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
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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