Permit v
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00577
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/24/2008
PARCEL: 2S 102CA - 00916
SITE ADDRESS: 13445 SW VILLAGE GLENN DR ZONING: R-4.5
SUBDIVISION: VILLAGE GLENN LOT: 016 JURISDICTION: TIG
PROJECT: KUREK
Project Description: Install pellet insert.
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:
WOD 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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm:
OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Owner: FEES
ELEONORA KUREK Description Date Amount
13445 SW VILLAGE GLEN
TIGARD, OR 97223 [MECH] Permit Fee 11/24/20( $72.50
[TAX] 12% State Surch 11/24/20C $8.70
Phone: 503- 0639 -5489
Total $81.20
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact #:
Reg #:
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.
Jul
Issu =d By: / A.// ; Permittee Signature:. th. ,
Call 503.639.4175 by 7:00 a.m. for inspections that i ' usiness 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 time of each inspection.
Mecltanical Permit Application FOR OFFICE USE ONLY
City of Tigard g DateB ey if Ai/ Os Permit No ��
HeteacD5
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
-
Phone 503 639 4171 Fax 503 598 1960 DateBy Other Permit
T I G A R D
Inspection Line 503 639 4175 Date Ready /By Juns ® See Page 2 for
Internet www tigard - gov Notified/Method // / e Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New 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 OF CONSTRUCTION Value $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other: Description Qty I Ea I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: (3 S VV V I LLI 6 , G L EJ'V DR • Air conditioning or heat pump
(requires site plan showing placement) 14 00
City /State /ZIP: 7t 6 A-(I ( OR 9i') 2/3 Furnace 100,000 BTU (ducts /vents) 14 00
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
^ /n I II DESCRIPTION OF WORK Water heater _ 10 00
Gas t 6f - a-V✓l. e i It l s 1 le, ` 145 e Flue fireplace
vent f foo r water heater or g 10 00
Flue vent as
��o fireplace 10 00
1 e (apt aLe Log lighter (gas) 10 00
Wood/pellet stove I 10 00 Mu)
Wood fireplace /insert 10 00
p PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent id
.a.)
00 �-c1(.)
/�
{� y � �/ Other 10 00
r
Name: I'-" t, CON O R r 1 k U RE K Environmental exhaust and ventilation
Address: 1 3 4 (.i S 51NI V ` Lt19 GUN N DR i Range hood /other kitchen
equipment 10 00
City /State /ZIP: it. G 19-/RD O R 9+22 3 Clothes dryer exhaust 10 00
Single -duct exhaust (bathrooms,
Phone: ( 593 639-54 8 (3 Fax: ( ) toilet compartments, utility rooms) 6 80
pf APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10 00
Other 10 00
Business name: Fuel piping
Contact name: t ( O N- Q A- K U R E K $5.40 for first four; $1.00 for each additional
Address: 1 344 5 SW Ucu,i6E GLUM k DR , Fumace, etc.
Gas heat pump
City /State /ZIP: 1 (GPO) ( OR 91-223 Wall /suspended/unit heater
Phone: ( 503) ,639 _ 6-1.48 9 Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name:
Clothes dryer (gas)
Other
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: Subtotal
Minimum permit fee ($72 50) - 4, 1
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB tic.: / State surcharge (12% of permit fee) F.
TOTAL PERMIT FEE al,
Authorized signature: d, • This permit application expires if a permit is not obtained within 180
nr � I days after it has been accepted as complete.
Print name: U f G . E( eO, ( v Q R A Date: Z I d J, 4' la6 * Fee methodology set by Tn- County Building Industry Service Board
1 \BuddingNermits \MEC- PermnApp doc 01/19/07 / 440- 4617T (11/02/ OM/WEB)
•
Mechanical Permit Application - City of Tigard
Page 2 = Supplemental Information'
Commercial Fee Schedule:
Total' Vahiation:' `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 \Budding \Penmts\MEC- PennitApp doc 01/19/07 2
•
•
Information Notice to Property Owners About
Construction Responsibilities Statement
Oregon Law requires residential construction permit applicants who are not licensed
with the Construction Contractors Board to sign the following statement before a
building permit can be issued. [ORS 701.055 (4)]
This statement is required for residential building, electrical, mechanical and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Please check the appropriate box and complete the following statement:
I own, reside in, or will resideNin the completed structure and my general contractor is:. .,
Name ' CCB #, Expiration -Date
I will instruct My general contractor, that all subcontractors who work on the structure must be
licensed with the: Construction Contractors Board.
I will be perform :w
ing ork on property I own, a residence that I reside in or a res that 1 will
` reside in. If •I hir s ubcontractor s I will hire ubcontractors licensed with the Construction
Y
Contractors Board. If 1 change my mind and hire a general contractor,:I will contract with a":
contractor contractor who is licensed with the CCB and will immediately the office issuing this:building
perniit,of the naine the 'contractor,
I. have read and understand the Information Notice to Property Owners about Construction
Responsibilities contained on these two pages and I hereby certify that the information checked,and -
completed above is correct and accurate.
_ (,E-o O RA KU RE
Print name of permit applicant : Signat (re of permit applicant
3®
Permit #:
This form is supplied to building 2
permit offices by the Oregon Address: 1 546 - "' 0 g , /d
Construction Contractors Board
as required by ORS 701.055 (6) " "
Issued Date: ///0/
This copy to issuing permit office
. . i,
1
CITY OF TIGARD '`-
BUILDING DIVISION • PERMIT #: Ml. C200t Otfs7`/
13125 SW Hall.Blvd., Tigard, OR 97223 DATE ISSUED: 11/24/2008
Phone: (503) 639- 4171 s
Inspection Requests (24 Hrs.): (503) 639 -4175 ` __..
INSPECTION WORKSHEET FOR DATE: 12!151 X13 TIME: 7:00AM PAGE: f3
SITE ADDRESS: 1344f, 1 VILLAGE GLENN DR CLASS OF WORK:
SUBDIVISION: VILLAGE GLENN LOT #: 016 TYPE OF USE:
PROJECT NAME: KUREI<
DESCRIPTION: Install pellet insert.
OWNER: KUREK, ELEONORA PHONE #: 503 4639.5489
M CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12/15/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
G99 Mechanical final 079048.01 503639 -5489 N
Corrections/Comments/Instructions:
1 II PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL / CALL FOR INSPECTION ❑ ADDITION FE S ASSESSED
Inspector: Date: Phone #: (503) 718-
yi_L.
i t ( , , " .