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Permit CITY TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2001 -00286 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/10/01 PARCEL: 2S 104AA -02700 SITE ADDRESS: 12255 SW 126TH AVE SUBDIVISION: BELLWOOD ZONING: R -4.5 BLOCK: LOT: 039 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: 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: 1 AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Replacement of gas furnaace. Owner: FEES WEISS, STEVEN R + REBECCA M Type By Date Amount Receipt 12255 SW 126TH AVE PRMT CTR 8/10/01 $72.50 272001000C TIGARD, OR 97223 5PCT CTR 8/10/01 $5.80 272001000C Total $78.30 Phone: Contractor: COLUMBIA HEATING + COOLING INC PO BOX 230397 TIGARD, OR 97223 REQUIRED INSPECTIONS Heating Unt Insp Phone: 624 -2704 Final Inspection Reg #: LIC 76359 PLM 34 -175 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 obtapopies of these rules or direct questions to OUNC by calling (503)246 -9189. Issue By:{ic �C��l �' Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for inspections needed, he next1 siness day Mechanical'Permit = • i - i • ' ation G .� Date received / Permit no.: /46( .,,1t' 4 i! City of Tigard ( Project/appl. no.: Expire date: City nfTigard Address: 13125 SW Hall Blvd, T :ard, OR ' 23 Phone: (503) 639-4171 Date issued: By: 0 Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT p 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction U Addition/alteration /replacement Cl Other: JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE Job address: / a,2 S 5 5 v.J t Q ( o ff . 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: ISubdivision: *See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City /county: — 1; e ct Yek ZIP: 917 2.23 I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE Description and location of work on premises: _ AND COM11F.RICAI,/INDUSTRI AL EQUIPI[ENTSCIIEDULE fit' ��r� c.. ( I) cur vtc _ _ 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? 0 Yes 0 No Air handling unit CFM Air conditioning (site plan required) Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors Business name: tate boiler permit no.: Co CG�ttwthiGt N cG. 4 - irr Ciit HP Tons BTU /H Address: k (- 10 0 ,s, IkArvl16Avv 3 Fire/smoke dampers/duct smoke detectors City: Tc r State: OYL ZIP: 97 223 Heat pum te. required) Phone: ( _ 2 .709 I Fax: E -mail: Install. eplacefurnac urner BTU /H Including c work/vent liner O Yes O No CCB no.: '7 Co 3 5 Install/replace/relocate heaters-suspended, City /metro lic. no.: D/ 2 7 ..2 wall, or floor mounted Name (please print): 9 (.1 ) n r I o Se i t-- Vent fora • • liance other than furnace CONTACT PERSON ' e 1 : era on: Absorption units BTU/H Name: b A. ,N) �L: jiiit r + Chiller HP Address: J ( Compressors HP Environmental exhaust and ventilation: City: I State: I ZIP: Appliance vent Phone: ' 2 r. - 2 70- Fax: E -mail: Dryer exhaust Hoods, Type 11 IUres. kitchen/hazmat hood fire suppression system Name: P:).e c lL lAie i S s Exhaust fan with single duct (bath fans) Mailing address: 1 ZZ 5 S i.,.1 17 to ik Exhaust system apart from heating or AC City: c „. c.A St te: 13YC- ZIP: (212 3 Fuel piping and distribution (up to 4 outlets) Phone: I Type: LPG NG Oil 57q - 39N F 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: State: I ZIP: Insert - type Phone: Fax: I E -mail: Woodstove/pelletstove Applicant's signature: Other: A PP g ��-�� ` I Date: � 7- 2 �.. . 1 � Other: Name (print): 7 IC Not all jurisdictions accept credit cards, please call jurisdiction for more information Permit fee $ 7 9 . 51., O Visa O 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 %) .... $ Name of cardholder as shown on credit card accepted as complete. TOTAL $ $ Cardholder signature Amount 440-4617 (600/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 Qh (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 ASSUMED VALUATIONS PER APPLIANCE: 8) 3-15 BTU 14.00 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 >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. is \dsts \f . rms\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 e- / 7 AM PM BLD Location l Z Z S / 26 Suite MEC UGC/ G O Z .8 21 Contact Person 04130 Ph . V - a7C 4 7 4 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 MECHANICAL Post & Beam Rough In Gas Line Sm e Dampers S 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 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 Ext 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 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 4 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 Engineered soils Mechanical rough -in Welding Lab Final Fire damper Concrete Lab Final Duct work Bolting Lab Final Smoke detector 1 Structural observation Mechanical final 1-7 1� 1 Fireproofing Lab Final 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 fmal RP /backflow preventer Fire alarm fmal 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 I 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 CITY TIGARD MECHANICAL PERMIT w DEVELOPMENT SERVICES PERMIT #: MEC2001 -00286 Ail 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/10/01 PARCEL: 2S 104AA -02700 SITE ADDRESS: 12255 SW 126TH AVE SUBDIVISION: BELLWOOD ZONING: R -4.5 BLOCK: LOT: 039 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: 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: 1 AIR HANDLING UNITS OTHER UNITS: FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 cfm: Remarks: Replacement of gas furnaace. Owner: FEES WEISS, STEVEN R + REBECCA M Type By Date Amount Receipt 12255 SW 126TH AVE PRMT CTR 8/10/01 $72.50 2720010000 TIGARD, OR 97223 5PCT CTR 8/10/01 $5.80 2720010000 Total $78.30 Phone: Contractor: COLUMBIA HEATING + COOLING INC PO BOX 230397 TIGARD, OR 97223 REQUIRED INSPECTIONS Heating Unt Insp If Phone: 624 -2704 Final Inspection Reg #: LIC 76359 II PLM 34 -175 0 P This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. A 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 suspende 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 -008 You may obta' opies of these rules or direct questions to OUNC by calling (503)246 -9189. Issue B Permittee Signature: _ A g . , . , . . . . . e< Call (503) 639 -4175 by 7:00 P.M. for inspections neede•\ he next siness day iiiii%