Permit ti
CITY OF TIGARD MECHANICAL PERMIT
•
o i DEVELOPMENT SERVICES PERMIT #: MEC2000 -00444
s.� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/13/2000
PARCEL: 2S 111 CD -05100
SITE ADDRESS: 15975 SW BRENTWOOD CT
SUBDIVISION: SUMMERFIELD NO.9 ZONING: R -7
BLOCK: LOT: 510 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: 1 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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Remarks: Installation of exterior residential NC unit. Unit cannot be placed within the required setbacks.
Owner: FEES
PEGGY ZEITZINGER Type By Date Amount Receipt
15975 SW BRENTWOOD CT PRMT CTR 11/13120C $72.50 2720000000
TIGARD, OR 97223 5PCT CTR 11/13/20C $5.80 2720000000
Total $78.30
Phone: 503 - 624 -1925
Contractor:
SPECIALTY HEATING + FABRICATIO •
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Mechanical lnsp
Phone: 620 -5643 Final Inspection
Reg #: SUP 2570RET
LIC 006657
ELE 34 -341 CR
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)246-918'.,
Issue By: � Air A ' Permittee Signature: d r9 /e/9-/ / D�l
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
a
Datereceived: // /3 A, Permit no.: /1.7 � C't00 -O9 r y
11 City of Tigard Projecdappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 ' 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 '
0 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction Cddition /alteration/replacement ❑ Other:
JOB SITE INFORMATION . . COMMERCIAL VA LUATION SCHEDULE '
. Job address: i 5 G 75 so / f(/I7l oecto C.'i 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: 'y9 S..e! T — / rf €-7-- jurisdiction's fee schedule for residential permit fee.
City /county: ysa.- / - 04-5 4 ZIP: 9 7 2 3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: 1.44,0 /G I COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
G4-5 Fee(ea.) Total
Est. date of completion/inspection: 7/ /1 / OO Description Qty. Res. only Res. only
Tenant improvement or change of use: Air handling unit CFM
Is existing space heated or conditioned? 21 Yes ❑ No Air Air conditioning (site plan required)
Is existing space insulated ?, Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
State boiler permit :
no.
Business nameLS lX�yr� L. t/d y ¢ / YJ�iI ?G H Tons BTU /H
Address: f jr" 6 a) _ 7 e S f / Fire /smoke dampers/duct smoke detectors
City: - 775"0./1 q yyy I State: O ,e_I ZIP: q 7 v.. 3 Heat pump (site plan required)
Phone:&)3( 6&/, Fax59ss 0 7 /et-E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: 4,4 .5 7 8 Install /replace /relocate heaters— suspended,
City /metro lic. no.: !b qc, wall, or floor mounted
Name (please print): " s rh . y-/ €15 Vent for appliance other than furnace
CONTACT PERSON
Refrigeration: _ _
Absorption units BTU /H
Name: ,, /4 /4 Leg p.( / y] Ile O.. Chillers HP
Address: (75 Sc. 7 i Q'' s' % Compressors HP
� aA d I I q 7oZ, --2 Environmental exhaust and ventilation:
City: Sta e:Qe ZIP: Appliance vent
Phone 4 o - S 6 'Fax:598 07 /8' E -mail: Dryer exhaust
• OWNER • Hoods, Type 1/ IUres. kitchen/hazmat
hood fire suppression system
Name: / 7 .e/ i r,../ ill' € / - Exhaust fan with single duct (bath fans)
Mailing address: / ,n Q 7 s w C f s�7 idocc Cr- Exhaust system apart from heating or AC
City: 9 /l d I Staten /'J I ZIP: 9 7�_3 Fuel piping and distribution (up to 4 outlets)
7 Type: LPG NG Oil
Phone: 'D3 , -1q, 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: I Fax: I E - mail: Woodstove/pelletstove
(� �, ate: / Other:
Applicant's signature:
���f>;l- tl/l�l Wit'- 7 / ��4T/ Other.
Name (print): f j f `I I1?to 14 S f�! /l/' r
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7 s 0
Notice: This permit application Minimum fee $
Cl Visa ❑ MasterCard
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been
State surcharge 8%
g ( )....$ 5 •PO
Name of cardholder as shown on credit card accepted as complete. TOTAL $ 7 P, 'JJ d
$ Cardholder signature Amount 440 -4617 (6 /00 /COM)
Commercial Schedule
1 &2 Family Dwelling Schedule
I ASSUMED VALUATIONS PER APPLIANCE
- • Description
Furnace to 100,000 BTU Table IA Mechanical Code Qty Price Total
including ucts & vents 955 1) Furnace to ducts & 0 BTU
g including duds vents 14.00
Furnace > 100,000 BTU 2) Furnace 100,000 BTU+
including ducts & vents 17.40
including ducts & vents 1,170 3) Floor Furnace
including vent 14.00
floor fumace . 4) Suspended healer, wall heater
including vent 955 or floor mounted heater 14.00
suspended heater, wall heater 5) Vent not included in appliance permit 6.80
or floor mounted heater 955 6) Repair units 12.15
` Check all that apply 'Boiler Heat Air.
Vent not included in appliance permit 445 For items 7 -10, see or Pump Cond Qty Price Total
Repair units 805 footnotes 1,2 Comp
P 7) <3HP; absorb unit to
< 3 hp; absorb.unit 100K -BTU 14.00
8) 3 -15 HP; absorb unit
to 100k BTU 955 100k to 500k BTU 25.60
3 -15 hp; absorb.unit 9) 15 -30 HP; absorb
unit .5 -1 mil BTU 35.00
101k to 500k BTU 1700 10) 30 -50 HP; absorb - -
unit 1 -1.75 mil BTU 52.20
15 -30 hp; absorb.unit 11) >50HP; absorb unit >1.75 mil BTU
87.20
501k to 1 mil. BTU 2310 12) Air handling unit to 10,000 CFM
30 -50 hp; absorb.unit 10.00
13) Air handling unit 10,000 CFM+
1 -1.75 mil. BTU 3400 ' 17.20
> 50 hp; absorb.unit 14) Non - portable evaporate cooler
10.00
> 1.75 mil. BTU 5725 15) Vent fan connected to a single duct
6.80
Air handling unit to 10,000 cfm 656 16) Ventilation system not included in
appliance permit • 10.00
Air handling unit > 10,000 cfm 1170 17) Hood served by mechanical exhaust
1 0.00
Non - portable evaporate coller 656 18) Domestic incinerators
vent fan connected to a single duct 446 17.40
19) Commercial or industrial type incinerator
Vent syst. not included in appliance permit 656 69.95
Hood 20) Other units, including wood stoves
ood served by mechanical exhaust 656
10.00
Domestic incinerator 1 170 21) Gas piping one to four outlets
5.40
Commercial or industral incinerator 4590 22) More than 4-per outlet (each)
1.00
Other unit, including wood stoves, inserts, etc. 656 Minimum Permit Fee $72.50 SUBTOTAL WM WEI --
Gas piping 1-4 outlets 360 8% SURCHARGE ffiffn NOM
PLAN REVIEW 25% OF SUBTOTAL .1 1 r ._
Each additional outlet 63 Required for ALL commercial permits only _ x f
TOTAL t- '"7"3
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
Total Valuation Fee 3. Additional plan review required by Ganges. additions or revisions to plans (minimum
charge-one-half hour) $72.50 per hour
'Slate Contractor Boiler Certification required
$ .00 to $5,000.00 Minimum $72.50 "Residential NC requires see plan showing placement of will
$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
$50,000.00 and up $742.00 for the first $50,000.00 and $1.20
for each additional $100.00 or fraction
thereof
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CITY OF TIGARD BUILDING INSPECTION DIVISION •
24 -Hour Inspectieh Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested / 7, — r`i AM PM
BLD
Location lS? 7-) 5e) Suite MEC 2 ' ' -c/a c/
Contact Person $kertiwvv4 Ph G `1 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
(a12pp
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
ECHANIC
Post & Beam
Rough In
Gas Line
Smoke Dampers
ina
S PART FAIL
EL CTRICAL
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk
Other Date / 2 - - Inspector • Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.