Permit CITY TIGARD MECHANICAL PERMIT
A-4,1�r DEVELOPMENT SERVICES PERMIT #: MEC2001 -00268
' - 13125 SW Hall Blvd., Tigard, O R 97223 (503) 639 -4171 DATE ISSUED: 7/25/01
PARCEL: 2S110BD -03200
SITE ADDRESS: 14916 SW 116TH PL
SUBDIVISION: HELM HEIGHTS ZONING: R -4.5
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:
GAS 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS: 2
Remarks: Installation of gas outlets to bbq and cook top.
Owner: FEES
STROHECKER, LARRY S + Type By Date Amount Receipt
DIANE L PRMT CTR 7/25/01 $72.50 272001000C
14916 SW 116TH PL 5PCT CTR 7/25/01 $5.80 2720010000
TIGARD, OR 97223
Total $78.30
Phone:
Contractor:
R + S HEATING INC
1123 MEADOWVIEW COURT
WEST LINN, OR 97068 REQUIRED INSPECTIONS
Gas Line Insp
Phone: Final Inspection
Reg #: LIC 00070720
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 c pies of these rules or direct questions to OUNC calling (503)246 -9189.
Issue By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
+ Mechanical Permit Ap 1 lication
Date received: Permit no. 2/ .(, g
' ' : � . City of Tiga /& Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard 3 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 PERMIT
O I & 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 LICt l (2 s l.t / \ t 6 c . < c to 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 ZIP: I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? CI Yes CI No Air handling unit CFM
space insulated? ❑ Yes ❑ No Air conditioning rati of existing plan HVAC Is existing system
g P Alterati of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: A }-. S '-\ e,,.�-� State boil permit no.:
HP Tons BTU /H
Address: \, \ 4.1 r., es ap w V, e t- 4- Fire/smoke dampers/duct smoke detectors
City: L ..\ L--; n el I State: ON ZIP: 9 ek 15 Heat pump (site plan required)
Phone: (,s 1 y ( l[) I Fax: 5c,,. -t I E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: '16Z t 3 ..) O Install /replace/relocate suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): .S , tT (c, e- Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: S ,_,„t‘ I rc.K Chillers HP
Address: \ WI rne440 t -1 ew C,}- Compressors HP
Ennronmental exhaust and ventilation:
City: L C) k Lt 0 ,. 1 I State:pr I ZIP: Co (76;) Appliance vent
Phone: --I ce (, Fax: E -mail: Dryer exhaust
OWNER Hoods, Type 1/ II/res. kitchen/hazmat
0
, B hood fire suppression system
Name: 2 n 2 vko (c, n S k zi A) 0 UJ 1W V Exhaust fan with single duct (bath fans)
Mailing a ress: (L{ g I L 5 t.✓ (( (, 0 4 c Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City: k [ (, /� b (L
I State: I ZIP: Type: LPG 1C NG Oil c/- a
Phone: ` 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: I State: I ZIP: Insert —type
Phone: ( Fax: I E -mail: Woodstove/pelletstove
Other:
Applicant's signature: _ Date: Other:
Name (print):
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee
O Visa ❑ MasterCard Notice: This permit application Minimum fee $ - 7-2- Z U
Credit card number: / if a permit is not obtained
/ / Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
. $ TOTAL $ -- n, 30
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+ 17.40
$10,000.00. including ducts & vents
$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 induding 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 than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum 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 A/C requires site plan showing placement of unit.
i:\dsts\forms\nech- 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 Y AM PM BLD
Location /41/6e /6e S'✓ // et Suite MEC Zi1,/ —44) 26Y
Contact Person Ph 3/6/ PLM
Contractor Ph SWF,
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 13 PS? fes r
Insulation
Drywall Nailing
Firewall
Fire Sprinkler 1- >P
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL j r
PLUMBING (a S C
Post & Beam O
Under Slab
Top Out °IC
Water Service , !0
Sanitary Sewer N ( � '
Rain Drains
Final
PASS PART FAIL
C .`
e am
Rough In
• e Dampers
• PART FAIL
TRICAL
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 7-2‘/ ns a/ Inspector Extre"
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
BUP - Building Permit ELC - Electrical Permit
Inspection Description Date Passed By
p p y � � 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 ,f Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry /Reinforcement
Framing
MFG - Structure set -up MEC - Mechanical Permit
Insulation
� Inspection Description Date Passed By
Drywall nailing
Post/beam mechanical
Suspended ceiling Gas line 7-ld -%
Engineered soils
Welding Lab Final Mechanical rough -in
Concrete Lab Final Fire damper
Duct work
Bolting Lab Final Smoke detector
Structural observation
Fireproofing Lab Final Mechanical final 7 -L6 0 l
Final inspection
PLM - Plumbing Permit
BUP — Fire Protection System Permit Inspection Description Date Passed By
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
AI 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
is \dsts \forms \InspRecordBUP.doc 04 /17/01
. . A h i CITY OF TIGARD MECHANICAL PERMIT
,, IN DEVELOPMENT SERVICES PERMIT #: MEC2001 -00268 DATE ISSUED: 7/25/01
,�- "'I
1 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S1106D 03200
SITE ADDRESS: 14916 SW 116TH PL
SUBDIVISION: HELM HEIGHTS ZONING: R -4.5
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:
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:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 2
> 10000 cfm:
Remarks: Installation of gas outlets to bbq and cook top.
Owner: FEES
STROHECKER, LARRY S + Type By Date Amount Receipt
DIANE L PRMT CTR 7/25/01 $72.50 2720010000
14916 SW 116TH PL 5PCT CTR 7/25/01 $5.80 2720010000
TIGARD, OR 97223
Total $78.30
Phone:
Contractor:
R + S HEATING INC
II I
1123 MEADOWVIEW COURT
WEST LINN, OR 97068 REQUIRED INSPECTIONS
t
Gas Line Insp
Phone: Final Inspection
Reg #: LIC 00070720
V
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. O
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 Orego
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -008
You may obtain c•pies of these rules or direct questions to OUNC calling (503)246 -9189. Vba
Issue By: (/J _ .4 ;,7� P e rmittee Signature:`( �,,.�_-
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
(317