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Permit CITY TIGARD � MECHANICAL PERMIT � DEVELOPMENT SERVICES PERMIT #: MEC2001 -00051 All "- J � 13125 S W Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/7/01 PARCEL: 1 S135CD -05600 SITE ADDRESS: 09702 SW LONDON CT SUBDIVISION: LONDON SQUARE NO.2 ZONING: R -25 BLOCK: LOT: 008 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: 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: CLO DRYERS: FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 1 FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1 > 10000 cfm: Remarks: Installation of gas piping and gas insert. Owner: FEES SHANNON, ARLEEN M Type By Date Amount Receipt 9702 SW LONDON CT PRMT CTR 2/7/01 $72.50 2720010000 TIGARD, OR 97223 5PCT CTR 2/7/01 $5.80 2720010000 . Total $78.30 Phone: Contractor: JACOBS HEATING +A/C 4474 SE MILWAUKIE AVE PORTLAND, OR 97202 REQUIRED INSPECTIONS Gas Line Insp Phone: 503 - 234 -7331 Mechanical Insp Reg #: LIC 1441 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 -0010 through OAR 952 - 001 -0080. You may a o •'es of these rules or direct questions to OUNC by calling (5 )246 -9189. Issue B : , ; 4 , - / !, , , 1 . Permittee Signature: 444. Q,Q i Call (503) .39-4175 by 7:00 P.M. for inspections needed the next business day - Mechanical Permit Application ` 4 Date received:2 ,S O/ Permit no.: H�F cov-Oaa "/ ,. 1 ' City of Tigard �� r� oo \ ,` Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, 1 d, OR t9 ��� Date issued: By: I Receipt no.: - - Phone: (503) 639 - 4171 % F AQ Fax: (503) 598-1960 �� Q tc `�� Case file no.: Pa type Land u appr • • 4 .\\ Building permit no.: • . TYPE OF PERMIT .W & 2 family dwelling or accessory 0 Commercialindustrial ❑ Multi - family 0 Tenant improvement 0 New construction 0 Addition/alteration /replacement 0 Other: JOB SITE INFORMATION ' L COMMERCIAL VALUATION SCHEDULE Job address: 9.7 Oa S (;J 1-0 rti cloy (� 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: (Block: I Subdivision: *See checklist for important application information and Project name: A LE 1 6 4 0 • A • , jurisdiction's fee schedule for residential permit fee. City /county: -I &A 'Lb ZIP: q 7.2 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE Description and location of work n remises: AND COMMERICALIINDUSTRIAL EQUIPN ENT SCIIEDULE i V5719 i L- J /P work / )Ci to 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? 0 Yes 0 No Air handling unit CFM space insulated? ❑ Yes 0 No Alt Alteration existing HVAC C Is existing system P Alterati of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors Business name: "I A C.() es H ec> 1,,, is n State boiler permit no.: HP Tons BTU /H • Add ress: q t - - € cYl 1 ) 1 ,„ 3 sax.LA s Fire /smokedampers/duct smoke detectors City: 17 - I State: 6 ZIP: - q 'a 0 Heat pump (site plan required) - Phone: 73,- I Fax: I E - mail: Install/replace furnace/burner BTU /H CCB no.: /y Including ductwork/vent liner O Yes O No �/ / InstalUreplace/relocate heaters - suspended, • City/metro lic. no.: )c (o S' wall, or floor mounted Name (please print): S ) ,t2 Ll= H 4 (-3 Vent for a r r fiance other than furnace ' efngeration: �— CONTACT PERSON Absorption units BTU/H Name: Chillers HP Address: . Compressors HP Environmental exhaust and ventilation: City: State: I ZIP: Appliance vent Phone: Fax: ; 1'3 -• . -mail: Dryer exhaust Hoods, Type!' II/res. . .,- „ -- sw - -,. hodfiresuppression system azmat Name: t )i L£F /3 .5 H 4 ft) al l CSA.) Exhaust fan with single duct (bath fans) Mailing address: q.- s(,J Nw n ) e T - Exhaust system apart from heating or AC City: - 7 - 1 G V9 Q N I State: (52 TI ZIP: 4 7,2,9 3 Fuel piping and distribution (up to 4 out et v Type: LPG X NG Oil J Phone: t'p 3 - P/O? Fax: E -mail: Fuel piping each additional over 4 outlets ENGINEER Process piping (schematic required) Number of outlets Name: Other listed appliance or equipment: Address: Decorative fireplace / 0 '- City: I State: • I ZIP: Insert - type / A/3 e r. -I - Phone: I Fax: I E -mail: -- Woodstove/pellet stove - - - Other: Applicant's signature: - V I Date: - Other: - - - - • - .- - Name (print): . . - - - - - - Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee • ' ' $ 0 Visa ❑ MasterCard Notice: This permit application Minimum fee $ . 1a 5 expires if a permit is not obtained Plan (at _ % Credit card number: an review ( %) $ Expires within 180 days after it has been State surcharge (8 %) .... $ 5 I-% Name of cardholder as shown on credit card accepted as complete. TOTAL $ ya Cardholder signature Amount 440 -4617 (6/00/COM) 230 S MECHANICAL PERMIT FEES 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 $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 Check all that apply: Boiler Heat Air . $1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond fraction thereof. footnotes below. Comp* ** 7) <3HP;absorb unit ASSUMED VALUATIONS PER APPLIANCE: - to 100L STU 14.04 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 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 dm 656 69.95 Air handling unit >10,000 cfrn 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: $ Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 8% State Surcharge $ inserts, etc. Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $ 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. '' A/C requires site plan showing placement of unit. is \dsts \forms\mech- fees.doc 10/11/00 CITY OF TIGARD BUILDING INSPECTION DIVISION 6,D,---- 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST ii ,/ BUP 613 eliP g Date Requested _ sue'' 6 AM PM l Z . g Location q 10 2 , ' s Suite M • Q, ( — mood( Contact Person 1 1I CP tt Ph - e D t ..0'r 0.00.4,'7 Contractor `al b-. ( C. 1 P qZ 2 - q Z SWR BUILDING Tenant/Owner • �0 ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection •tes: D n -,,,� Slab !ii/..e..- Ca-GC �T1/ / SIT Post & Beam Ext Sheath /Shear I1.-1 i., A !' C.0 a'f-lC: Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final P FAIL PLU I d ' os & Beam t : . Under Slab Top Out (: Water Service' ti . 1. ' Sanitary Sewer \---" ' • Drains AS PA R1 FAIL HANK Post & Beam -1 '' ' Rough In `' - . T..- ,pW Gas Line Sm.. ampers ' PAS; PART FAIL CTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE BackfilUGrading 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 �I Approach /Sidewalk Date ` 1 Q I L / mil ' 1I Other Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.