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Permit A l CITY O TI GA R D MECHANICAL PERMIT I DEVELOPMENT SERVICES PERMIT #: MEC2003-00127 ik 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/20/03 PARCEL: 2S 110AC -02100 SITE ADDRESS: 11492 SW LAUREL GLEN CT SUBDIVISION: LAUREL GLEN ZONING: R -4.5 BLOCK: LOT: 004 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: DOMES. INCIN: LPG 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS ?: 30 - 50 HP: GAS PRESSURE: 50 + HP: WOODSTOVES: FURN < 100K BTU: 1 AIR HANDLING' UNITS CLO DRYERS: OTHER UNITS: 2 FURN > =100K BTU: <= 10000 cfm: > 10000 cfm: GAS OUTLETS: 3 Remarks: Install gas furnace, water heater and stub for range. Owner: FEES DON BUSS Description Date Amount 440 NW HILLTOP RD [MECH] Permit Fee 3/20/03 $72.50 PORTLAND, OR 97210 [TAX] 8% StateTax 3/20/03 $5.80 Phone: 503 245 - 9876 Total $78.30 Contractor: ALPENGLOW 5620 SW KELLEY AVE. PORTLAND, OR 97239 REQUIRED INSPECTIONS Phone: 503 793 - 3866 Gas Line Insp Mechanical Insp Reg #: LIC 131932 Heating Unt Insp Final Inspection 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:, 7 - M Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day Mechanical Perthit Application FOR OFFICE USE ONLY . Received n . Mechanical Date/By3 -D-(...9 - 03 r �2 , Permit No.11.019' -ODla7 Planning Approval Building City of Tigard 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 //i�adl0 1 I IA Date/By: Case No.: Internet: www.ci.tigard.or.us . I Contact Juris.: ® See Page 2.for 24 -hour Inspection Request: 503- 639 -4175 s -W Name/Method: Supplemental Information. r" :° ; ` ` 7 v - '" l COMMERCIAL FEE*,SCHEDULE 1DSE CFIE IZL1ST ;� - �s�.��..�..�..__� „e�. ��TYPE�F��ORK..�._�°._:� .�.:t. _.� ❑ 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 .... _ • ___-._. %MA A. IC�OEGORYAFt`CONSTRUCTIQN, � , ,� ,, _ a..,,,,;. VI mechanical materials, equipment, labor, overhead and profit. 1 & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule Accessory Building ❑ Multi - Family ''' ' RESIDENTIAlaQ IIPMEN'I /SYSTEMS FEE* SCHEDULEVA Description I Qty Fee(ea.) I Total ❑ Master Builder ❑ Other: Heating/Cdoiing.._;,..'. . 7 ' JOBiSITE' INFORMATION and;LOCATION '' e : ; Furnace - add -on air conditioning ** / 14.00 Job site address: I I '-/ �' 2 6W G- ✓ l5 �/ - e.r Lv` • 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: (fo radiator or hydronic system) 14.00 I e'jC O y) ' / I �i5 4 y m ��ll //7` // (for y Unit heaters (fuel, not electric) / (in wall, in -duct, suspended, etc.) 14.00 lej 1 1 1171 m y/ // L / , - / o 0 fie/ U- e:--1 Flue /vent (for any of above) 10.00 Repair units 12.15 Subdivision: Lot #: , t �us <. AOtFi i ' :Ebel Appli a .. _ ,-X,':;,'.„... Tax map /parcel #: Water heater / - 10.00 ( 24 7n; DES:CRIttION OF:WORT{ w viwi „ it Gas fireplace 10.00 flew 6 f L e a 1 ' / k 5 qs k Flue vent (water heater /gas fireplace) 10.00 Log lighter (gas) 10.00 tuna ('O I lam• H • ) �✓�, { Wood/Pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 Ptit �d _.. , t 1. - TENANT. , ". Z(., av Other u s 10.00 '.O / n WNER ,., .: ame: ! 'T / ,� D • Y�?G6 . , s Envi rori in e t ions Range hood/other kitchen equipment 10.00 Address: 6 20 5 "1 gee1/' � � ,. ` Clothes dryer exhaust 10.00 City /State /Zip: P/i1 0,1- c/ -3 1 / Single duct exhaust Phone: 799-386 Fax: 2-115 (bathrooms, toilet compartments, zF.3 APPLICANT;., , gv< El €`CONTACTPERSON# ,a'. utility rooms) • 6.80 Name: 6C. vi---t Attic /crawl space fans 10.00 Other: 10.00 Address: ., - ° r.3 ?FueliPAipiii .' .: °` 1 64' 3`.5 ,0•°° : .. `. :P8 City /State /Zip: * *($5.40 for first 4, $1.00 each additional) F etc. 1 ** Phone: Fax: Gas heat pump ** E-mail: Wall /suspended/unit heater ** . tf ' _i i. .' ..CONTRAC,TOR µ ' E .. :...' _._ '' ' Water heater i ** Business Name: "1-( e 5 /o l-1-0 Fireplace ** ** Address: SG t w ge 11 4 RBQ ** City /State /Zip: Pf-- ice _ °t OA. 7 Z 31 Clothes d er (gas) ** Phone: 79 -3 ,96,6 Fax: Zli 5 -776f Other: e " gry &ti i ** q3 2- / 6 "sZly - -D Total: CCB L1C. #: `Me c l i ant elifr er mitFe e s ,',', :, , '' °,`, Authorized Subtotal: $ Signature: Minimum Permit Fee $72.50 $ '7 . D _ _ he., I Y � 6 -C CwY _ _ __ _ J Plan Review Fee (25% of Permit, Fee) $ (Please print name) State Surcharge (8% of Permit Fee) $ f() • TOTAL PERMIT FEE $ 3. Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board. 180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: , $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, 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. $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or • fraction thereof. ASSA1111pit.., A L, 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 mil. 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: i:\Dsts\Permit Forms\MecPermitAppPg2.doc 01/03 1/4/2005 /1101,....!,,,. Case Activity Listing 1:40:38PM TIDEMARK Case #: MEC2003 -00127 COMPUTER SYSTEMS, INC. . r `� . ,,nwz' r °A ss i "ned "Done " a ii , 9r, \�.. :.� Ntj %O:$'F�,:r >ia i �+'y+y,� 3 rr. �: �" . . . ,.ra .. . _ , ... 44:"I'''' oiar _ D ���;, „ B`" NON ores � . „.� .. a e ; l Date2 ,� a te�3 � � s '��,. To' � , � .: ".. >< Descri tion . � y „ `D t � -:; a ' n Actw t, _ � �° w, ... , , --.. .., . ".....a�, . .: .: P.,. . >,. „:p�? �,. =” „u,, ,,� + .�. �. . . . e ..ua. �” ". \. .,.. ... ,.....�... :...... w . /.. 6 �f$ #a.':',u ....��u,r.. .a MECA007 Application received 3/20/2003 None DONE BB 3/20/2003 BLD MECA008 Create Permit 3/20/2003 None DONE BB 3/20/2003 BLD MECA705 Gas Line Insp 4/3/2003 None PASS TLP 4/3/2003 TLP None 3/20/2003 MECA715 Mechanical Insp BLD MECA725 Heating Unt Insp None 3/20/2003 BLD MECA799 Final Inspection 5/20/2004 None FAIL KBS 5/20/2004 KBS MECA060 (F) Issue permit 3/20/2003 None DONE BB 3/20/2003 BLD MECC075 (F) Reprint permit 5/20/2004 None DONE WO 5/20/2004 WO I 5/20/2004 None 5/20/2004 MECA000 SF Detached Menu -1 unit MRS MECA799 Final Inspection 5/20/2004 None PASS MRS 5/20/2004 MRS MECA800 Case Finaled 5/20/2004 None PASS MRS 5/20/2004 MRS Page 1 of 1 CaseActivity..rpt CITY OF TIGAFa': 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST '3//f BUP Received Date Requested s OSAM PM BUP Location / / </q x Suite MEC Contact Person C wt i�._- Ph ( ) "79 3 ` F6 P PLM Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footings ELC Fn Access: - ' ELR Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath/Shear Framing Insulation Drywall Nailing Fi rewal I Fire Sprinkler Fire Alarm Susp'd Ceiling Roof — ��► try i Other: Final / / PASS PART FAIL 5� - PLUMBING �} Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain - Shower Pan • PART FAIL HANIGAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL - Service Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hail Blvd. PASS PART FAIL SITE ,'' • Please call for reinspection RE: Unable to inspect — no access Fire Supply Line -- — ADA Approach /Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TOGA:', D _ 24 -Hour BUILDING Inspection .Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date: - .nested �---. AM �.--'"----- PM BUP Location IAc, 4 Suite a) ? 3-lxil 2-7 Contact Person 1-4--&- Ph ( ) - 7 3 — 3 g' ' • M ? r7-C'e-t »7.z Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC 6 770 G03 I l l Footing Foundation Access: ELC_ , 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 P9T FAIL ...) , `'Pest-St Beam '• gh -In /07'. va - ervice V Sanitary Sewer Rain Drains Catch Basin / Manhole N •`' Storm Drain Shower Pan Other: Fi. - .') • • RT FAIL Po t & Beam cRough -I0 Gas Line Smoke Dampers n PAS PART FAIL ELECTRICAL .> ':: r Service . .i MUM UG /Slab , Low Voltage Fire Alarm • F , % n Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. `LF* PART FAIL SI ' : , - ;,,- .;,'4 ❑ Please call for reinspection RE: n Unable to inspect — no access Fire Supply Line i . ADA Approach/Sidewalk Date / I n spector , Ext Other: Final • DO NOT REMOVE this inspection record from the job site. PASS PART FAIL