other 10.00 Name: Kirk € (min Environmental exhaust and ventilation p n ,,,� } p l Range hood /other kitchen Address: eUI t 1 `-i equipment 10.00 City /Slate /ZIP; Clothes dryer exhaust 10.00 (� Single -duct exhaust (bathrooms, Phone: ( tp j ) 5610 • t'1io Fax: ( ) toilet compartments, utility rooms) 6.80 %APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Business name: Other: j 10.00 _ Fuel piping Contact name: jj l`i 114.100171 $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City/State /ZIP: Wall /suspended/unit heater Phone: ( ) F x:: ( ) Water heater , Fireplace E -mail: Range , CONTRACTOR Barbecue Business name:, c Ctt I Clothes dryer (gas) h��p� Other: Address: I3 [50 e* N- d J l l /'�V V MECHANICAL PERMIT FEES* City/State /ZIP: Q�' �� O�. I 1O4 Subtotal Phone: (50 5s7�� �22b � ramas5 Fax: ( ^ilk, 667 Qqici Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic : 720 State surcharge (12% of permit fee) I TOTAL PERMIT FEE • g) Authorized signature: ��� ��Y This permit application expires if a permit is not obtained within 160 ' d ays a it has been accepted as complete. Print name: ) JQjt6 MQ5a Date: 1,01 I VA • Fee methodology set by Tri- County Building Industry Service Board t, d' \Buildingermits\MEC•PermitApp don 01/19/07 440.461 (11 /02/COM/WEP) CITY OF TIGARD BUILDING DIVISION PERMIT #: MEC2008-00512 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/16/2008 Phone: (503) 639- 4171uu'4 @�6�'� Inspection Requests (24 Hrs.): (503) 639 -4175 . ' ''! .. INSPECTION WORKSHEET FOR DATE: 1012212008 TIME: 7:00AM PAGE: 10 SITE ADDRESS: 12465 SW 129TH AVE CLASS OF WORK: SUBDIVISION: BELLWOOD NO. 3 LOT #: 137 TYPE OF USE: PROJECT NAME: SFLLMAN DESCRIPTION: Replace furnace. OWNER: SELLMAN, KIRK PHONE #: 501- 5901063 CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 503 - 657 -2220 Inspection Request Scheduled For: Date: 10122J2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 077046-01 603-557-2220 N Corrections/Comments/Instructions: 09/Z-- G f74 L -#'—�5' - / el 95 i r,1 �o�. -1- , ,9 -� f' . s '� PASS ❑ PARTIAL APPROVAL CANCEL NO ACCESS ❑ FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: Date: -A -20,---8 Phone #: (503) 718- 2.51 (4,