Permit A CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2001 -00002
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/2/01
PARCEL: 2S 112CB -16000
SITE ADDRESS: 15301 SW 84TH AVE
SUBDIVISION: HAMPTON COURT ZONING: R -7
BLOCK: LOT: 009 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:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Installation of gas piping (from left side of garage to the right side).
•
Owner: FEES
•
RENEA BERGER Type By Date Amount Receipt
15301 SW 84TH AVE 5PCT CTR 1/2/01 $5.80 2720010000
TIGARD, OR 97224 PRMT CTR 1/2/01 $72.50 2720010000
Phone: 503-624-2308 Total $78.30
Contractor:
JAY'S GAS PIPING
11525 SW CANYON
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 626 -4652 Final Inspection
Reg #: LIC 0119836
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: / `' Perm ittee Signature: lC
Y � �i � _ �l g �
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
_A Datereceived:/ a 0/ Permit n o.- (CZDDO -. O p
,_ .� �_ City of Tigard P roject/appl. no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Dateissued: By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 PN Ta�O - Case file Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
0 I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: / S 3 d / Sc gc-/ /h ( -i v a 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: IBlock: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: j, A p, ZIP: 7z- .- 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of woyli on premises: 94s � h c. AND COMMERICAL /INDUSTRIAL EQUIPM ENTSCHEDULE
rro,?7 hr// S /ot.t ef' JG re 7 e 7/o r / 4 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? dYes 0 No Air conditioning (site plan required)
Is existing space insulated? Ja ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Nib Business name: �' GAS P rl State boiler permit no.:
,•';'" / r S HP Tons BTU /H
Address: I J Fire/smoke dampers/duct smoke detectors
City: I State: I ZIP: Heat pump (site plan required)
Phone: IFax: E-mail: I InstalUreplacefurnace/burner BTU /H
Including ductwork/vent liner ❑ Yes 0 No
CCB no.: () I lq 3 Cp InstalUreplace/relocate heaters — suspended,
City /metro lic. no.: UC7 p p 5 1 I 0 wall, or floor mounted
Name (please print): A ,o 11 e Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type 1/ IUres. kitchen/hazmat
hood fire suppression system
Name: (. ✓t Q Pt -e ( C .P ( Exhaust fan with single duct (bath fans)
Mailing address: /5' 30 ( 5 (,J 5 //‘ a 1/F. Exhaust system apart from heating or AC
r. let (o/ I State: d4 I ZIP: q 7 2 7- �( Fuel piping and distribution (up to 4 outlets)
City:
Type: LPG 2 NG Oil
Phone: , - 2c/ -23 Fax: E -mail: (ell e 4 / #H@ 44 (- 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: I ZIP: Insert — type
Phone: I Fax: I E -mail: Woodstove/pelletstove
Other:
Applicant's signature: „vim I Date: /_ 2 - o r Other:
Name (print): e" C to .2 .p rc P .
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa ❑ MasterCard Not Th permit application Minimum fee $ '79. , S U
/ expires if a permit is not obtained Plan review (at _ %) $
Credit card number: w ithin 180 days after it has been
Expires State surcharge (8 %) .... $ .5 ,Pr.)
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $ iV " 34
Cardholder signature Amount 440-4617 (6/00 /COM)
MECHANICAL PERMIT FEES T N.
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
I 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 t - er outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 UBTOTAL: $
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\mech-fees.doc 10/11/00
CITY OF TIGARD BUILDING INSPECTION DIVISION ,;; ` as Z
MST O �' G
244-lour Inspection Line: 639 -4175 Business Line: 639-4171 - -
BUP
D ate Requested / i Z AM PM BLD •
Location 1�3 0/ SL 6/ 7 rt 4 4 9 Suite MEC / -DOU D 7�
Contact Person Ph 780 -76 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 . •
Insulation y ,�
Drywall Nailing J I 1'• CO "?TA
Firewall
Fire Sprinkler Zaitb — OS M
Fire Alarm
Susp'd Ceiling JVCC) — 1 25 'Pr
Roof Z�rC• 1 : ��
Misc:
Final
PASS PART FAIL
PLUMBING 1■Mo — 1 roK) , iND ON's 1
Post & Beam
Under Slab No L 1 Nrjv4L - 2_ 1ST j - Ai ,M3t12_
Top Out
Water Service -
Sanitary Sewer .
Rain Drains
(1/-01 Final (
PASS PART FAIL
MEC11MCAt?
it
Post & Beam
Rough In
as Li
Smo a Dampers
Final
PASS PART FAIL)
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm -
Final
PASS PART FAIL .
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [y4 Reinspection fee of $ 6 • a) 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
Approach /Sidewalk Date I 12 D Inspector Ext
Other 1
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
1�
CITY OF TIGARD BUILDING INSPECTION DIVISION MS
24 -Hour Inspection Line: 639 -4175 ' Business Line: 639 -4171 •
BUP
Date Requested /7 -0 / AM / \ PM BLD
Location / 53o / ' Suite MEC 241/ — 60e0
. Contact Person laKie 6-PiY Ph 70 `- 70 j PLM
Contractor Ph SWR
BUILDING V Tenant/Owner ELC
Retaining Wall ELR
Footing - Access:
Foundation `1/ S " �� F P FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: 7t? b �1 1- t
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 FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer V
Rain Drains
Final
PASS PART FAIL
Post & Beam
Rough In
Smoke Dampers
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 / ` � 7-- / Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.