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Permit CITY OF TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2001 -00058 s -+ �- 5 ! I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/15/01 PARCEL: 2S114BD -01200 SITE ADDRESS: 09860 SW RIVERWOOD LN SUBDIVISION: PICKS LANDING ZONING: R -4.5 BLOCK:. LOT: 073 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: 1 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: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: WOODSTOVES: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: 1 Remarks: VENT FOR RELOCATED DRYER GAS PIPING Owner: FEES TORRENCE, EVELYN P K + Type By Date Amount Receipt STANLEY E TRUSTEES 5PCT CTR 2/15/01 $5.80 2720010000 9860 SW RIVERWOOD LANE PRMT CTR 2/15/01 $72.50 2720010000 TIGARD, OR 97224 Total $78.30 Phone: Contractor: RAYBORN'S PLUMBING 19990 SW CIPOLE RD PO BOX 69 REQUIRED INSPECTIONS TUALATIN, OR 97062 Gas Line Insp Phone: 503 - 692 -4139 Mechanical Insp Reg #: LIC 00087852 Final Inspection PLM 34 -166 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 -ification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You ay obtain copies o rules or direct questions to OUNC by cal . (5 3) a :- 189. / , Issue By: , , to _ �� Permittee Signature: x Call (5: ` 639 -4175 by 7:00 P.M. for inspections needed the next business da , Mechanical Permit Application Date received: l O/ Permit no.: :f l City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.: • Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT '1 & 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: g , tl Pt • i eo 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:R/Qd_f , jurisdiction's fee schedule for residential permit fee. City /county: & m., Q R__ I ZIP: 5' 7 e 9'. cl 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE r1T Description and location of work on pre ises: \( /*/t'_.. AND COMMERICAL/INDUSTRIAL EQUIPMENT SCHEDULE X •f ,JG — Die_'f 2 , k f t...m.l7'O', 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 conditioning unit CFM space insulated? ❑Y es ❑ N o Air conditioning (site plan required) Is existing P Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors Business n e: P A1/3,0/L�1 � Lte yi 4 ,Adm State boiler permit no.: HP Tons BTU /H Address: Pio `7 )( 60? Fire/smoke dampers /duct smoke detectors City. u -/ 1 / p,...) ' I State:D/e. -I ZIP: 9766 Q.- Heat pump (site plan required) Phone:5' 41 -y /,3? I Fax I E - mail: Installlreplacefurnace/burner BTU /H Including ductwork/vent liner 0 Yes ❑ No �j CCB no.: g 7 O Install /replace/relocateheaters - suspended, City /metro lic. no.: wall, or floor mounted Name (please print): \C 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 U II/res. kitchen/hazmat � l hood fire suppression system . !T Name: �J( /V (D2� `Cii Exhaust fan with single duct (bath fans) Mailing address: Exhaust system apart from heating or AC City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets) • Type: LPG NG Oil Phone: Fax: E -mail: Fuel piping each additional over 4 outlets f ENG INEER Process piping (schematic required) Name: Number of outlets Other listed appliance or equipment: Address: Decorative fireplace City: • I State: I ZIP: Insert -type Phone: I Fax: I E -mail: Woodstove/peiletstove Other: Applicant's signature: I Date: Other Name (print): • Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7A SD ❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $ • 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 %) .... $ 3 . So Name of cardholder as shown on credit card accepted as complete. . $ TOTAL $ -7g . 3O - Cardholder signature Amount 440 -4617 (6/00/COM) • . 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 up $742.00 for the first $50,000.00 and =•.CFieck all ttiat {i ;.;;:; Bbilerw 4R Meat : = -' ' . ",,, , y ,:.-,I, ` t. £ $50,001.00 and p $ , �.�� � a p .�� � �,� � � � � r $1.20 for each additional $100.00 or F r e 7 11 s ee d .2 o Pump - ; Cond %� 0 A, �ry ; fraction thereof. footn below Comp_ -. "°` -, I.,I . 7) <3HP;absorb unit to 100K BTU 14.00 ASSUMED VALUATIONS PER APPLIANCE: 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 17.20 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 cfm 656 69.95 • Air handling unit >10,000 cfm 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 Permit Fee $72.50 SUBTOTAL: '=�4F „:i' Domestic incinerator 1, 7 Minimum erm ee . W:1 g $ Commercial or industrial incinerator 4,590 Other unit, including wood stoves, 656 8% State Surcharge ' 'N i` ; ' $ inserts, etc. s; ''` "gam -. Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) r <�h3 ;x ` 'C; a< > $ Each additional outlet 63 Required for ALL commercial permits only 4 I, TOTAL COMMERCIAL , . . $ . TOTAL RESIDENTIAL PERMIT FEE `' $ VALUATION:; a . ` ,. �. .V .. 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. ""`Residential NC requires site plan showing placement of unit. is \dsts \forms\mech- fees.doc 10/11/00 . • CITY OF TIGARD BUILDING INSPECTION DIVISION . - MST Viour Inspection Line:. 639 -4175 Business Line: -63 171 s, BUP Date Requested ,3� Z-y AM j PM BLD. Location 9,6 G - �'t4' Suite C�G /— O/da(.e Contact Person- ph G. 9Z- f( 3 . ' ;-• Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: . Foundation FPS Ftg Drain • Crawl Drain .. Inspection Notes: - • • . . SGN Slab- _ - Post &.Beam SIT Ext.Sheath/Shear I rif Sheath/Shear Framing _ Insulation — — Drywall Nailing , -, Firewall Fire Sprinkler .v ...:. ,. " i \ Fire Alarm Susp'd Ceiling . Roof Misc: t Final C • PASS PART FA1L C > eam Under Slab ' Top Out Water Service Sanitary Sewer • • P rains FAIL Rough In Gas Line Sm r a Dampers fN . , tt) PART FAIL • , RICAL , Service Rough In UG /Slab , Low Voltage Fire Alarm . - Final -PASS- PART . FAIL SITE Backfill/Grading 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 - Approach/Sidewalk pa 3/ C 1 / In ector Other P. \( Ext Final PASS PART FAIL• DO NOT REMOVE this inspection record from the job site. . CITY OF TIGARD BUILDING INSPECTION DIVISION MST -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP D ate Requested ra y AM PM gLp v � Location 9Sbo 1 ����dd� S uite M EC � �/��" coo57 Contact Person it t42 Ph 9 PLM Contractor Ph A69-390 SWR BUILDING `' ` Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: J_oL-�' p 0 A41..m. , ..�D Slab 1 SIT .. Post & Beam • Ext Sheath /Shear j / A- 7T L42. • Int Sheath /Shear Framing Insulation • Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam t as Laas- Smoke Dampers 41m PART FAIL E TRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line t [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA // / / / y� Approach /Sidewalk D / I 6 / 6 / In 7 '" 1 Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.