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Permit C ITY OF TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2003 -00534 ` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/2/03 PARCEL: 2S110AD -05900 SITE ADDRESS: 10555 SW DEL MONTE DR SUBDIVISION: LANG HILL NO.2 ZONING: R -12 BLOCK: LOT: 052 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: 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: 2 FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 cfm: Remarks: Install gas fire place. Replace and relocate water heater. A plumbing permit is required. Owner: FEES BECKER, JOAN M Description Date Amount 10555 SW DELMONTE DR TIGARD, OR 97224 [MECH] Permit Fee 9/2/03 $72.50 [TAX] 8% StateTax 9/2/03 $5.80 Phone: 503 639 - 0930 Total $78.30 Contractor: SHAMBURG HEATING LLC PO BOX 829 TUALATIN, OR 97062 REQUIRED INSPECTIONS Phone: 503 Gas Line Insp Mechanical Insp 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 you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00 Issued By: _ Permittee Signature: © � Call (503) 639 -4175 by 7:00 P.M. for inspections needed tt xt busin • ay Mechanical Permit Application Received FOR OF F ICE IJS ONLY Mechanical Date/By: 9 /. 1 b 3 Permit No f - O 3 CIt Of � aPd Planning Approval Building y g Date/By Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By Permit No Phone: 503- 639 -4171 Fax 503 -598 -1960 Post - Review Land Use 4 >a� DateB Internet. www.ci.tigard.or.us � I , ����� case No �:{�. _���, Contact t Juns.: ®See Page 2 for 24 - hour Inspection Request: 503 639 - 4175 Name/Method: Supplemental Information. ❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all mechanical materials, equipment, labor, overhead and profit. ® 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule ❑Accessory Building ❑ Multi- Family "7[2F]l]GL�'T.I +QVI?NTSSVJf]171 SGlATTIEY:N ❑ Master Builder ❑Other : Description Qty Fee(ea.) Total „' ,.y u,' : ` „i' °. <<: neatin Cuolin illi c; JOB,SIiI'RtIi ')�fQ TION ai tOtON` !1 t Furnace - add -on air conditionmg ** 14.00 Job site address: Sly LHc,Jr E t R 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 electnc) (in wall, in -duct, suspended, etc.) 14.00 Flue /vent (for any of above) 10 00 Subdivision: Lot #: Repair amts 12.15 Tax map /parcel #: ., I ' ..§ '” _ - °OtherlFuel Appliances x s; ,' sue' €• "° ; . ss Water heater 10.00 Gas fireplace 10.00 L°�aS i;:: inp €1-%€. -s Flue vent (water heater /gas fireplace) 10.00 LoT wta�r� {Z L1 E(�Z�� �C�� Log lighter (gas) 10.00 Wood/Pellet stove 10.00 ` Wood fireplace /insert 10.00 Chimney/liner /flue /vent 10.00 fl io 1 WOW NERL Ls `` E : 1 £. '_ Other: 10.00 No ' s= .:`=,«' kf ;Env ronmeiital Efh u` t &r Ventilati i ' 1/ Range hood/other kitchen equipment 10.00 Address: ► cSS Q__,���� € Clothes dryer exhaust 10.00 City/State/Zip: i , �Ad2� tit S T22 Ci Single duct exhaust Phone( c3) b3� �3� Fax: (bathrooms, toilet compartments, �AEYL1'' = ®O ° QC:BESOT utility rooms) 6.80 Name: Attic /crawl space fans 10.00 Address: S '� �.F -low 2 Other: 10.00 t o 5 City/State/Zip D2 [ 22. Q * *($5.40 for first 4, $1.00 each additional) Phone: 'Fax: Furnace, etc. _ ** Gas heat pump ** E -mail: ! �7 Wall /suspended/unit heater ** tz`� 9',aSC-i l l T® re' L � '• s ^ t,� �.� „� >.__ ��..: ' Water heater * * Business Name: ~x.c - \ Fireplace ** Address: 2 34'i 5 S� >�e��ias�+� �P r) Range ** City /State /Zip:1L 1 L Z Clothes dryer (gas) ** Phone.(So3)�Q� 5�3 Fax: Other: ** CCB Lic. #: l Total: Authonzed := ,_M.._` ^,' , .s l;: k °'Mechanical :` Permit' Fes* -`; :, `/ _Z Subtotal: $ � � •, � Signa a 1( \i Date: Minimum Permit Fee $72.50 $ ���, Plan Review Fee (25% of Permit Fee) $ State Surcharge 8% of Permit Fee $ , .3 ' (Please print nar'rie)` g ( ) TOTAL PERMIT FEE 7 Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tr-County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Pernvt Fonns\MecPermitApp.doc 01/03 I 6- Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: miffaUtit4 $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, o 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. 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 roil. 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 $ VALUATION: \Dsts \Permit Forms\MecPermitAppPg2.doc 01/03 CITY OF TIGARE `' 24 -Hour - BUILDING Inspection Line: x (503): 639 -4175 f r INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested I I — 7 AM PM BUP Location I OS Suite — 00 5 Contact Person c I 0 Ph ( ) (oS9 — D93 PLM Contractor Ph ( ) SWR .BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling 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 ECHANIGAL Pos eam Rough -In Gas Line Smoke Dampers 4 PART FAIL ICAL . - Service Rough -In UG /Slab Low Voltage Fire Alarm Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line / 1-- . " ."/ A ADA // —7-0 Approach /Sidewalk Date 3 Inspector • Ext Other: Final DO NOT REMOVE.this inspection record from the job site. PASS PART FAIL