Permit ~' a CITY OF TIGARD MECHANICAL PERMIT
t�, DEVELOPMENT SERVICES PERMIT #: MEC2000 -00487
"I I 1 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/14/00
PARCEL: 1 S 136AA -02000
SITE ADDRESS: 10340 SW 69TH AVE
SUBDIVISION: FUR VALLEY ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
GAS 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 2
> 10000 cfm:
Remarks: Replace Furnace
Owner: FEES
DAVID GLASGOW Type By Date Amount Receipt
10340 SW 69TH PRMT CTR 12/14/00 $72.50 2720000000
TIGARD, OR 97223 5PCT CTR 12/14/00 $5.80 2720000000
Total $78.30
Phone:
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503 - 557 -2220 Mechanical lnsp
Reg #: LIC 72623 Final Inspection
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 -0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503)246-9189.
Issue By: i �Q /yr] Permittee Signature: adopt
Call ( 3) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Date received: Pe o.2 OW -O a
e.,„,,elovit, City of ><gar Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Bi,rlfl 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171 Ei���� --
Fax: (503) 598 -1960 1 ZQpq Case file no.: Payment type:
Land use approval Building permit no.: •
e EtBY • •
TYPE OF PERMIT
ifl & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION • COMMERCIAL VALUATION SCHEDULE
. Job address: /Q34/0 .S'ZJ i - n Q7,,2.3 Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: 'Block: ISubdivision: *See checklist for important application information and
Project name:ja /v 61QS60p.t.) jurisdiction's fee schedule for residential permit fee.
City /county: 7/s47 v I ZIP: Q 7.2_23 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Descrirpti� and of work on premises: - AND` COMMERICAL /INDUSTRIAL SCIIEDULE
�,CP /44$ ✓!oa C/e Fee(ea) Total
Est. dale of completion/inspection: /2 - /%'- O Description Qty. Res.only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned ?,Yes ❑ No Air handling unit CFM
Air conditioning (site plan required)
Is existing space insulated? ► • es ❑ No Alteration of existing HVAC system
i1 CONTRACTOR Boiler /compressors
%-j A /�_ State boiler permit no.:
Business name:
C "tit t/!7Z> Tlrs� / OJ'lTl1D / HP Tons BTU /H
Address: 3/. SD S.' (1 /.40.4'd,',4,`
gC�,rGg,s /�/ a _. Fire /smoke dampers/duct smoke detectors
City: � pyt C ,y'(� Mate: 6 el ZIP: 070/5" , Heat pump (site plan required)
Phone _6� 7�?O I Fax _0Q9/C) I E -mail: InstalUreplace furnace /burner c O
Includin rork/vent liner Yes BTU /H ❑ No �,
CCB no.: =4...1_7 7 Install/replace/relocateheaters- suspended,
City /metro lic. no.: //I /' wall, or floor mounted
Name (please print):: qp & . Vent for ap I liance other than furnace
CONTACT PERSON Refrigeration: _.-
Absorption units BTU/H
Name: f+�i4.�! Chillers HP
Compressors HP
Address: Environmental exhaust and ventilation:
City: I State: ' Appliance vent
Phone: Fax: E -mail: Dryer exhaust
Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: MOW -t &,fritci. 4I,QSAD /0 Exhaust fan with single duct (bath fans)
Mailing � - Exhaust system apart from heating or AC
Fue pip g an d ton (up to 4 out ets
1e:jjFax:E-rnj : Fuel piping each additional over 4 outlets
Process piping (schematic required)
Number of outlets .
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert-type
Phone: 1 Fax: 1 E -mail: Woodstove/pelletstove
Other:
Applicant's signature: I Date: Other:
Name (print):
Not all jurisdictions accept credit cards, please call jurisdiction for more infonnation. Permit fee $ Z2:
❑ Visa ❑MasterCard Notice: This permit application Minimum fee $
/ expires if a permit is not obtained Plan review (at %) $
Credit card number: Expires w ithin 180 days after it has been
p State surcharge (8 %) .... $ ��
Name of cardholder as shown on credit card accepted as complete. TOTAL $ 'g,-_e)
Cardholder signature Amount 440 -4617 (6/00/COM)
Commercial Schedule
1 &2 Family Dwelling Schedule
ASSUMED VALUATIONS PER APPLIANCE
Description
Fumace to 100,000 BTU . Table 1A Mechanical Code Qty Price Total
ducts & vents 955 1) Fumace to BTU
including ducts & 0 vents g including duds & vents 14.00 ,/
Furnace > 100,000 BTU 2) Fumace 100,000 BTU+ /7 4
including ducts & vents ( 17.40 1
including ducts &vents 1,170 3) Floor Furnace • •
including vent 14.00
floor fumace 4) Suspended heater, wall heater
including vent 955 or floor mounted heater 14.00
suspended heater, wall heater 5) Vent not included in appliance permit 6.80
or floor mounted heater 955 6) Repair units 12.15
Check all that apply: 'Boiler Heat Air
Vent not included in appliance permit 445 For items 7 -10, see or Pump Cond Qty Price Total
Repair units 805 footnotes 1,2 Comp
P 7) <3HP; absorb unit to
< 3 hp; absorb.unit 100K BTU 14.00
8) 3 -15 HP; absorb unit
to 100k BTU 955 100k to 500k BTU 25.60
3 -15 hp; absorb.unit unit 5 mil BTU 35.00
- 101k to 500k BTU 1700 10) 30 -50 HP; absorb
unit 1-1.75 mil RT11 52.20
15-30 hp; • absorb.unit 11) >50HP; absorb unit >1.75 mil BTU
87.20
501k to 1 mil. BTU 2310
12) Air handling unit l0 10,000 CFM
30 -50 hp; absorb.unit 1000
13) Air handling unit 10,000 CFM+
1 -1.75 mil. BTU 3400 17.20
• > 50 hp; absorb.unit 10.00
Non potable evaporate cooler 1000
> 1.75 mil. BTU 5725 15) Vent fan connected to a single dud
6.80
Air handling unit to 10,000 cfm 656 16) Ventilation system not included in
appliance permit 10.00
Air handling unit > 10,000 cfm 1170 17) Hood served by mechanical exhaust
Non-portable evaporate coller 656 10.00
Non -
P P 18) Domestic incinerators
vent fan connected to a single duct 446 17.40
19) Commercial or industrial type incinerator
Vent syst. not included in appliance permit 656 69.95
Hood served by mechanical exhaust 656
20) Other units inducting wood stoves 10.00
Domestic incinerator 1170 21) Gas piping one to four outlets
5.40
Commercial or industral incinerator 4590 22) More than 4-per outlet (each)
1.00
Other unit, including wood stoves, inserts, etc. 656 Minimum Permit Fee $72.50 SUBTOTAL aglow -
Gas piping 1-4 outlets 360 8% SURCHARGE wag ENS
Each additional outlet 63 PLAN 25% OF SUBTOTAL : °a -v
Required for ALL commercial permits only .' yam_ ^
r_;..
TOTAL MI
MI
Other Inspections and Fees:
1. Inspections outside of normal business lours (minimum charge -two hours)
572.50 Per hour
2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
_. _s72.50 per four
Total Valuation Fee 3. Additional plan review required by changes.. additions or revisions to plans (minimum
charge-one-half hour) 872.50 per hour
•State Contractor Boiler Certification required
$1.00 to $5,000.00 Minimum $72.50 "Residential me requires site pan shaving placement of unit
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
each additional $100.00 or fraction thereof,
•
to and including $10,000.00
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54
for each additional $100.00 or fraction
thereof, to andincluding $25,000.00
$25,001.00 to $50,000.00 ' $379.50 for the first $25,000.00 and $1.45
for each additional $100.00 or fraction
thereof, to and including $50,000.00
$50,000.00 and up $742.00 for the first $50,000.00 and $1.20
for each additional $100.00 or fraction
• thereof
CITY OF TIGARD BUILDING INSPECTION DIVISION -. MST
24 -Hour Inspettion1 ine: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /Zi t I AM PM BLD
Location 1 b 3 ScA) GI +4 Suite MEC 'Caro — (9.94[10
Contact Person Ph PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer .
Rain Drains
Final
P SS PART FAIL
ost & • eam
Rough In
Gas Line 0 Smo - ampers
F
PART FAIL
• CTRICAL
Service
Rough In
UG /Slab
•
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer.
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
• Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date /2/14/ f Inspector D/ 41%. Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour InspetionLine: 639 -4175 Business Line: 39 -4171 &Mr
// /
Date Requested / . Z ��/ ) AM PM BLD
Location /03 qv ,5 tv Suite —.1 124 2. Gc.) aJ
Contact Person Ph S0 - f57 -ZZ& PLM
Contractor Ph SWR
/�
BUILDING Tenant/Owner /� I "GI 3-C C4 (( C t,� v ■► ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Ina Sheath /Shear G �! /1/1 _ /�/� Lori
Framing �j (� �J OU O
Insulation O � . l' _
Drywall Nailing � `�,✓� %
Firewall
Fire Sprinkler
Fire Alarm W /; S (-49
Susp'd Ceiling �Jw��
--- ✓✓lll���II l
Roof
Misc: 511."\--Q n 4 / l ,,
6 V V 'H lJ�` `�
PA Final SS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
d {A CH ANIC
Post & Beam
gpu In
as Li
Smo e_ Dampers
m
PART 42
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA ( a b /C. Inspector
3 (7
Approach /Sidewalk Date \ 11% S l Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.