Permit C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2002 -00130
1 II DATE ISSUED: 4/3/02
• 13125 S Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S111 CC -12100
SITE ADDRESS: 10415 SW HIGHLAND DR
SUBDIVISION: SUMMERFIELD NO.4 ZONING: R -
BLOCK: LOT: 172 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:
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: 1
Remarks: Kitchen remodel - add one gas outlet
Owner: FEES
WILLIAM JAMIESON Type By Date Amount Receipt
10415 SW HIGHLAND DR PRMT CTR 4/3/02 $72.50 2720020000
TIGARD, OR 97224 5PCT CTR 4/3/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
PACIFIC GAS WORKS
PO BOX 30646
PORTLAND, OR 97294 REQUIRED INSPECTIONS
Final Inspection
Phone: 503 - 317 -5573
Reg #: LIC 136391
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 OU • ing
(n1174R -a1 RA
•
Issue By:. Permittee Signat _ /.�! "'
Call (503) 639 175 by 7:00 P.M. for inspections = "ded the next business day
lUt
Mechanical Permit Application _
• �`' `
Date received: y- 3 --d� Perm tai k 0 Z -001 j 0
% 'i "
City of Ti and
• • �.. g Project/appl. no.: Expire date: •
of Tigard
Address: '13125 SW Hall Blvd, Tigard OR 97223
City f 8 Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Paymen•type:
Land use approval: Building permit no.:
TYPE OF PERMIT .
.id & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family • • 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: / 2 :W 6 _ZL. � / 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: IBlock: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: 77,-/ A I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description ancation of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling
Is existing space heated or conditioned? 0 Yes 0 No unit CFM
Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
G L' / ^�c� State boiler permit no.:
Business name:
t / �� HP Tons BTU /H
Address:,J / 31ter; VF Fire/smoke dampers/duct smoke detectors
City: ,. _, 2 I Stat . I ZIP: ?7 ' ' /' Heat pump (site plan required)
Phod : -96< • / &' E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner O Yes O No
CCB no.: /. ? e ,7/ Install /replace /relocate heaters — suspended,
City /metro he. no.: wall, or floor mounted
Name (please print): ` . , j � 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 I/ II/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
State: ZIP: Fuel piping and distribution (up to 4 outlets)
City: I I Type: LPG ( NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorativefireplace
City: • I State: I ZIP: Insert — type
Phone: (Fax: I E -mail: Woodstove/pelletstove
Other:
Applicant's signature: I Date: Other.
Name (print):
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7 a� CU
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Plan review (at _ %
Credit card number: Expires / wit hin 180 days after it has been ( %) $
State surcharge (8 %) .... $ 5r gD
Name of cardholder as shown on credit card accepted as complete. TOTAL $ 3 ) --- ni
Cardholder signature Amount 440 -4617 (6✓00 /COM)
•
if lir
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
. y� � P uce= Total
TOTAL ALIJATION ''P,E'RMIT FE Z , . 1 " : Descnptwn .
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A • �� ., e.ty ' (Ea) " °'_ "Amts_
$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 6.80
$1.45 for each additional $100.00 or .
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:alf that apply:' _: . dB_o`ilej': ,`'Heat 1. Air; " •. ,.
$1.20 for each additional $100.00 or Forifems 7 see kor_ Pump Cond -
fraction thereof. footnote w sfbelo - '''.C-,. omp - -
.;
' � ' ' . , . . e , . . , , ' • : ,` 7) <3HP; absorb unit
$
Minimum Permit Fee $72.50 SUBTOTAL: to 100K BTU 14.00
8% State Surcharge 8) 3-15 HP; absorb
$ unit 100k to 500k BTU 25.60
25% Plan Review Fee (of subtotal) $ 9) 15 -30 HP; absorb 35.00
Required for ALL commercial permits only unit .5 -1 mil BTU
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20
unit 1 -1.75 mil BTU
11) >50HP; absorb
unit >1.75 mil BTU 87.20
-. 12) Air handling unit to 10,000 CFM
:ASSUMED'VALUATIONS' APPLIANCE "" :` . `: 10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust •
Vent not included in applicance 445 , 10.00
permit 805 18) Domestic incinerators 17.40
Repair units
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101 k to 500k BTU 10.00
15 -30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: : = „ . `� $
>1.75 mil. BTU t: h% :;
Air handling unit to 10,000 cfm 656 8% State Surcharge " . �� . :', `,t $
Air handling unit >10,000 cfm 1,170 '°„ e; ' -',T';
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: =' w $
Vent fan connected to a single duct 446
Vent system not included in 656 4 ` ''' `
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator 1,170 $62.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge - half hour)
Other unit, including wood stoves, 656 • $62.50 per hour
inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge -one -half hour) $62.50 per hour
Each additional outlet 63 * State Contractor Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL i $ **Residential A/C requires site plan showing placement of unit.
, . . -',
VALUATION: _,W ^ < All New Commercial Buildings require 2 sets of plans. .
is \dsts \forms\mech- fees.doc 12/26/01
CITY OF TIGARD 24 -Hour y
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date R quested AM PM BUP
Location / 4/7< t r `l « ti 7 Suite MEC — D l W
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing 1 Al
Insulation ! i f
Drywall Nailing v ( ll
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
P ASS PART FAIL 517- /tom
PLUMBING //
Post & Beam
Under Slab Rough -1n c
Water � ^��
Water Service
Sanitary Sewer
Rain Drains lls /
Catch Basin / Manhole . �,�� 4/PC L/
Storm Drain
Shower Pan
Other: ✓ � / � -(�!
Final
PASS PART FAIL
— NIC�►1�,
Pos & Beam
V AA5 211
S e Dampers
PAS PART FAIL
ELECTRICAL
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 ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line jiLlf.
!
ADA
Approach /Sidewalk Date ` Inspector . / Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL