Permit CITY OF TIGARD
MECHANICAL PERMIT
'I& DEVELOPMENT SERVICES PERMIT #: MEC2001 - 00177
c �" I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/29/01
PARCEL: 2S102BA -00800
SITE ADDRESS: 12155 SW GRANT AVE A
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING: I -P
BLOCK: LOT: 059 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 4
Remarks: Installation of gas piping (roof and east wall) for suites A, B, C & D.
Owner: FEES
SEE - ZER PROPERTIES Type By Date Amount Receipt
26785 SW NEILL RD PRMT CTR 5/29/01 $72.50 2720010000
NEWBERG, OR 97132 5PCT CTR 5/29/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
WATSON PLUMBING CO.
7935 E BURNSIDE ST
PORTLAND, OR 97215 REQUIRED INSPECTIONS
Gas Line lnsp
Phone: 503 - 256 -3720 Final Inspection
Reg #: LIC 111855
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 -9189.
jI
Issue By: , I j Permittee Signature: x
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
`~ Mechanical Permit Application .
Date received:529 D/ Permit no.: retook-40/77
tl : City of Tigard Project/appl. no.: Expire date: •
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By:IOTA ' eipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Paymentlype:
Land use approval: Buildingpermitno.:
TYPE OF PERMIT '
❑ 1 & 2 family dwelling or accessory ,0 Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ • ddition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: / / � c-- S (� 6 /L/i-7.4 T Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: /I- C' cr Q I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ ��d .
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: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
De ription and location of work on premises: AND COMMERIC.AL/INDUSTRIAL EQUIPMENTSCIIEDULE
O T � T W t - L 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? ❑ Yes CI No Air handling unit CFM
space insulated? ❑Yes ❑ No Air conditioning (site plan required)
Is existing P Alteration of existing HVAC system
MECHANICAL CONTRACTOR . Boiler /compressors
Business name: Y / S Q I CAA y uN `(, State boiler permit no.:
HP Tons BTU /H
Address : .7 9 ,? Z ct2i�{4f l E Fire/smoke dampers/duct smoke detectors
Cit fit/ I StateIP:� ?� f Heat pump (site plan required)
Phoned. '7 S�- (�j�(I E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: ,71��� Install/replace/relocateheaters- suspended, .
City /metro lic. no.: 4 l S— U wall, or floor mounted
Name (please print): t L L J Ui u Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU /H
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type 1/ IUres. kitchen/hazmat
. hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
_ Mailing address: Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets 4
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: • E 1 Woodstove /pellet stove
Other:
Applicant's signature: / �yp d)ate:,_ S' S
Gi�J �'/ Other:
Name (print): D <n / v 2 I /cx� _ _roe, l J
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ / oG s v
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
(at expires if a permit is not obtained Pl review %
Credit card number: / � ( %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ S S. PO
Name of cardholder as shown on credit card accepted as complete.
. $ TOTAL $ 7 v
Cardholder signature Amount 440 -4617 (6/00 /COM)
MECHANICAL PERMIT FEES - .
1,
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
including ducts & vents 14.00
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
fraction thereof, to and including including ducts & vents 17.40
$10,000.00. Floor Furnace
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) including Furnace 14.00 vent
$1.54 for each additional or Suspended heater, wall heater
fraction n therereof, , to to and including luding 4) p 14.00
$25,000.00. or floor mounted heater
$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_- _ . . Air' . .
$1.20 for each additional $100.00 or Fgr"item -11 .
, see ° _ ; or Pump . "Corid
fraction thereof. f ootnotes°belovv: '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 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: 1 $
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656 8% State Surcharge " ` ,: e ",'' $
inserts, etc.
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) t $
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 NC requires site plan showing placement of unit.
is \dsts \forms\mech - fees.doc 10/11/00 .
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CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 5-3u AM PM BLD
Location J 2 (S 7frG w 7 L Suite �- G D- MEC 2 / - o/27
Contact Person Ph - D JZ 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 P FAIL
Post & Beam •
Rough In
Gas
moke Dampers
Fi
PAS PART FAIL
TRICAL _..
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART . FAIL
SITE ° .
Backfill /Giading
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
Oth roach /Sidewalk Date I I nspecto r 1 's - -- E x t
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.