Permit ,‚ z CITY OF T I GA R D MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00039
T IGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/24/2008
PARCEL: 2S 104AA -90102
SITE ADDRESS: 12662 SW KAREN ST 10 ZONING: R -12
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUMS LOT: JURISDICTION: TIG
PROJECT: BELLWOOD APT
Project Description: Units 10, 11. New dryer vent to outside.
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:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
MOZINSKI, STEVEN P Description Date Amount
PO BOX 189
YAMHILL, OR 97148 [MECH] Permit Fee 1/24/200E $72.50
[TAX] 12% State Surch 1/24/200E $8.70
Phone:
Total $81.20
Contractor:
RELIABLE HEATING
RELIABLE HOME IMPROVEMENT
PO BOX 4821 REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97208
Contact #: PRI 503- 481 -0240
FAX 503 -521 -8489
Reg #: LIC 00048637
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 -00 -I 00. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: P ermittee Signature: �'
Call 503.639.4175 by 7:00 a.m. for inspections that • siness day. /
This permit card shall be kept in a conspicuous place on the job sit: until completion of the project.
Approved plans are required on the job site at the i 1 - of each inspection.
Mechanical Permit Appli? FO OFFICE USE ONLY
City of Tigard Received Permit
��`� Date/By: / q'
13125 SW Hall Blvd., Tigard, OR 97 22ti�N 2 4 / O( '� y `� /0% f3 6 ead68 - `
Phone: 503.639.4171 Fax: 503.598 -�.n clump Date Plan Revie Other Permit:
pl � / ®F Date/By: TI C ARD Inspection Line: 503.639.4175 6/ o e ^ i Date Ready/By: iris: H See Page 2 for
Internet: www.tigard -or.g B 1� ®i��y��1II�ILJ� Notified/Method: Supplemental Information
i
T OF e1 RK COMMERCIAL FEE* SCHEDULE _USECHEGKLIST
Mechanical permit fees* are based on the value of the work
N ew construction
❑ ❑ Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition - Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY ;O
Y F CONSTRUCTION Value: $
1- and 2-family dwelling `''RESIDENTIALEOUIFMENT /SYSTEMS "FEES* .
❑ y g ❑ Commercial /industrial ❑ Accessory building
jaMtslti- family ❑ Master builder ❑ Other: For special information use checklist.
Description - Qty. Ea. Total
• JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: /a l0 C0.01. <' � ii- p L S P - Air conditioning o heat pump
+-> (l � J / ` (requires site plan showing placement) 14.00
City /State /ZIP: ` J ,y O '�l 6- 0 2 7 �� 3 Furnace 100,000 BTU (ducts /vents) 14.00
�` Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: /0 / / Project name: l n G_AJ Q p Gas heat pump 14.00
Cross street/directions fo job site: Duct work 10.00
/ b 7:#4' ��' A< N . Hydronic hot water system 14.00
Q� Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.:
Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
.. DESCRIPTION. OF WORK - Water heater 10.00
-. ` Gas fireplace 10.00
(�, !JN N 1 - rJ () fireplace 10.00
for water heater or gas 10.00
rU - ■■' .' = ♦ - s=f��
Log lighter (gas) 10.00
tel-lr"4525$11r-1 • --/
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
4 PROPERTY OWNER . ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: L.- I' 7A e.,.5
Environmental exhaust and ventilation
Range hood /other kitchen
Address:/,, 0. / 1r 0/ L equipment 10.00
City /State /ZIP: y*/7)14. ` i 0 . Clothes dryer exhaust 10.00
Phone: (5') ) 66g- /0 3 o F ax: (
Single-duct compartments, (bathrooms, utility o )
( ) toilet corn menu, utili rooms) 6.80
. ❑ APPLICANT . ' - ❑ CONTACT PERSON Attic /crawlspace fans 10.00
�/ / i Other: 10.00
Business name:
v G, A��3.� »1 7.,1,/ l I) & - Fuel piping
Contact name: , AN T. $5.40 for first four; $1.00 for each additional
: ��J a
Furnace, etc.
Address
�t d f J Gas heat pump
City/State /ZIP: 1,94212444. 1, 9 7,2( Wall/suspended/unit heater
Phone: 33 ) £/ � r cA c/ Fax:: (56 3 )sue -gycf? Water heater
E -mail: / Fireplace
I Zf4-i►r Ca ( L e x) _ /U-P� • Range
C ONTRACTOR Barbecue
Business name: �/!!/ 14 `, n P/1 ti Clothes dryer (gas)
�y� //5-4 � T/' t Other:
Address: fi , d r 4OK i3 � Q Is MECHANICAL.PERMIT • -
City /State /ZIP: , 7L t,a J of- y 76 4l r Subtotal
Phone: ( L( l ( _ O a- 'l O Fax: (Sc)) $2 I __.b.,(7/ b__.b.,(7/ Y Minimum permit fee ($72.50)
- )
Plan review (25% of permit fee)
CCB lic.: (f g / _ 3 7 State surcharge (12% of permit fee) 10
`' CG 3 TOTAL PERMIT FEE I . a.0 Authori !r turf: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Printry ' ..../ - Date: / ^ 4 `I 4- ' Fee methodology set by Tri- County Building Industry Service Board
I:\Buildi• ermits\ PermitAp..do •/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 9,F TIGARD 0 1 1 5 OA
BUILDING DIVISION o xd PERMIT #: .tv1FC2008-00039
13125 SW Hall Blvd., Tigard, OR 97223 Vi °I ii( DATE ISSUED: 1/24/2000
Phone: (503) 639-4171 \ /10 4100ii /fit\
Inspection Requests (24 Hrs.): (503) 639-4175 gefA 111.
INSPECTION WORKSHEET FOR DATE: 2/11/2008 TIME: 7:01AIVI PAGE: 18
SITE ADDRESS: 12662 SW KAREN ST 10 CLASS OF WORK:
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUM LOT #: TYPE OF USE:
PROJECT NAME: BELLWOoD APT
DESCRIPTION: Units. 10, 11. Nem( dryer vent to outside. •
OWNER: tv10.Z.INSKI, STEVEN P, PHONE #:
CONTRACTOR: RELIABLE HEATING PHONE #: 503-481-0240
Inspection Request Scheduled For: Date: 2/11/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
616 Mechanical rough-in 064809-01 503-481-0240 N
Corrections/Comments/Instructions:
iv_ '.) ,--. , it-
/-
PASS Li PARTIAL APPROVAL El CANCEL 0 NO ACCESS
fl FAIL CALL FOR INSPECTION II] ADDITIONAL FEES ASSESSED
,./
----.-
Inspector: - - Date: 2 -/7 Phone #: (503) 718- __________
,_ , . .. . •.. ..