Permit CITY T I GA R D MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2001 -00132
�I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/29/01
PARCEL: 2S112AC -01200
SITE ADDRESS: 14865 SW 74TH AVE 270
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT: 020 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS: 1
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:
Remarks: type 1 hood
Owner: FEES
KNHS DEVELOPMENT CO Type By Date Amount Receipt
26262 S MERIDIAN RD PRMT CTR 5/29/01 $140.90 2720010000
AURORA, OR 97002 5PCT CTR 5/29/01 $11.27 2720010000
PLCK CTR 5/29/01 $35.00 2720010000
Phone: Total $187.17
Contractor:
REQUIRED INSPECTIONS
Hood Inspection
Phone: Final Inspection
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 -0080.
You may obtain copies of these rules or direct questions to OUNC b calling (503)246-9 ;9. / /
Issue By: 4J&i L 7724) Permittee Signature: ) / b11
j � �
,: g'
o
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
4 2 X1o'
_
.- Mechanical Permit Application y�� "�� �
Date received: I-112 3/0( Permit rlcl.f.GC.OS bO / - V /3;
rr v t4 �, 1 I A
Ali. 11.. City of Ti Project/appl. no.: Expire date: •
CiryofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory % Commercial/industrial ❑ Multi- family • ❑ Tenant improvement
0 New construction ❑ Addition/alteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: I L-I- $fn St.3 1. Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: 1 Suite no.: 0_P value of all mecha ical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ 9 ,5 - p O ,
Lot: IBlock: I Subdivision: *See checklist for important application information and
Project name: k -i 1,V> Ce.APA I inn l jurisdiction's fee schedule for residential permit fee.
City /county: - Tc nd ZIP: J 1 & 2 FAMILY ; DWELLING PERMI FEE .SCHEDULE
Description and I ation of work on premises: AND COMMERICAL/INDUSTRIAL EQ IPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: _ HVAC:l 0,'ilau2d-2.6"l ',y,
Is existing space heated or conditioned? 0 Yes ❑ No Air handling unit CFM Z�w
Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
• MECHANICAL CONTRACTOR Boiler /compressors
-�� p State boiler permit no.:
Business name:
C.t ). . 1 -x`t, HP Tons BTU /H
Address: / 5, P /2hyeQj Cri Fire/smoke dampers/duct smoke detectors
City: c i �;Li State:O�L ZIP: " Heat pump (site plan required)
Phone:(. ,-/ %go Fax:65c 30q E- mail:Cfl C vat nstadireplacefuab BTU /H
i ncluding duc[work/vent rnce/urner liner ❑ Yes 0'�Io
CCB no.: , - 7282q InstalUreplace /relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): ' JJ' • vvrt m • _ Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU /H
Name: 1\),A11 _. y f- . A Chillers HP
Address: Compressors HP
t� Environmental exhaust and ventilation:
City: Chw ( I State: _I ZIP: ?` V Appliance vent
Phone: (, . -} 5'90 ' Fax:(, -, aq ' E -mail: Dryer exhaust
OWNER s o • s, Ty p. (g es. kitchen /hazma S..— /
. .._Lire suppressionsystem 11"
Name: 641.0 lut' Exhaust fan with single duct (bath fans)
Mailing address: 7/) 1C 1 Gil Exhaust system apart from heating or AC •
Fuel piping and distribution (up to 4 outlets)
City: .j/4p, I State: cje... I ZIP: °in fld Z_ Type: LPG NG Oil
Phone: (j 7''- $? ; Fax: 6,7 / Z E -mail: Fuel piping each additional over 4 outlets
ENGINEER - Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: I Fax: E -mail: Woodstove/pelletstove
, Other:
Applicant's signature/ ' - 'j / /(' of I Date: C/74 /� Other:
(, t
Name (print): t'Y,, y avz.4 OY7Lt.J 3 1 • /�/ /�
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ ! / Q , 7 6
CI Visa ❑MasterCard Notice: This permit application Minimum fee $
/ expires if a permit is not obtained Plan review (at Z.S %) $ .3 5
Credit card number: Expires within 180 days after it has been
accepted as complete.
State surcharge (8 %) .... $ /7 , a2 7
a cre
Name of cardholder as shown on credit card p p TOTAL $
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) Furnace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 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 Furnace
$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) <3HP;absorb unit
to 100K BTU 14.00
ASSUMED VALUATIONS PER APPLIANCE: 8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount 9) 15 -30 HP; absorb
Furnace to 100,000 BTU, including 955 unit .5 -1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents 11) >50HP: absorb
Floor furnace 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+
permit 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 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 656 69.95
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% State 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 NC requires site plan showing placement of unit.
is \dsts \forms\mech - fees.doc 10/11/00 .
CITY OF TIGARD BUILDING INSPECTION DIVISION --MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
•
Date Requested �� 3� AM PM BLD
Location / c/ n S 5 w 7" ?7E. P Suite 2 2 v MEC 2e).0/--&0/3
2
Contact Person Ph g.3 9 4 j 73 PLM
Contractor Ph SWR
BUILDING Tenant/Owner J. J,( CGW r ELC
Retaining Wall ELR
Footing Access: —
Foundation / . / 9 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
PASS PART FAIL
SMECHANICAL
Post & Beam Jf9_ /
Rough In I
Gas Line
Hoke Dampers
PASS PART FAIL
TRICAL
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 �� I 1
Approach /Sidewalk Date — I 10 I Ins Ext
Other 6
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.