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Permit CITY TIGARD MECHANICAL PERMIT IFS DEVELOPMENT SERVICES PERMIT #: MEC2001 -00076 .41.1- DATE ISSUED: 3/1/01 ' • 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 I PARCEL: 1S135CD-02700 SITE ADDRESS: 11725 SW 95TH AVE SUBDIVISION: BOETCHERS ADDITION ZONING: R -4.5 BLOCK: LOT: 006 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: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: WOODSTOVES: FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Replacement of existing gas furnace with like kind. Owner: FEES RUTHERFORD, JANET M TRUSTEE Type By Date Amount Receipt BY ETHEL M STAN PRMT CTR 3/1/01 $72.50 2720010000 11785 SW 95TH 5PCT CTR 3/1/01 $5.80 2720010000 TIGARD, OR 97223 Total $78.30 Phone: Contractor: SPECIALTY HEATING + FABRICATIO 9528 SW TIGARD ST TIGARD, OR 97223 REQUIRED INSPECTIONS Heating Unt Insp Phone: 620 -5643 Final Inspection Reg #: LIC 006657 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 t 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility otificatior>\enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain coo es of th -se ul-. or direct questions to OUNC by calling (503 246 -9189. Iss e By: k a�.I . "j/ , �, • Permittee Signature: eUO ( �„� Call (503) • : -4175 by 7:00 P.M. for inspections needed the next business day Mechanical Permit Application All. Date received: 5 i p/ Permit no.: j/f e v/ av 70 k• L V.A L City of Tigard Project/appl. no.: Expire date: City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receiptno.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building permit no.: • TYPE OF PERMIT 4 - 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement 0 New construction Addition/alteration/replacement 0 Other: JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE Job address: /7 /ZS' Sk) q,.6 t'/ 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: Subdivision: *See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City /county: ( 4 CQ- Lt)adi 'ZIP: q 7 a-- )-3 I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE Description d location of work on premises: AND COMMERICAIJINDUSTRIAL EQUIPMENTSCHEDULE re66 Fee(ea.) Total Est. date of completion/inspection: D escription Qty. Res. only Res. only Tenant improvement or change of use: HVAC: • Is existing space heated or conditioned ?J4'Yes 0 No Air handling unit CFM Air conditioning (site plan required) Is existing space insulated ?0Yes Cl No • Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors ��/ G State boiler permit no.: Business namei\ L ,' / 4 ! • ./ n� HP Tons BTU/H Address: S LC) S Fire/smoke dampers/duct smoke detectors City: Thai d I State: 041 4 ZIP: q 9 3 Heat pump (site plan required) Phone:&;3 /,j Fax59fs 0 /r m ail: Install/replace furnace/burner c4TU /H i Including ductwork/vent liner, Yes O No CCB no.: C, 4 5 7 5- InstalUreplace/relocateheaters- suspended, b 9 City /metro lic. no.: ( � wall, or floor mounted Name (please print): , rillA. h /1 `IS Vent for appliance other than furnace CONTACT PERSON Refrigeration: _ Absorption units BTU/H Name: K . Ti-t Lee N ( ✓f ✓1 e 4 Chillers HP , Address: 4's9^ 8' s.5 ( ) ical d S Compressors HP `{ Environmental exhaust and ventilation: City: 7 d I Stale: Ce [ ZIP: q 70 - - 4 Appliance vent Phone6d3 6.2e."- ' Fax: 59(0?/8' E -mail: Dryer exhaust OWNER Hoods, Type U lUres. kitchen/hazmat hood fire suppression system Name: / 09 � Or t/ Exhaust fan with single duct (bath fans) Mailing . a dress: / / ! 1 5' q 5 �t+ Exhaust system apart from heating or AC City QA c( I StateQ,_' ZIP: q 7a a-. Fuel piping and distribution (up to 4 outlets) Type: LPG NG Oil Phone: 3 - LP 3 Fax: E -mail: Fuel piping each additional over 4 outlets Process piping (schematic required) Name: Number of outlets Other listed appliance or equipment: Address: Decorative fireplace City: 'State: I ZIP: Insert - type Phone: 1 Fax: 1 E -mail: Woodstove/pellet stove Other: Applicant's signature: aajleN 4 .Date: pZ Jd( Other. Name (print): )( -geee H c;(;174/(,_ Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7. so 0 Visa 0 MasterCard Notice: This permit application Minimum fee $ Credit card number: / / expires if a permit is not obtained Plan review (at %) $ Expires within 180 days after it has been State surcharge (8 %) .... $ . 4 Name of cardholder as shown on credit card accepted as complete. TOTAL $ 7/ A Cardholder signature Amount 440 -4617 (6/00 /COM) • • w • Commercial Schedule • 1 &2 Family Dwelling Schedule ASSUMED VALUATIONS PER APPLIANCE - Description Furnace to 100,000 BTU Table 1A Mechanical Code Qty Price Total ducts & including du vents 955 1) Furnace to 100.000 BTU g ducts & vents including l 14.00 Furnace > 100,000 BTU 2) Furnace 100,000 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 For Items all that 7-10, Boner Heat Air Vent not included in appliance permit 445 For kerns 7 -10, see or Pump Cond Qty Price Total footnotes Comp Repair units 805 7)c3HP; 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 unit .5 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 501k to 1 mil. BTU 2310 87.20 1 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 conneded 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 20) Other units including wood stoves ood served by mechanical exhaust 656 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 mot -- Gas piping 1-4 outlets 360 8% SURCHARGE l_i Each additional outlet 63 PLAN REVIEW 25% OF SUBTOTAL ` Required for ALL commercial permits only ._ - . TOTAL '-". • , ISM Other Inspections and Fees: I. 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 -hai hour) $72.50 per hour Total Valuation Fee 3. Additional plan review required by changes. additions or revisions to plans (minimum chargeone.hat hour) $72.50 per hour 'State Contractor Boiler Certification required $ 1.00 to $5,000.00 Minimum $72.50 - -Residential MC requires site pan showing 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 CITY OE TIGARD BUILDING INSPECTION DIVISION MST • . 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested AM PM BUD Location q /1 Suite 496€— Ock77>o Contact Person Ph e97- -3 PLM Contractor k! Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain 4SGN Crawl Drain Inspection Notes: e c4 c �� 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�� FAIL Poems & Beam Rough In Gas Line S • e 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 Hail, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Appro Other ch/Sidewalk D ate � Inspector Other Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. C ITY OF TIGARD MECHANICAL PERMIT I, DEVELOPMENT SERVICES PERMIT #: MEC2001 -00076 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/1/01 PARCEL: 1S135CD-02700 SITE ADDRESS: 11725 SW 95TH AVE SUBDIVISION: BOETCHERS ADDITION ZONING: R -4.5 BLOCK: LOT: 006 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: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: WOODSTOVES: FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Replacement of existing gas furnace with like kind. Owner: FEES RUTHERFORD, JANET M TRUSTEE Type By Date Amount Receipt BY ETHEL M STAN PRMT CTR 3/1/01 $72.50 272001000C 11785 SW 95TH 5PCT CTR 3/1/01 $5.80 272001000C TIGARD, OR 97223 Total $78.30 Phone: Contractor: SPECIALTY HEATING + FABRICATIO 9528 SW TIGARD ST TIGARD, OR 97223 REQUIRED INSPECTIONS Heating Unt Insp Phone: 620 -5643 Final Inspection Reg #: LIC 006657 $ 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 otificatiorhCenter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain co..es of th -se ul -. or direct questions to OUNC by calling (503 246 -9189. 6 4 ( Iss a By: k �_.I �/ , �, Permittee Signature: .�M �1 Call (503) 6 s -4175 by 7:00 P.M. for inspections needed the next business day BUP - Building Permit ELC - Electrical Permit 4 Inspection Description Date Passed By 4 Inspection Description Date Passed By Footing /Setback Underground cover Foundation walls Wall cover Footing drain Ceiling cover Waterproof bsmt walls Electrical rough -in Slab Electrical service Crawl drain Electrical final Underfloor insulation Post/beam structural Shear walls /anchors ELR - Restricted Energy Permit Roof nailing J Inspection Description Date Passed By Firewall Low voltage Tilt -up panel Electrical final Masonry /Reinforcement Framing MFG - Structure set -up MEC - Mechanical Permit Insulation Drywall nailing � Inspection Description Date Passed By Post/beam mechanical Suspended ceiling Gas line Engineered soils Mechanical rough -in Welding Lab Final Fire damper Concrete Lab Final Duct work Bolting Lab Final Smoke detector Fireproofing Lab Final Mechanical final 3 S -c Structural observation Final inspection PLM - Plumbing Permit -4 Inspection Description Date Passed By BUP - Fire Protection System Permit Plumbing underslab 4 Inspection Description Date Passed By Crawl drain Sprinkler underfloor /slab Post/beam plumbing Sprinkler rough -in Plumbing top -out Sprinkler final RP /backflow preventer Fire alarm final Rain drain Storm drain Water service SIT - Site Permit Sanitary sewer Inspection Description Date Passed By Culvert/catch basin Footings Pump /fill septic tank Foundation walls Plumbing final Sprinkler supply lines Sprinkler underfloor /slab Catch basin /Manhole SWR - Sewer Permit Engineered soils 4 Inspection Description Date Passed By Engineering acceptance Sanitary sewer Final inspection Final inspection INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR, MEC, SIT PERMITS