Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2016-00060
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/25/2016
Parcel: 2S 104AA90051
Jurisdiction: Tigard
Site address: 12666 SW KAREN ST 5
Project: BELLWOOD TERRACE LLC Subdivision: BELLWOOD TERRACE CONDO Lot: 5
Project Description: Replacing clothes dryer venting.
Contractor: RELIABLE HOME IMPROVEMENT INC Owner: BELLWOOD TERRACE LLC
PO BOX 230815 PO BOX 189
TIGARD, OR 97281 YAMHILL, OR 97148
PHONE: 503-481-0240 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Clothes Dryer Exhaust 01/25/2016 $33.39
Type of Use: MF 12%State Surcharge-Mechanical 01/25/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 01/25/2016 $56.61
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if wor s not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to fo w the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090 Y u may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By a ee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspe ion date.
This permit card shall be kept in a conspicuous place on the job site u I completion of the project.
Approved plans are required on the job site at the time each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
Received gg
City Of Tigard ° DateiBy: O`� t� PennitNo.:
13135 SW'Hall Blvd.,Tigard,OR 97223 <3 Plan Review
� Phone: 503.713?439 Fax: 503.595.19 �� b►` Date By: Other Permit:
Inspection Line: 503.639.4175 ,, Date Ready By: Juns: ® See Page 2 for
Internet: www.tiaard-or.gov J`" Notified.Method: 7-7- Supplemental Information
TYPE OF WORK . ' C6Mfl1ERCIAL FEE*.SCHEDULE =USE CAECKL7ST'=`
Mechanical permit fees*are based on the value of the work
'�Ped'd
❑ New construction o& ition,!altera � Mfki ment performed. Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑ Other:
mechanical materials,equipment.labor,overhead,and profit.
_ Value:S
CATEGORY OF CONSTRUCTION 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. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating cooling:
Air conditioning 46.75
Job site address:
Furnace 100.000 BTU(ducts vents) 46.75
City/State/ZIP: 1 Furnace 100,000+BTU(ducts vents) 54.91
Heat pump 61.06
Suite/bldg.iapt.no.: Project name: l t� � 1 Duct work 03.32
Cross street directions.Iffto job site: Hvdronic hot water system 23-32
Residential boiler(radiator or
hvdronic) 23.32
Unit heaters('fuel-type,not electric)•
in-wall,in-duct.suspended,etc. 46.75
Flue vent for anv of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF `FORK Gas fireplace insert 33.39
Flue vent for water heater or gas
V90* fireplace 23.32
r
Log lighter(gas) 23.32
Wood.pellet stove 33.39
Wood fireplace."insert 23.32
Chimnev:'liner fluervent 23.32
Other: 723.32
ROPERTY+OWNER ❑ TENANT
Environmental exhaust and ventilation:
Name: Z Range hood other kitchen
equipment 33.39
Address: L L Clothes dryer exhaust 33.39 �j•
City/State/ZIP: Single-duct exhaust(bathrooms.
/ toilet coartments.utility rooms) 23-32
m m
Phone:( ) Fax:( ) Attic;crawlspace fans 23.32
❑; APPLICANT 95-CONTACT,PERSON Other: 23.32
w
Business name: s Fuelpiping:
A L � �(
SI4.15 for first four;$4.03 for each additional
Contact name: Furnace.etc.
Gas heat um
Address: U 1 Wall suspended unit heater
City/State/ZIP: �� �� �� Water heater
Phone:4c.,�) L - Fax: :( ) Fire lace
t �,pp _^� Ranoe
E-mail: (e` L' !11 e f G *f ' — Barbecue
CONTRACTOR VClothes dryer(gas)
Business name: Other:
MECHANICAL PERMIT FEES*
Address: 3
Subtotal
City!State/ZIP: Minimum pennit fee(590.00) 6111.4cQ
Plan review(25%of permit fee) .�
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB he.: TOTAL PERMIT FEE
This permit application expires if a per is not obtai ed within 180
days after it has been accepted as complete.
Authorized signature: �� * Fee methodology set by Tri-County Building Industry Service Board
Print name: &Z- —ze-1
1.Buildtna Permits VIEC_Peil5l'p 9.701 I3.doc 440-9617T(I 10'_Co,,,wEB)