Permit •
CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES ____ _ PERMIT #: MEC2002 -00141
AA A I! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4" "/8/02
PARCEL: 2 S 103 C B -02000
SITE ADDRESS: 12220 SW JAMES ST
SUBDIVISION: WILLAMETTE ZONING: R -4.5
BLOCK: LOT: 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: 1 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
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace existing furnace with like kind.
Owner: FEES
LARRY IVERSON Type By Date Amount Receipt
12220 SW JAMES ST PRMT CTR 4/8/02 $72.50 2720020000
TIGARD, OR 97223 5PCT CTR 4/8/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
FITZ ENTERPRISES INC
232 NE MIDDLEFIELD RD
PORTLAND, OR 97211 -1238 REQUIRED INSPECTIONS
Heating Unt Insp
Phone: 503 - 283 -1256 Final Inspection
Reg #: LIC 33512
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 adopt d -in the Oregon
Utility�cation- Center. Those rules are set forth in OAR 952 - 001 -0010 through AR
952 =001 -0080. Yo 'may obt.. in copies of these rules or direct questions to 9 UNC by calling!,
- t /� / P erm ittee S ignature: ��� t
I ue By: - ! M/ r
-- - Call (503) -•39 -4175 by 7:00 P.M. for inspections needed the next't u iness da •
Mechanical Permit Application
Date received: �9 Permit no.: V-D0I
."► City of Tigard Project%appl. no.' A xprr q
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: . By t �!' e ceipt • no.:
Phone: (503) 639 -4171 -
Fax: (503) 598 -1960 Case file no.: MI "Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT '
)il 1 & 2 family dwelling or accessory Li Commerciallindustrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: tt % VaEiir*'i � �..• ' (2- - -. L'..- Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: Lk �� L',--' l 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: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Descri lion and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
v " ,)LL— LA A 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 1:1 No Air c unit CFM
Air conditioning (site plan required)
Is existing space insulated? -Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: 'i Z State boiler permit no.:
�t L< <�C ��� CHIC �'C� HP Tons BTU /H
Address: 2132, � : WL� ._ _, Fire/smoke dampers /duct smoke detectors
City: ''1 I State:CAe_ I ZIP: VZ Z_\ Heat pump (site plan required) ,
Phone: Z '" : 1 Fax: 2.3:1' ' ,, , E -mail: Install/replacefurnace/burner 1 7 BTU /H
Including ductwork/vent liner 1 Yes CI No
l
CCB no.: ,33_E 1 * Install /replace /relocate heaters- suspended,
City /metro lic. no.: c � C -1-0-( wall, or floor mounted
Name (please print): '- t 7.-Z- 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: (,..,V P Y( t ' 14 Exhaust fan with single duct (bath fans)
Mailing address: CZ Z.Z -c,,,. Sc.,_, ,rjl'<'W\
S Exhaust system apart from heating or AC
City: �l�j� —f� I State ZIP: °C1:2:2.-;3 Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: S a ,C, Fax: E -mail: Fuel piping each additional over 4 outlets -
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: v x : mail:
Woodstove/pellet stove
Other:
Applicant's si nature: � 4 i Date; 8Z—
Other:
g - -�� +� �'� � 1 � "�
Name (print): \ ---'L, t CT ^t
Not �all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ ` ^
0 Visa ❑MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at — %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ S•b c'
Name of cardholder as shown on credit card accepted as complete.
. $ TOTAL $ Zt
Cardholder signature Amount I 440 -4617 (6/00 /COM)
•
MECHANICAL PERMIT FEES _. .�
•
COMMERCIAL_ FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION ; PERMIT:FEE L x , ' Desc it io , ; Pnce Total' '
$1.00 to $5,000.00 Minimum fee $72.50 .Table 1A M'echantcal)Code „; Qty, ", , Amt,
$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
$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 CfiecKall,that;agplyp:1. - Boiler ` - Heat - Air " - '
$1.20 for each additional $100.00 or Fo r- items 7` -1P1, see , : or Pump . , Conti
fraction thereof. ,footnotes below > t .Comp ,, - , .
- ::'":,',;:r , :: .'' _ ,'' 4,_ . ,, .G . ' ::;: rt . . _
Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU 14.00
8% State Surcharge $ 8) 3-15 HP; absorb 25.60
unit 100k to 500k BTU
-
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
x - - -- - 12) Air handling unit to 10 CFM
ASSU, MED ; VALUATIQNS`PER; °APPL;IANCE;. m N 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 appliance 445 10.00
permit 18) Domestic incinerators
Repair units 805 17.40
< 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 g.:#44 ,a
Air handling unit to 10,000 cfm 656 8% State Surcharge ,a ==;' $
Air handling unit >10,000 cfm 1,170 4K'' "*. e"
g i :',' :,ate
Non - portable evaporate cooler 656 ;, $
Vent fan connected to a single duct 446 TOTAL RESIDENTIAL PERMIT FEE: :,� :,
P Rr;:9, --;
Vent system not included in 656 `'1 ; :' =�t'. °'
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 ,� $ **Residential A/C requires site plan showing placement of unit.
,, a °; 9 :: E . A v:4SE ,s .
VALUATION: v d;' !':,;'*:' All New Commercial Buildings require 2 sets of plans.
is \dsts \forms\mech -fees.doc 02/11/02
Oregon Construction Contractors Board » License Details Page 1 of 1
OREGON CONSTRUCTION CONTRACTORS BOARD
License Details as of April 8, 2002 1:59 PM
LICENSE NUMBER: 33512
NAME: FITZ ENTERPRISES INC
ADDRESS: 232 NE MIDDLEFIELD RD PORTLAND OR 97211 -1238
WORK PHONE NUMBER: 503 - 283 -1256
LICENSE STATUS: Active ENTITY TYPE: Corporation
EXPIRATION DATE: 6/9/2003 LICENSE CATEGORY: Specialty Contractor /Res
DATE FIRST LICENSED: 7/25/1980 EMPLOYER STATUS: NON - EXEMPT
BOND COMPANY: TRAVELERS CASUALTY INSURANCE COMPANY: WESTPORT INS
& SURETY CO OF AMER CORPORATION
BOND AMOUNT: $ 10000 INSURANCE AMOUNT: $ 1000000
BOND EFFECTIVE TO: 6/9/2003 INSURANCE EFFECTIVE 6/30/2002
TO:
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Page Last modified: February 22, 2002
*QUERY COMPONENTS READ LIVE DATA
State of Oregon Liability Statement
http:// ccbed. ccb .state.or.usBill /regno222.asp 4/8/02
CITY OF TIQAR 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVJSIOF4 Business Line: (503) 639 -4171 MST
BUP
Received Date Requested � 1 AM PM BUP
Location 9,61- ' Suite MEC . ' 4 , e 21. y/
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/
Ve.AKi - _a. .J ELC
Footing / ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain -
Slab Inspection Notes: � � SIT
Post & Beam
_
Sr Anchors
Ext Sheath/Shear
ear ti
Int Sheath/Shear
Framing Pin ' -_ r L. ,G, to"(
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
<MECHANICAL)
Post& Beam
Rough -In
Gas Line
Smoke Dampers
maw
0 AS) PART FAIL
ELECTRIC AL
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 2
•
Approach /Sidewalk Dat Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL