Permit C ITY OF TIGARD MECHANICAL PERMIT
iI DEVELOPMENT SERVICES PERMIT #: MEC2001 -00385
<.� - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/31/01
PARCEL: 1 S136AA -00801
SITE ADDRESS: 10380 SW 71ST AVE
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR 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:
LPG 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: AIR HANDLING UNITS OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Installation of new gas insert and gas piping.
Owner: FEES
COLOMA, DALE A + CHARLOTTE K Type By Date Amount Receipt
10380 SW 71ST AVE PRMT CTR 10/31/01 $72.50 2720010000
TIGARD, OR 97223 5PCT CTR 10/31/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503 - 656 -1184 Mechanical Insp
Reg #: LIC 447 Final Inspection
PLM 3 -286PB
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 i - suance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to low rules adopted in the Oregon
Utility No • = • • Center. Those rules are set forth in OAR 952 -001 1014 through OAR
95 :81-0080. Yo q ay ob - • •ies of these rules or direct ques on- • OUNC by calling
f. A19dR -Q1RQ �
Issue By: • "'fill • / � //„.% Permittee Signature:
Call (503) 63 ' -4175 by 7:00 P.M. for inspections nee. • d he ext business day
- A Mechanical Permit Application
Date received: /, ,,g/ 4/ Permitno.: /.4,,GD/. evgg
44- ,J I City of Tigard Project/appl. no.: Expire date:
CityojTigard Address: 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 -4171 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
l'11'E OF PERM I1
1a1 & 2 family dwelling or accessory O Commercial/industrial U Multi - family O Tenant improvement
O New construction O Addition/alteration /replacement O Other:
.1011 SITE INF010E1110N COi1N9ERCIAL VALUATION SCHEDULE
Job address: l0 3 go 5s4, 7 It A ye, Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map/tax lot/account no.: profit. Value $ .
Lot: Block: Subdivision: *See checklist for important application information and
Project name: C + G — 60 c.0 jurisdiction's fee schedule for residential permit fee.
City/county: iti ZIP: R 7 z I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND CONIMERICALIINUUSTRIAL I QUIPi 1ENi'SCIIEDULI
6, k 5 Pi .r -p1 4 - ' C Fee(ea.) Total
Est. date of completion/inspection: Desert . i on Qty. Res. only Res. only
Tenant improvement or change of use: C ' ■ --
Is existing space heated or conditioned? O Yes O No Air handling unit CFM
Air conditioning (site plan required) IIIII
Is existing space insulated? O Yes O No Alteration of existing HVAC system IIII
191:C11:1NICA1. CONTR:1CT01Z State boiler boilerp permit no.:
,■■
Business name: � tater ermit
. A Al N , I HP Tons BTU/H
Address: - 5 - 5 0 S E ' t , z , AiL - Fire/smoke dampers/duct smoke detectors -
City: �Lk C K R M -r F ax: E-mail: ate: p /L ZIP: q 7 S Heat pump (site plan required) :
Phone: So;
• Install/replace furnace/burner BTU /H
I I ' Including ductwork/vent liner O Yes O No
CCB no.: +-ldt InstalUrepla " relocate heaters- suspended, II
City/metro lic. no.: wall, or floor mounted
Name (please print): A D 2.[—cv S � G t pi Vent fora • 'Hance other than furnace i
CON FACI PERSON Absorption units BTU/H III
Chillers HP MO
Co ressors HP
=
Address: i � � _ a , . nmeu ust an . ven 11 . I on: ■ --
r EMS ZIP: Appliance vent _
Phon o • - - ., 9 3 Fax: E -mail: Dryer exhaust ME
OWNER Hoods, Type I/ Il/res. kitchen/hazmat ■ __
hood fire suppression system
Name: 0. , 1 2_1_0 - rr, C'o c,o vt y1 Exhaust fan with single duct (bath fans) -
Mailing address: 0 I W I S -r , Exhaust s stem • • art • • m heatrn: or AC I=
NZI e p p , : an I n '*r t on up to ' ou ets e-
ZIP: 7 2:2_3 Type: LPG X NG Oil MI
Phone: 503 2 y - l Zy Fax: E -mail: Fuel . i . ing each additional over • outlets MN _
ENGINEER ' ' , p p (schematicrequired) - IM =MI
Name: Number of outlets
I er I app t or eq pment: ■ -
Address: Decorativeftreplace
City: State: ZIP: Insert - type — . Mii — I Ma
Phone: Fax: E -mail: Woodstov pellet stove
Other:
Applicant's signature j • • /,', j D ate: , , , t 1 er: Mill
Name (print): 54,., m , r `� -
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
O Visa O MasterCard Notice: This permit application Minimum fee $ 'I 2..5
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been State surcharge (8%) .... $
5. 9)0
Name of cardholder as shown on credit cars $ accepted as complete. TOTAL $ 7830
Cardholder signature Amount 440-4617 (6/00/COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: - Description: Price Total
$1.00 to $5,000.00 Minimum fee $72.50
- - Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Fumace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Fumace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Fumace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and - 5) Vent not included in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond
fraction thereof. _ footnotes below. Comp* **
7) <31 :absorb unit
ASSUMED VALUATIONS PER APPLIANCE: - to 100K BTU 14.00
8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount - 9) 15 -30 HP; absorb
Fumace to 100,000 BTU, including 955 unit .5-1 mil BTU 35.00
ducts & vents - 10) 30-50 HP; absorb
Fumace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents - 11) >50HP: absorb
Floor fumace including vent 955 - unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM
_floor mounted heater - 10.00
Vent not included in applicance 445 13) Air handling unit 10,000 CFM+
_ermit _ 17.20
Repair units 805 - 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 10.00
to 100k BTU - 15) Vent fan connected to a single duct
3-15 hp; absorb. unit, 1,700 6.80
101k to 500k BTU - 16) Ventilation system not included in
15-30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00
mil. BTU 17) Hood served by mechanical exhaust
30 -50 hp; absorb. unit, 3,400 10,00
1 -1.75 mil. BTU 18) Domestic incinerators
>50 hp; absorb. unit, 5,725 17.40
>1.75 mil. BTU Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 656 - 69
Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 - 10.00
_Vent fan connected to a single duct 446 - 21) Gas piping one to four outlets
Vent system not included in 656 5.40
appliance permit - 22) More than 4-per outlet (each)
Hood served by mechanical exhaust 656 - 1.00
Domestic incinerator 1,170 - Minimum Permit Fee $72.50 SUBTOTAL: $
Commercial or industrial incinerator 4,590 -
Other unit, including wood stoves, 656 .
8% Surcharge $
inserts, etc. -
Gas piping 1-4 outlets 360 _ 25% Plan Review Fee (of subtotal) $
Each additional outlet 63 _ Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION:
Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour.
2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
$72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimum
charge-one -half hour) $72.50 per hour
* State Contractor Boiler Certification required for units >200k BTU.
** Residential A/C requires site plan showing placement of unit
i:\dsts\forms\rnech- fees.doc 10/11/00 .
` f .F -
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 - 4171
BUP
Date Requested 1 -7 AM 1,131-V1 BLD
Location /D3 go - 71 r ' - C Suite MEC 02(X)7 60_1
Contact Person Q1j/L'C Ph 09 – 8 3 5 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 ONE -INNe , I Occ c./
Insulation
Drywall Nailing �� Sv1 v his,/ / viz' L4 h/
Firewall �O _ __
Fire Sprinkler / A 7 ;r1 o A I S ►�J� _ .
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
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
as
Smoke Da pers
'9 +� /
S P ��:1L , .
EL - CTRI
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
Other Date /1- f- a/ Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CI1 OF TIGARD BUILDING INSPECTION DIVISION MST
24 - Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /( ( AM PM BLD
Location /0 E13 7/.Zis * e___ Suite _ MEC ;L 7f 0 c3 ��
Contact Person Ph a 0 7 $ , ,S 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 O,S" ( S. 5.7 S
Insulation -
Drywall Nailing >� v7 -2n..c AC�<: ✓ /J-
Firewall n
Fire Sprinkler /'A 56 vcS c , 'Zi A- -/LZrti
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
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
erartr
SS.•, Dampers
vat
PASS PART FAIL
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
/ 11-/A
Approach /Sidewalk Date 11 t7/ Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.