Permit - CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00005
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/3/2008
PARCEL: 1 S133AD -05300
SITE ADDRESS: 12965 SW HAWK'S BEARD ST ZONING: R -7
SUBDIVISION: AMART SUMMERLAKE LOT: 097 JURISDICTION: TIG
PROJECT: JUNGKIND
Project Description: Furnace change - out
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
ROSE JUNGKIND Description Date Amount
12965 SW HAWK'S BEARD ST
PORTLAND, OR 97223 [MECH] Permit Fee 1/3/2008 $72.50
[TAX] 8% State Surcha 1/3/2008 $8.70
Phone: Total $81.20
Contractor:
KENTEC HEATING CONTRACTOR
PO BOX 233
WOODBURN, OR 97071 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 982 -6082
FAX 503- 982 -6284
Reg #: LIC 63621
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.
Issue By: •�1 f, Permittee Signature: Y 9 /6"&"
Call 503.639.4175 by 7:00 a.m. for inspections that busines 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 . FOR OFFICE USE ONLY' .
' Received iii �,. - .amity of Tigard Date /By: / - 3 d' PennttNo.: /lie ��yj
a 13125 SW Hall Blvd., Tigar OR 97223 Plan Review vw
6 ' Phone: 503.639.4171 Fax: 503.598.1960 Date /By. Other Permit:
Inspection Line: 503.639.4175
TIGARD Ready /By: Read /B El Page e 2 for
Internet: www.tigard-or.gov Notified/Method. B
d. Supple Pa lnformation
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction 0-Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ /, goo
dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1 - and 2-family g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
r n / 1 Air conditioning or heat pump
Job site address:
/02 91p � .5 /-fa Beard 5 . (requires site plan showing placement) 14.00
City /State /ZIP: 1 / Ar-o/ e Furnace 100,000 BTU (ducts /vents) / 14.00 / y
�/ C 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 hcatcr 10.00
// Gas fireplace 10.00
. Si rna. Cam_ cf. ti q e_ G c.- f Flue vent for water heater or gas
J fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
Tif PROPERTY OWNER ❑ TENANT
Other: 10.00
Name: 50,_ t_.., c Q---cA INA, 41 i 7\.\`-D Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name: Other: 10.00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address:
Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR - Barbecue
Business name: , c_ t7 .72 t Clothes dryer (gas)
Other:
Address: pc i3v,e t �7 � 33 / //o a a E�i„, f D r ° _MECHANICAL PERMIT FEES*
City /State /ZIP: ( w ocilct / a / OE • 97o 7/ Subtotal
Minimum permit fee ($72.50)
Phone: (Su) 9 5-9d 7 Fax: ( .923 ) 98 —O 4 3 3
3 �o? ' Plan review (25% of permit fee)
CCB lic.: 63 to / f 1 _ t7 State surcharge o of permit fee) g. 70
/ / TOTAL PERMIT FEE 7 . P 0 r.
T hi it
Authorized signature: A s permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: � � S - , prn i Date: / -3 - O g * Fee methodology set by Tri- County Building Industry Service Board
1:\Building \Permits \MEC- PermitApp.doc 01/19/07 440 -4617T (11 /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 fraction
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.
I: \Building\ Permits \MEC- PermitApp.doc 01/19/07 2
!
CITY OF TIGARD 5 1�1G , ;
BUILDING DIVISION i y PERMIT #: MEC200B- 00005
13125 SW Hall Blvd., Tigard, OR 97223 Cl - t 941' DATE ISSUED: . 113/2008
Phone: (503) 639 -4171 fiA u t It abq, i
Inspection Requests (24 Hrs.): (503) 639 -4175 ... 111.
INSPECTION WORKSHEET FOR DATE: 1/4/2008 TIME: 7 :01AM PAGE: 36
SITE ADDRESS: 12966 SW HAWK'S BEARD ST CLASS OF WORK:
SUBDIVISION: AMART SUMMER{ LOT #: 097 TYPE OF USE: •
PROJECT NAME: JUNGKIND
DESCRIPTION: Furnace change
OWNER: JUNGKIND, ROSE PHONE #:
CONTRACTOR: KENTEC HEATING CONTRACTOR PHONE #: 503 -982 -6082
Inspection Request Scheduled For: Date: /14/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 062574 -01 dog 503 - 710.0126 Y ice- ." y ,(- 0- y•i <v7`
Corrections /Comments /Instructions:
,
. i
PASS I I PARTIAL APPROVAL n CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ' SSESSED
44.
Inspector: Date: t l i . - 6 I Phone #: (503) 718-