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Permit CITY TIGARD MECHANICAL PERMIT 1 DEVELOPMENT SERVICES PERMIT #: MEC2000 -00464 ° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/01/2000 PARCEL: 1S134CD-01300 SITE ADDRESS: 11955 SW 116TH AVE SUBDIVISION: LERON HEIGHTS NO.3 ZONING: R -4.5 BLOCK: LOT: 048 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: GAS 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: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1 > 10000 cfm: GAS OUTLETS: 1 Remarks: Gas piping and gas logs Owner: FEES SHELTON, JAMES C + JUDY C Type By Date Amount Receipt 11955 SW 116TH PRMT CTR 12/01/20C $72.50 2720000000 TIGARD, OR 97223 5PCT CTR 12/01/20C $5.80 2720000000 Total $78.30 Phone: 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. n n Issue By: .--1--yr Permittee Signature: (Y\ Call (50) 639 -4175 by 7:00 P.M. for inspections needed the next business day Mechanical Permit Application JED Date received: Permit no. iniz,z i c j 4 . ll ..I �_ City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9'1 D Date issued: By: Receiptno.: Phone: (503) 639 -4171 LUt� Fax: (503) 598 -1960 COMMUNITY DEVELOPPF', Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT x i & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Other: JOB SITE INFORMATION COMM VALUATION SCHEDULE Job address: i i Q SS 5io I I o -a,_ Aim 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: jurisdiction's fee schedule for residential permit fee. City /county: i 1 o / / / ///yyY�� 1 Z f & 2> AMILY DWELLING PERMIT FEE SCHEDULE Descriptio and lodaflf n of wo on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENT SCHEDULE E. gas I vie_ 1 C'S Fee(ea.) Total date of completioMmspection: ! . / .5Jc Description Qty. Res. only Res. only Tenant improvement or change of use: HVAC: Air handling unit CFM Is existing space heated or conditioned? ❑ Yes ❑ No Air conditioning (site plan required) Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors Business name: (t is i t • State boile permit no.: L.� � HP Tons BTU /H Address: ds s J ,5W e v[ D Fire /smoke dampers /duct smoke detectors City -re l? t/ To y . Stat I ZIP: q 7045 Heat pump (site plan required) Phone:f,.4k .. I Fax:/ .q /j E - mail: Install/replacefurnace/burner BTU /H Q _ Including ductwork/vent liner CI Yes CI No CCB no.: lc( g.Ib Install /replace/relocateheaters— suspended, City /metro lic. no.: 57) V wall, or floor mounted Name (please print): Vent for appliance other than furnace C6NTACT PARSON Refrigeration: Absorption units BTU /H Name: a e n N 4e In `� — . Chillers HP Address: / ( Q.5 .54 1 0 p vt`. Compressors HP Enviromnental exhaust and ventilation: City:F,ga I St t:. — I ZIP: q7 .as Appliance vent Phone: _ A pr Fax: , _ , ' , E -mail: Dryer exhaust ONi'NER Hoods, Type U lures. kitchen/hazmat hood fire suppression system Name: Silel - dyl T i y s} - �Ltet Exhaust fan with single duct (bath fans) Mailing address: I S'S ,SC.t) i It Ed , / ok oe, Exhaust system apart from heating or AC City: i Qv' State: al. ZIP: _ Fuel piping and distribution (up to 4 outlets) Type: LPG x NG Oil ' S. VC' Phone: _ _ r Fax: E -mail: Fuel piping each additional over 4 outlets ' _... ENGINEER. .. Process piping (schematic required) Name: Number of outlets Other listed appliance or equipment: Address: Decorative fireplace City: I State: I ZIP: Insert — type Phone: F.,,,4 E -mail: Woodstovelpellet stove Other: . • i A fY, Applicant's sit ture: AfiAMIPPIUM5027BM , Other: Name (print :- ae pit , , h Z • 5 40 ' Not all jurisdictions accept credit cards, please call jurisdiction for more information:' Permit fee $ / O Visa ❑MasterCard Notice: This permit application Minimum fee $ 7,- . SO Credit card number: expires if a permit is not obtained Plan review (at _ %) $ Expires within 180 days after it has been State surcharge 8% a O Name of cardholder as shown on credit card accepted as complete. g ( ) $ $ TOTAL $ 7$ _ 5n ` 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 Table 1A Mechanical Code Qty (Ea) Amt $1.00 to $5,000.00 Minimum fee $72.50 1) Furnace to 100,000 BTU $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and including ducts & vents 14.00 $1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+ fraction thereof, to and including $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 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 1 CFM, permit 17.20 Repair units 805 ' 14).Non- portable evaporat2 aoler < 3 hp; ebscrb. unit, 955 , • • 10.00 to 100k BTU , ' , *4 _ S.. r 15) Vent fan connected•tp,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 mechanioal•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 Y 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 ` ; • . 16.00 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 Domestic incinerator 1,170 Mininnfm Permit Fee 572.50 , 'SUBTOTAL: $ Commercial or industrial incinerator 4,590 . Other unit, including wood stoves, 656 • 8 % State Surcjlarae ' ' $ 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.hotirs (minimum charge -two hours) $72.50 per hour. - - ' • 2. Inspections for which no fee is specifically indicated. frginimum 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. Q ** Residential NC requires site plan showing placement of unit. is \dsts \forms\rnech- 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 / Z 7 AM PM BLD Location I r q S 56 14/ 6 Suite MEC zv , G U 4 ' - q Contact Person d7 Ph 5Z' 5 � 3 J LPLM 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 Post & Beam Rough In 4 5 -0, Smoke Dampers PART FAIL 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 Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk • Other Date /( 7/k U Inspector /�l E Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested , Z' AM PM BLD Location ) 9 ) > j L✓ //G e( ti-e Suite MEC D y� Contact Person Ph 529 / 9 k/ PLM Contractor gide. i Ph G L4 �G S L SWR BUILDING Tenant/Own' 12/104 Le ( Gl wn f- / e w ) G0,4_ ELC Retaining Wall AU- SA, / ELR Footing Access: Foundation FPS Ftg Drain Crawl Drain Inspection Notes: SGN Slab ; " � SIT Post & Beam Ext Sheath /Shear 1•30 ��--- Int Sheath /Shear Framing Insulation Drywall Nailing Firewall ,,! )2'�� u /'�� _ L Fire Sprinkler /1/0'4 L �2{� 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 ECHANI COK 601N)6!) 6K— .1=k ail x./ Post & Beam Roush In Smoke Dam ers Fin PASS PART FAIL ELECT 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 Other Date I Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. BUP - Building Permit EL C - Electrical Permit 4 Inspection Description Date Passed By I 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 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 - 4 Inspection Description Date Passed By Post/beam mechanical Suspended ceiling Gas line I2Itoa/?) Engineered soils Mechanical rough -in Welding Lab Final Fire damper Concrete Lab Final Duct work Bolting Lab Final Smoke detector Fireproofing Lab Final Mechanical fmal 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 fmal Rain drain Storm drain Water service SIT - Site Permit Sanitary sewer 4 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 Inspection Description Date Passed By Engineering acceptance Sanitary sewer Final inspection Final inspection _ INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR MEC, SIT PERMITS A CITY OF TIGARD MECHANICAL PERMIT p e r {� DEVELOPMENT SERVICES PERMIT #: MEC2000 -00464 � -- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/01/2000 PARCEL: 1 S 134CD- 01300 SITE ADDRESS: 11955 SW 116TH AVE SUBDIVISION: LERON HEIGHTS NO.3 ZONING: R -4.5 BLOCK: LOT: 048 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: GAS 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: 1 FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1 > 10000 cfm: Remarks: Gas piping and gas logs Owner: FEES SHELTON, JAMES C + JUDY C Type By Date Amount Receipt 11955 SW 116TH PRMT CTR 12/01120C $72.50 2720000000 TIGARD, OR 97223 5PCT CTR 12/01/20C $5.80 2720000000 Total $78.30 Phone: Contractor: JAY'S GAS PIPING 11525 SW CANYON BEAVERTON, OR 97005 REQUIRED INSPECTIONS Gas Line Insp Phone: 626 -4652 Final Inspection Reg #: LIC 0119836 8 1 0 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes 0 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 6% calling (503)246 -9189. Issue By: i ...4--yy\, Permittee Signature: r lr n ` a-&--(2)2.—c- .4111r11411' Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day