Permit • CITY OF TIGARD MECHANICAL PERMIT
I A, DEVELOPMENT SERVICES PERMIT #: MEC2003 -00220
+L '�' II 13125 SW Hall Blvd., Tigard, O R 97223 (503) 639 -4171 DATE ISSUED: 4/30/03
PARCEL: 2S103AC -07200
SITE ADDRESS: 12999 SW 113TH PL
SUBDIVISION: FONNER WOODS ZONING: R -4.5
BLOCK: LOT: 008 JURISDICTION: TIG
CLASS OF WORK: OTR 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:
ELE 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
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of residential AC. Cannot be placed in the required setbacks.
Owner: FEES
JOHN & MALISSA PETROV Description Date Amount
12999 SW 113TH [MECH] Permit Fee 4/30/03 $72.50
TIGARD, OR 97223 [TAX] 8% StateTax 4/30/03 $5.80
Phone: 503 - 598 - 9038 Total $78.30
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Cooling Unt Insp
Final Inspection
Reg #:
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 -00
Issued By: 6,4140/0 Le.1112.) Permittee Signature: 4/`/all
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
• FOR OFFICE USE c al
ONLY
Mechanical Permit Application
I4eceived Mechanical
' Date/By: Permit No.: filEC o9�
Planning Approval Building
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post Land Use
lm� /iryli {!�' >
ww � Date/B : Case No.:
Internet: w.ci.tigard.or.us • �' I Contact Juris.: e See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ""' Name/Method: Supplemental Information.
'7'''"'" = x� ,' TYPE OF WORK; ,,' ' n .: , ' '' '' ' '?4,r ‘ COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
�;
❑ New con tctin ❑ Demolition Mechanical permit fees* are based on the total value of the work
III Addi on/alteration/ placement El Other: performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead and profit.
GORY OF CONSTRUCTION '.,. -`-
a 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
El Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: • cooling
1111111MI•7 IMO IIDel►1 C4,,IKA ` ®i Furnace - add n air conditioning ** / 14.00
Job site address: (2,799 Su) i t3 7-4. PLO-CE.- Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work 14.00
Project Name: w_ r b V A C- Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: I Lot #: Repair units 12.15
Other Fuel Appliances
Tax ma. /.arcel #: Water heater 10.00
1 t ;� � � � r � a+ � > m i *. , Gas fireplace 10.00
t 71,� t; Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue /vent 10.00
16" .„ ,' " „ L P $'s. `t :v, t''' l'';.' N _ Other: 10.00
Name: _51)1474 4 )-/ 4{, 5 vii ' 7 4 e Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: j ui. sw U t , Clothes dryer exhaust 10.00
City /State /Zip: --- r S C-1 a 012._ 77223 2'Z3 Single duct exhaust
Phone: 5 F 4D ; I Fax: (bathrooms, toilet compartments,
• APPL '' ' _ :. I ❑ CONTACT PERSON ' >::; IP utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Other: 10.00
Address: Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: I Fax: Furnace, etc. **
Gas heat pump **
E -mail: Wall/suspended/unit heater **
-�t ` .: V= Water heater **
Business Name: (r) U) nj�,� s* Fireplace **
Address: Range **
City /State /Zip: Clothes dryer (gas) **
Phone: Fax: Other: **
CCB Lic. # � ' cal Total:
Pe
� Mechanical Permit Fees*
Authorized
1( "�ZY Subtotal: $
Signature: _vI ■!� /�.. � Date: 11 Minimum Permit Fee $72.50 $ 1 29, i SO
/: v W l Plan Review Fee (25% of Permit Fee) $ /
/ (Please print name) State Surcharge (8% of Permit Fee) $ .<i - tS ()
TOTAL PERMIT FEE $ -7_,T : 30
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
$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.
$50,001.00 and up $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof.
Assumed Valuations Per Appliance:
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
< 3 hp; absorb. unit, 955 — to 100k BTU
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU
15 -30 hp; absorb. unit, 501k to I mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU •
>50 hp; absorb. unit, 5,725
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656
Vent fan connected to a single duct • 446
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION:
is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03
. . I
. '
. , - ' - - - ': 7 : '' ,' • - . ' .
' I
. I
I
. 0
1
I
I
4
L,
. I
. I
. 4 I
. .
VI I
. .
. .
. , I
. .
I • 1
.... ' I
. I
. ' I
. . ----
1
. 1
. ) 1 H . • I
, ; ■ - .
. ...t4 r... .. .. . . - ..
/ . ) I _________----4
1
,
. . 1
. . . . 1
. 1 .
. .
4
- 4
1 4
. , 4
. ,
. •
. , 4.. .
I' I
. .
. ...,
. .
. . ,
. .
. . -
. . ' .
. . . ,
■ 4
' . 4
4
' 4
. .
. .
• . 4
. .
. .
4 .. . , .
. . •
. .
I
. .
.. ' .. .
) i
. .
. .
. .
! ,
1
. 4
. 4
. I
4
. . 4. ,
4
' • 4
. 4
. . , .
I
1
CITY OF TIGARD 24 -Hour _
•
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTIO ► - a ` Business Line: ,(503)•639 -4171
poi / BUP
Receive. 1 0 • Date Requested 1/4 AM PM BUP
Location I- Y g'7 1/ 3 c PL-- Suite MEC 3 D d c C)
Contact Person Ph ( ) r'! S -94 3 g PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 0 O - 903 ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing .t J EEO 671sc7-&/ , Ci4 ei `'a- 2a ,, ,= =v Ai° Gt t. A.ra2
Insulation /-�
Drywall Nailing C4-C, 4A-4 t `� �iJ`� %`��-
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan III
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In ' - G •
Gas Line
Smoke Dampers
mal
ASS PAR FAIL
ELECT
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date G' �� Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL