Permit C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00560
DATE ISSUED: 9/12/03
IC'��i " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S136CA-90011
SITE ADDRESS: 10900 SW 76TH PL 01
SUBDIVISION: TIGARD WOODS A CONDO COMM ZONING: R -25
BLOCK: LOT: 001 JURISDICTION: TIG
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:
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:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of gas fireplace insert and gas piping.
Owner: FEES
ROBBIE MATTSON Description Date Amount
10900 SW 76TH AVE. #1
TIGARD, OR 97223 [MECH] Permit Fee 9/12/03 $72.50
[TAX] 8% StateTax 9/12/03 $5.80
Phone: 503 620 - 3005 Total $78.30
Contractor:
THERMAL FLO
14865 SW 74TH AVE. #190
TIGARD, OR 97224 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503
Final Inspection
Reg #: LIC 151847
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 -00
•
Issued By' / �� Permittee Signature:
f
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical�Periiut Application
Datereceived: 4 - Q3 Permitno.: NIrC�003�0.%
. i, i i." City of Ti E I E
t r y Project/appl. no.: A. Expire date:
Ci of Tigard Address: 13125 SW lvd, Ti ar OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639-414frItr 1 LO
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approl, TY OF TIGARD Building permit no.:
Id LDING DIVISION
n
, .TYPE OF PERMIT
1 & 2 family dwelling or accessory Cl Commercial/industrial ❑ Multi- family 0 Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
t
?_ r 2...10B` SITE INFORMATION " COMMERCIAL- VALUATION SCHEDULE '' -
Job address: locie30 5u,1 7c r o, , 4 1 Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: 1 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: jurisdiction's fee schedule for residential permit fee.
City /county: ZIP: ' 1 & 2 FA MILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: A CaAS AND COMMERICAL /INDUSTRIAL
FtA1 ,i'}C}k Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? ❑ Yes ❑ No Air conditioning (site plan required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
-: ..E IECHANICAL.CONTRACTOR '. -" Boiler /compressors
State boiler permit no.:
Business name: '
( �41'c,G..w LA._�c 7 , Ttic_ , HP Tons BTU /H
Address: f4(,5 .j vJ 7'-\ Tik Jam(. C - t' O Fire /smoke dampers /duct smoke detectors
City: 'T�,V fr - ) State: o �
it (ZIP: q, 77 1 Heat pump (site plan required)
Phone: 6 5 70. 5a ) i...V Fax:( E - mail: InstalUreplacefurnace / burner BTU /H
Including ductwork /vent liner 0 Yes 0 No
CCB no.: 161 Q - ] Install/replace /relocate heaters - suspended,
City /metro lic. no.: 75.0 7 wall, or floor mounted
Name (please print): A ro., Schk1tt-/Or Vent for appliance other than furnace
G t' r �` ` . '' CONTACT PERSON'' '' Refrigeration:
Absorption units BTU /H
Name: l �E-M2.tCA jr�,�,s Chillers HP
Address: x ._ ,.e-c2., A-6.1:0 LOlam. Compressors HP
Environmental exhaust and ventilation:
City: State: ZIP: Appliance vent
Phone: Z ? (c, • Fax: E-mail: Dryer exhaust
- % . Hoods, Type I/11/res. kitchen/hazmat
� ,' - s hood fire suppression system
Name: Re-664A, "4 p. 7-1-50N---) Exhaust fan with single duct (bath fans)
Mailing address: ‘.Oa.00-) , a jj 7(j� -t G , # ( Exhaust system apart from heating or AC
y. �t_C_, o I 0 ot Z Fuel piping and distribution (up to 4 outlets) //
Cit State: ZIP: ZZ3 Type: LPG IV NG Oil t
Phone: ,Zo Z . cx), S Fax: 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 I4 Ar_ - 1
Phone: 1 Fax: I E -mail: Woodstove/pelletstove
Other:
Applicant's signature( (2—Us-- Date:q - (Z,- Other:
Name (print): ( !t4,, fk P..t
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa ❑MasterCard Not Th permit application Minimum fee $ I2, 5 C
expires if a permit is not obtained Plan review (at %) $ / / Credit card number Expires within 180 days after it has been S
p State surcharge (8 %) $ 8v
Name of cardholder as shown on credit card $ accepted as complete. TOTAL $ 78. cJ
Cardholder signature Amount 440-4617 (6100 /COM)
-r
MECHANICAL PERMIT FEES
•
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELL.ING FEE SCHEDULE:
_. 1 Pn ce , : e ' Total
TOTAL VALUATION ,.. PERMIT FEE: : Descrption
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A.Mechanical-C ode, ..' .':. Qt' (Ea)v,; :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 heate r
$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 thaf apply , „ Boiler H eat Ar' g.
$1.20 for each additional $100.00 or For items 7 11 see o E Pump Corid
fraction thereof. footnotes below
r
Com 3 ` t� ' -� ,
Minimum Permit Fee $72.50 4 3 SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU , 14.00
8% State Surcharge $ 8) 3-15 HP; absorb
unit 100k to 500k BTU 25.60
25% Plan Review Fee (of subtotal) $ 9) 15 -30 HP; absorb 35.00
Required for ALL commercial permits only unit . -1 mil BTU .
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20
unit 1 -1.75 mil BTU
11) >50HP; absorb
unit >1.75 mil BTU 87.20
12) Air handling unit to 10 C FM
ASS, LIMED\ /ALUATION$PERA , ,' __ £rv'; 10.00
Value Total 13) Air handling unit 10,000 CFI`1+
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler •
ducts & vents ' 10.00
Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a sin<le duct
ducts & vents 6.80
Floor furnace including vent 955 16) Ventilation system not incluc ed in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in appliance 445 10.00
permit
Repair units 805 18) Domestic incinerators
17.40
< 3 hp; absorb. unit, 955
to 100k BTU 19) Commercial or industrial typa incinerator
69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101 k to 500k BTU 10.00
15 -30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outle s
mil. BTU 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (eacli)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: a -' $
>1.1. 75 mil. BTU Al
Air handling unit to 10,000 cfm 656 8% State Surcharge ,': '- $
Air handling unit >10,000 cfm 1,170 ? w
Non - portable evaporate cooler 656 - t -
TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446 ' t
Vent system not included in 656 $
appliance permit .
Hood served by mechanical exhaust 656 Other Inspections and Fees:
Domestic incinerator 1,170 1. Inspections outside of normal IN isiness hours (minimum charge -two hours)
$62.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is s pecifically indicated (minimum charge -half hour)
Other unit, including wood stoves, 656 $62.50 per hour
inserts, etc. 3. Additional plan review required )y changes, additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge -one -half hour) $62.50 peer hour
Each additional outlet 63 * State Contractor Boiler Certifi:ation required for units >200k BTU.
TOTAL COMMERCIAL $ * * Residential A/C requires site plan showing placement of unit.
b
VALUATION: ^ -. ' All New Commercial Buildi igs require 2 sets of plans.
is \dsts \forms\mech - fees.doc 02/11/02
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION - Business Line: (503) 639 -4171 MST
BUP
Received 9 Date Requested / 1-1 AM P BUP
Location / 0 7 �-e Suite ! MEC , "J
' D0,5"IDD
Contact Person - Ph ( 57 2 -7/ z '? PLM
Contractor ��'(rt, -P -A�1ir -rtr Ph ( ) b� r A', 3 SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
Aeg rArTrrv'
Po : Beam
41010
mpers
, PART FAIL
TRICAL
Service ,
Rough -In
UG /Slab
Low Voltage
Fire Alarm •
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 'Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line 61 ADA Date / J r� v� Inspector Ext
Approach /Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL