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Permit
CI TY OF TIGARD MECHANICAL PERMIT C.I DEVELOPMENT SERVICES PERMIT #: MEC2003 -00185 All SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/11/03 PARCEL: 1S133DA-09000 SITE ADDRESS: 11096 SW 130TH AVE SUBDIVISION: CASTLES AT BRITTANY ZONING: R -7 BLOCK: LOT: 020 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: DOMES. INCIN: LPG 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: 1 > 10000 cfm: Remarks: Installation of gas piping for new range. • Owner: FEES . VAUGHN, PAUL J + MARY H Description Date Amount 11096 SW 130TH AVE TIGARD, OR 97223 [MECH] Permit Fee 4/11/03 $72.50 [TAX] 8% StateTax 4/11/03 $5.80 Phone: Total $78.30 Contractor: SHAMBURG HEATING LLC PO BOX 829 TUALATIN, OR 97062 REQUIRED INSPECTIONS Phone: 503 Gas Line Insp Final Inspection Reg #: LIC 126881 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 � ot- to- followrules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00 • . ��� Iss c y : C � p �r� :� e / L / 4t Permittee / A �` / _pis►.,/ / //r \ Call (50 ) 639 -4175 by 7:00 P.M. for inspections needed the next business • Mechanical Permit Application . , FOR OFFICE USE ONLY ; . Received ,/ 4 Mechanical Date/By: 7 // d Permit No.: Wl '6 City of Tigard Planning Approval Building Date/B Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503 - 639 -4171 Fax: 503-598-1960 /�nmrodl� Post - Review Land e Use , t Date /By: (�; a .' 1 � f.�s No.: �u n Internet: ww . I Contact Jur �: See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 -'' Name/Method: ( - . Supplemental Information. IAti -,,. itaet: x, COIVMERCI`AL?FEE*;&SCHEDULE ,,USE >;GFIEGRLIST. � �' '" `TYPESOF�WQRK ❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work 12— Addition/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all ,` g.., �� °��;'��;, CATEGORY .OEiCONSTRiJC,TION�;z��° _ . � ._ _- , - mechanical materials, equipment, labor, overhead and profit. & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule ❑ Accessory Building ❑ Multi- Family RESIDENTIALEQUIPMENT /SYSTEMSFEE* SCHED,ULEW Description I Qty Fee(ea.) I Total ❑ Master Builder ❑ Other: . . Heating/Cooliug� . 1? S JOBhSITEINEORMATION an"daLOCATIONF a Furnace - add -on air conditioning ** 14.00 Job site address: //OW, _.5,3 /.307.1q4-VE Gas heat pump 14.00 Suite #: Bldg. /Apt. #: Duct work 14.00 Project Name: 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 Repair units 12.15 Subdivision: Lot #: Other.Fuel;Appliance`s.._ .. ; =,'.... • -y Tax map /parcel #: Water heater 10.00 N fag g: DESCRI•PTION.:OF WORIZV Y„ Gas fireplace 10.00 ii i0 / /O.� (JO 7 Flue vent (water heater /gas fireplace) 10.00 /OIL lighter (gas) 10.00 Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 Ed ;, ' OP_ERTY OWNER '' E ," ; 1 T'ENAXNC ;Y, a ,$ Ia°:::i "M. Other: 10.00 Name: ( � ��fu :. - .Edvironine itahExhaust 8i Ventilation z-y Range hood/other kitchen equipment 10.00 Address: / / Oci/v _,2 /30 `141Lh/E Clothes dryer exhaust 10.00 City /State /Zip: � � t /JC- Single duct exhaust Phone: 521- 7 ,r Fax: (bathrooms, toilet compartments, aPVEICANT ;k ..,,.: a : ` „ 5 iffl G'ONTi,1CT PEFtS®N ";::`. utility rooms) 6.80 Name: !/./i177 b / - 9 LGL Attic /crawl space fans 10.00 (J Other: 10.00 Address: / U , f f,,,1-9 _.. ..‘FuehPipin: ,' r - :',. - :k „c... _: City /State /Zip: A,/ 2Z z. e:X_ ' 7, Z..e * *($5.40 for first 4, $1.00 each additional) Phone: (p 532 3 Fax: 1Z,9/-6,%675-5— Fumace, etc. ** Gas heat pump E -mail: - Wall /suspended/unit heater ** .,t . rE d; „ CONTR OTiO1R iM. I 4 . Water heater ** Business Name: j g S 62,, -n,/.e_ Fireplace ** • Address: Range e / ** 5 . 40 BBQ City /State /Zip: Clothes dryer (gas) ** Phone: Fax: Other: ** /� f/ T o t a l : CCB LIC. #: - * , :J'' Authorized Mechaiiical"Permit�Fees =� - - ./ y 0 / 1 , .././/e2/4i / / O Subtotal: $ 5 . y 0 Signature: Ai - Date: II I Minimum Permit Fee $72.50 $ '7,2.S //S/9 (� . $ , 2» z - Plan Review Fee (25% of Permit Fee) $ (Please print namo State Surcharge (8% of Permit Fee) $ 6 . qC.) TOTAL PERMIT FEE $ 7 fg , O 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: $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. ...AssumedYaluationsPer 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 1 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 '4147; .; VALUATION: i:\DstsTermit Forms \MecPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 a. INSPECTIO DIVISION Business Line: (503) 639 -4171 MST v' I4' BUP Received Date Requested j — / ' AM L--- PM BUP Location 11 0 4 /3 - Suite MEC 3 -00 / 25' Contact Person Ph ( ) r!o 902- 515 PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner hiaft (/ Z.c.e4t ELC Footing Foundation _ ._ _ELC _ Access: Ftg Drain - - "�---' ELR Crawl Drain e xuc ' Slab 'InS to : T I%?1P ea , rs hear earg Firewall • , . Fire Sprinkler - - - __ : . Fire Alarm Susp'd Ceiling F C�;, I�YT © / f VALv,= .�oC'�>"u� �:�r C,'4 :• s��T' 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 Other: Final PASS PART FAIL MECHANICAL Post& Beam Rough-In Smoke Dampers ( Fin * . �. 4 PART FAIL ELECTRICAL 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: ❑ Unable to inspect — no access Fire Supply Line • ADA 4" — Approach/Sidewalk Dat - Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL BUP - Building Permit ELC - Electrical Permit J 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 Inspection Description Date Passed By Suspended ceiling Post/beam mechanical ,�j, Engineered soils Gas line 4 - 14 — 03 if Welding Lab Final Mechanical rough in Concrete Lab Final Fire damper Bolting Lab Final Duct work Structural observation Smoke detector Fireproofing Lab Final Mechanical final 4 - 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 I 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 4 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 DEVELOPMENT SERVICES PERMIT #: MEC2003 -00185 All . DATE ISSUED: 4/11/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S133DA-09000 SITE ADDRESS: 11096 SW 130TH AVE SUBDIVISION: CASTLES AT BRITTANY ZONING: R -7 BLOCK: LOT: 020 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: DOMES. INCIN: LPG 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: 1 > 10000 cfm: Remarks: Installation of gas piping for new range. Owner: FEES VAUGHN, PAUL J + MARY H Description Date Amount 11096 SW 130TH AVE TIGARD, OR 97223 [MECH] Permit Fee 4/11/03 $72.50 [TAX] 8% StateTax 4/11/03 $5.80 Total $78.30 Phone: Contractor: SHAMBURG HEATING LLC PO BOX 829 TUALATIN, OR 97062 REQUIRED INSPECTIONS Gas Line Phone: 503 692 - 5563 Final Inspection Reg #: LIC 126881 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 ou-to- follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00 Iss d By: • o g,�� i � �'- / Permittee Signature: A AV , / �• / . //� Call (50 ) 639 -4175 by 7:00 P.M. for inspections needed the next business .ir Case Activity Listing 11/18/2004 TIDEMARK Case #: MEC2003 -00185 COMPUTER SYSTEMS, INC. 4 'm'' ` M � ate% �` 01 ,;D>t ° a''�. �,� te�.' g Y th an D� ,,�B. � ,' ° c es tr ,�.. 0� A, �� nFs �r !�Oi ✓u. ID".��,...�s,��d -, .. .. ,.q,,.. . /g�.:�..,v, .,i w.. ... "�',.. ...A �4c;','= _ ,.. ni °�.zw9 i ,i >R,ir ,;.. � . -��i'� ° <, ., , .,z , <_ ,.. /,,,,s.,< ..a Y. KKv i.i r �t2i' 6.wh / .,, „ <, , .. ft .: r�',r .. /. 64.s ,LS".'./"l/-S jjFF MECA007 Application received 4/11/2003 None DONE DEB 4/11/2003 RCP MECA008 Create Permit 4/11/2003 None DONE DEB 4/11/2003 RCP MECA705 Gas Line Insp 4/14/2003 None PASS KBS 4/14/2003 KBS MECA799 Final Inspection 4/14/2003 None PASS KBS 4/14/2003 KBS MECA060 (F) Issue permit 4/11/2003 None DONE DEB 4/11/2003 RCP MECA800 Case Finaled 4/14/2003 None PASS KBS 4/14/2003 KBS Page 1 of 1 CaseActivity..rpt