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Permit CITY OF TIGARD MECHANICAL PERMIT j DEVELOPMENT SERVICES PERMIT #: MEC2000 -00401 N' = 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/9/00 PARCEL: 1S136CA-04100 SITE ADDRESS: 11140 SW 79TH AVE SUBDIVISION: FRIENDLY ACRES ZONING: R -4.5 BLOCK: LOT: 007 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: 1 > . 10000 cfm: Remarks: Gas Furnace Owner: FEES JOHNSON, LEROY HALL + Type By Date Amount Receipt BAERWALD, KENNETH FRED /LOIS MA PRMT CTR 10/9/00 $72.50 2720000000 11140 SW 79TH AVE 5PCT CTR 10/9/00 $5.80 2720000000 TIGARD, OR 97223 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 Insp 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 95 4001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (50 246-91 °. Issue By: f �jyy/ e L Permittee Signature: Call (5039 -4175 by 7:O0 P.M. for inspections needed the next busine- - day .. __ Mechanical Permit Application Date received: Permit no,: i2iiZ /0/ _,:i t City of Tigard Project/appl. no.: Expire date: City of Tigard 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 ❑ New construction ❑ Addition/alteration/replacement ❑ Other: JOB SITE INFORMATION • COMMERCIAL VALUATION SCHEDULE . Job address: /(/ 470 Sic) 7q Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: I Suite po.: value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: profit. Value $ . Lot: Block: I Subdivision: *See checklist for important application information and Project name: /f- JS671J jurisdiction's fee schedule for residential permit fee. City /county: 76 I ZIP: 7 3-- 3 1 & 2 FAMILY DWELLING PERMIT' FEE SCHEDULE . Des ri��ion and location of work on pre ises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE ��fYS Fr. 2-N /�e____ -24 -re Fee(ea.) Total Est. date of completion/inspection: Description Qty. Res. only Res. only Tenant improvement or change of use: HVAC: Is existing space heated or co • itioned? Yes ❑ No Air handling unit CFM Air conditioning (site plan required) Is existing space insulated `Yes ❑ o Alteration of existing HVAC system . , MECHANICAL CONTRACTOR - Boiler /compressors Business name: T/��� TT � � • / � -� L 2t17 0 Stat boiler permit no.: ,� t -i HP Tons BTU /H Address: / / , .S. Ct(4 �ii4 /e te - - Z) VL Fire /smoke dampers /duct smoke detectors City: � 7 ei d Ci 6 I State:0/e ZIP: C? 70 q S - --- Heat pump (site plan required) / Install/replace Phone: Fax E furnace/burner 7 BTU /H — 20 1 �j j 7 O � / �/ Including ductwork/vent liner ylYes ❑ No ( 1���� CCB no.: 7? 6 .2- 3 Install /replace /relocate heaters - suspended, City /metro lic. no.: • wall, or floor mounted Name (please print): At C � �( )(S cv■--. Vent for appliance other than furnace • CONTACT PERSON Refrigeration: Absorption units BTU /H Name: /4"(.- ��'. LCl k S �y-� Chillers HP Address: Compressors HP Environmental exhaust and ventilation: City: I State: I ZIP: Appliancevent Phone: 5 72- -. 76v0 Fax: E -mail: Dryer exhaust • OWNER Hoods, Type I/ II/res. kitchen/hazmat hood fire suppression system Name: Ge. c17 fpA¢-N S' Exhaust fan with single duct (bath fans) s Exhaust system apart from heating or AC Mailing address: ��/ y o .Sc- 7� Fuel piping and distrib ion (up to 4 outlets) _ City: 7 r 2iz / I Statei7 I ZIP: q 7.2-J-3 Type: LPG NG Oil ( 5; Flu Phone: &3 - 33)- o 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: State: I ZIP: _Insert -type Phone: Fax �E:inail: Woodstove /pellet stove Other: ApplicanKsignat ��__ ` D. te: p - -z2- Other: Name (print): A--z._ a-2. Ci • ca-i. Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $-�? ❑ Visa ❑MasterCard Notice: This permit application Minimum fee $ - 72. 5 0 / expires if a permit is not obtained Plan review (at %) $ Credit card number: Expires within 180 days after it has been p accepted as com lete. State surcharge ( 8%) $ . 7� te Name of cardholder as shown on credit card p p TOTAL $ 7 ' 3D Cardholder signature Amount • 440 -4617 (6 /00 /COM) • Commercial Schedule 1 &2 Family Dwelling Schedule ASSUMED VALUATIONS PER APPLIANCE Description Furnace to 100,000 BTU Table 1A Mechanical Code Qty Price Total including ducts & vents 955 _ 1) Furnace to 100,000 BTU / cc' including duds & vents 14.00 /Z-1 Fumace > 100,000 BTU 2) Furnace 100 BTU+ including ducts & vents 17.40 including ducts & vents 1,170 3) Floor Furnace including vent 14.00 floor furnace 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 - 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 9) 15- 3o,HP; absorb unit .5 -1 mil BTU 35.00 101k to 500k BTU 1700 10) 30 -50 HP: absorb unit 1- 1.75 - mil BTU 52.20 15 -30 hp; absorb.unit 11)>soHP; absorb unit >1.75 mil BTU 87.20 501k to 1 mil. BTU 2310 12) Air handling unit to 10,000 CFM • 30 -50 hp; absorb.unit 10.00 13) Air handling unit 10,000 CFM+ 1 -1.75 mil. BTU 3400 17.20 > 50 hp; absorb.unit 14) Non - portable evaporate cooler 10.00 > 1.75 mil. BTU 5725 15) Vent fan connected to a single duct 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, including wood stoves 10.00 Domestic incinerator 1170 21) Gas piping one to tour outlets ( 5.40 S d 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 572.50 SUBTOTAL > Gas piping 1-4 outlets 360 8% SURCHARGE Each additional outlet 63 PLAN REVIEW 25% OF SUBTOTAL y xa 4j Required for ALL commercial permits only - ___,- :.;qt -, TOTAL '-'s4 °3 Other Inspections and Fees: 1. Inspect outside or normal business fours (minimum charge -two hours) 572.50 per tour 2. Inspections for which no fee is specifically indicated (minimum charge -hall hour) 572.50 per hour Total Valuation - Fee 3. Additional plan review required by changes. additions or revisions to plans (minimum charge-one-hat( hour) 572.50 per hour 'Stale Contractor Boiler Certification required $1.00 to $5,000.00 Minimum $72.50 - "Residential A/C requires site plan showing placement of unit $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for ( q` c)-0 each additional $100.00 or fraction thereof, q U to and including $10,000.00 /, F $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 / C-1 C/ for each additional $100.00 or fraction / thereof, to and including $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 �a. '24 -Hour Inspection Line: 639 -4175 Business Line: 639-4171 BUP Date Requested /0- /0 AM PM BLD Location /// 7 0 S h) Suite MEC 60'00 U/ Contact Person , l Ph j -5- 0 PLM Contractor Ph SWR BUILDING Tenant/Owner 6s1,/' 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 CAS �it�ir.rs _ •TESL = 3.6 i?S°_r moo/- /J frphA/' S Insulation • Drywall Nailing CM # U tz I 1 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 ASS EART 13 ECHANICAD Post & Beam , nugbJn .Gas Line.) Smoke Dampers Fi A 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 Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Date /i Ins Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.