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Permit CITY TIGARD MECHANICAL PERMIT liA DEVELOPMENT SERVICES PERMIT #: MEC2001 -00176 " r � l I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/29/01 PARCEL: 2S112CB -15300 SITE ADDRESS: 15179 SW 84TH AVE SUBDIVISION: HAMPTON COURT ZONING: R -7 BLOCK: LOT: 002 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: 1 DOMES. INCIN: 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: FURN > =100K BTU: < =10000 cfm: GAS OUTLETS: > 10000 cfm: Remarks: Installation of exterior A/C unit. Unit cannot be placed in the required setbacks. Owner: FEES ERIK SIMSHAUSER Type By Date Amount Receipt 15179 SW 84TH PL. PRMT CTR 5/29/01 $72.50 2720010000 TIGARD, OR 97224 5PCT CTR 5/29/01 $5.80 2720010000 Total $78.30 Phone: 503 - 968 -8285 Contractor: SPECIALTY HEATING & COOLING 9528 SW TIGARD ST TIGARD, OR 97223 REQUIRED INSPECTIONS Mechanical lnsp Phone: 620 -5643 Final Inspection Reg #: LIC 66578 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: •a / - A t Permittee Signature: , y Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day If4 . _ Air • i Mechanical Permit Application Date received: S Q / Permit no.: M At r j/ - / ' , . � City of Tigar Project/appl. no.: Expire date: City ofTigard 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 Pi RMIT ' K 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement 0 New construction ddition/alteration/replacement 0 Other: JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE Job address: /5/ 7'7 ,51,v Tr " Pi_ 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: I Subdivision: *See checklist for important application information and Project name: Si ' 11,44.4.S" — jurisdiction's fee schedule for residential permit fee. City /county: name: - /- I ZIP: (7 .9-'-/ 1 & 2 FAMILY DWELLING PERMIT FIE SCHEDULE Description and location of work on premises: .A_r,,,f/ ' C — AND COMMERICAL/INDUSTRIAL EQUIPMENTSCIIEDULE 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 conditioned? 0 Yes 0 No Air handling unit CFM Air conditioning (site plan required) Is existing space insulated? 0 Yes U No • Alteration of existing HVAC system 1%IECIIANICAL CONTRACTOR Boiler /compressors State boiler permit no.: Business nameLS 4-L . 'ir 9 e *6 17 /IC HP Tons BTU/H Address: 96 c -8' (SW ') ' ,g/ / —Heat dampers/duct smoke detectors City: '7 c i I State: 4 ZIP: q 7,9 9.3 Heat pump (site plan required) Phonef�3 Fax. 98- p 7 /' - mail: Instal Vreplace furnace/burner BTU /H Including ductwork/vent liner 0 Yes 0 No CCB no.: d,4.5 7 e Instal lreplace/relocate heaters— suspended, City /metro lic. no.: lb 9c, wall, or floor mounted Name (please print): • o p t i A 1-14 eIS Vent for appliance other than furnace CONTACT PERSON Refrigeration: ._ Absorption units BTU/H Name: A-T 1 1.-Ce N 14 ✓1 a 4 Chillers HP Address: Q'Sa- 8- Sc-c) 7 /1 G' S' % Compressors HP City: Tr �ti I I 9 70 Environmental exhaust and ventilation: Ci 0 Sta e :r ZIP: _Appliance vent Phone5d3 (o -6( C' Fax:59(o9 /S' E -mail: Dryer exhaust OWNER Hoods, Type I/ II/res. kitchen/hazmat In hood fire suppression system Name: / v / 01 S S e'r Exhaust fan with single duct (bath fans) Mailing address: / S 11 79 SW s � i G �i Exhaust system apart from heating or AC City: • / ,249 I State:D I ZIP. 7�4-4 Fuel piping and distribution (up to 4 outlets) Type: LPG NG Oil Phone: r- 9. r c Fax: E -mail: 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: [ZIP: Insert—type Phone: I Fax: I E -mail: Woodstove/pellet stove Other: Applicant's sign�a `re:l�'a (0,4 Date6 f S4) ( O� Other. Name (print): "A it )Leek s t4J€ ' �7 Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ "lc 5 O 0 Visa 0 MasterCard Not Th permit application Minimum fee $ Credit card number. / / expires if a permit is not obtained Plan review (at %) $ S R() Expires within 180 days after it has been State surcharge (8 %) .... $ Name of cardholder as shown on credit card accepted as complete. TOTAL $ 1 i. 3C) 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 ucts & vents 955 1) Furnace to duds & vents BTU g including duds &ents 14.00 Furnace > 100,000 BTU 2) Furnace 100,000 BTU+ including ducts & vents 17.40 including ducts & vents 1,170 3) Floor Furnace floor furnace including vent 14.00 4) Suspended heater, wall heater including velit 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 Hems 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 -30 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) >50HP; 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; absofb.Urllt 14) Non -portable 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 • 10.00 Non - portable evaporate coller 656 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 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 i Gas piping 1-4 outlets 360 8% SURCHARGE ten auk Each additional outlet 63 PLAN REVIEW 25 % OF SUBTOTAL A_.. Required for ALL commercial permits only TOTAL • Other Inspections and Fees: I. Inspections outside or normal business hours (minimum charge -two hours) 272.50 per hour 2. Inspections for which no fee s specifically indicated (minimum charge-half hour) 372.50 per hour Total Valuation Fee 3. Additional plan renew required by flanges. additions or revisions to plans (minimum charge how) $72.50 per hour 'Slate Contractor Boiler Certification required $1.00 to $5,000.00 Minimum $72.50 "Residential NC requires site plan stowing 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 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 $100.00 or fraction thereof • X 0 A4' •CITV'--`QF TIGARD BUILDING INSPECTION'DIVISIbN • 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP Date Requested ? AM PM BLD • Location /57 7 f 5" f i ' Suite MEC Z / 76 Contact Person /A A_ Ph w ZG 5 C/3 PLM Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab . SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear J , Framing 0 / f .4- 7Zi('A(. i.,u L y 7 f I - ! {��`jGC 62- P VC ��� �., T Insulation Drywall Nailing .. Firewall Fire Sprinkler, - Fire Alarm . Susp'd Ceiling .. Roof - Misc: Final • PASS PART FAIL PLUMBING Post &Beam Under Slab • Top Out Water Service - Sanitary Sewer • Rain Drains Final • PASS PART FAIL CH . Post& Beam Rough In Gas Line - - Smoke Dampers ASS PART FAIL ELECTRICAL Service • Rough In UG /Slab Low Voltage . Fire Alarm Final • PASS PART. FAIL . SITE • Backfill /Grading' '• Sanitary Sewer • Storm Drain • [ ] Reinspection fee of '$ required before next-inspection. Pay at City Hall, 13125•SW HaII Blvd Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access Fire Supply Line ADA Approach /Sidewalk Other Date 7-43— G /- Inspector o Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.