Permit C ITY OF TIGARD MECHANICAL PERMIT
,. DEVELOPMENT SERVICES PERMIT #: MEC2001 -00003
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/3/01
PARCEL: 1 S 135CD -02000
SITE ADDRESS: 11760 SW 98TH AVE
SUBDIVISION: GREENBURG HEIGHTS ZONING: R -4.5
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: REP 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:
OIL 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: Replace oil furnace with like kind, fire repair.
Owner: FEES
DAWESM, UNA JESSIE Type By Date Amount Receipt
11760 SW 98TH AVE PRMT CTR 1/3/01 $72.50 2720010000
TIGARD, OR 97223 5PCT CTR 1/3/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
ENERGY PLUS HEATING + COOLING
608 NW 189TH ST
RIDGEFIELD, WA 98642 REQUIRED INSPECTIONS
Heating Unt Insp
Phone: 360 - 887 -2014 Final Inspection
Reg #: LIC 95422
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 - V=01:11 bough OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by
c ling (503)246 -918•.
ssue By: ,a_n /414-4 .. Permittee Signature: S'j < � � , Lam `,„„"
Call (503) 639 -4175 by 7:00 P.M. for inspections needed th 'next business day ,
Mechanical Permit Application
Date received: e /-o3 -0/ Permit no.: JA ee/-''
' ;,� . City of Tigard Project/appl. no.: Expire date:
CiryofTigard 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 )ECI & 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: /1 74,0 S e 4 ' 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: - 7" 1 - c rck I ZIP: r7,9,?. 3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description an 1ocAon of work on premises: .J-Q)a-tet,ei2- AND COMMERICAL/INDUSTRIAL EQUIPMENT SCHEDULE
D - a - CSL Fee(ea.) Total
Est. date of completion/inspection: l-- 3 -Q ( Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? ❑ Yes ❑ No Air handling unit CFM
space insulated? ❑ Yes ❑ No Air conditioning rati fxi existing plan HVAC Is existing system
g P Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: r , A AkS geo_t-, ° - - C (.t- v‘ State boiler permit no.:
HP Tons BTU /H
Address: , Si' /U, it`, s- ` 5 Fire/smoke dampers/duct smoke detectors
City: - infirignil EMM ZIP. r. Heat pump (site plan required)
Phone: %. , _,� /4 Fax: $4- t_._ E -mail: Install/replace furnace/burner$ BTU /H I
Including ductwork/vent liner ❑ Yes10
CCB no.: q5-y, ?. /2-- 3 -0 / Install /replace /relocate heaters- suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration: .
Absorption units BTU /H
L V\4 lJ Chillers HP
Name: S —
Address: f l r7(D Q S. w , F A-tre - Compressors HP
Environmental exhaust and ventilation:
City: 11_ . , I State)" I ZIP:c7p9(2)3 Appliance vent _
Phone: 6,3— /6 LI Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: (1 Vo, 1. 4e 3 Exhaust fan with single duct (bath fans)
Mailing address: j (7( 0 S LQ) . ? g` 19rJ-Q - Exhaust system apart from heating or AC
City: cu . I State - I ZIP: 97a 3 Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: 3 .. /6'.S ax: 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: I State: I ZIP: Insert - type
Phone: , Fax: I E -mail: Woodstove/pellet stove
6604_ Other:
Applicant's signature: ,Ge ,6,, _ 4t - I Date: / -O3 -D ( Other:
Name (print): J / t1 `"' ,71-00's 0 7 //��
Not all jurisdictions accept credit cards, please call jurisdiction for more information Permit fee $ / �V
❑ Visa ❑ 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 %) .... $ 6, X v
Name of cardholder as shown on credit card $ accepted as complete. TOTAL $ 7 ' i?�r
Cardholder signature Amount 440 -4617 (6/00 /COM)
MECHANICAL PERMIT FEES
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
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
Air >1.75
ha mil. BTU 19) Commercial or industrial type incinerator 69.95
Air handling unit to 10,000 cfm 656
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 than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
_
Domestic incinerator 1,170 M inimum Permit Fee $72.50 SUBTOTAL: $
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656 8% State 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 NC requires site plan showing placement of unit.
is \dsts \forms\mech- fees.doc 10/11/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / - 4 AM PM BLD
Location /1 71 O 5 w 9t 171 Suite MEC -"efoe
Contact Person Ph Ul 3 Z/ 7 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
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
HA
Post & Beam
Rough In F ih H,,,,,
Gas Line
o Dampers
anal
PASS PART FAIL
E RICAL
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Other Date t 0 ( Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.