Permit r t
CITY OF TIGARD MECHANICAL PERMIT
��; DEVELOPMENT SERVICES PERMIT #: MEC2001 -00036
DATE ISSUED: 1/26/01
='�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S1 02 C B -00400
SITE ADDRESS: 10230 SW SCHOOL ST
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R -4.5
BLOCK: LOT: 034 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:
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: 0
> 10000 cfm:
Remarks: Installation of gas piping.
Owner: FEES
ELWELL, JOHN A Type By Date Amount Receipt
10230 SW SCHOOL ST PRMT CTR 1/26/01 $72.50 2720010000
TIGARD, OR 97223 5PCT CTR 1/26/01 $5.80 2720010000
Total $78.30
Phone: •
Contractor:
OWNER
REQUIRED INSPECTIONS
Gas Line Insp
Phone: Final Inspection
Reg #:
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 fo is in OAR
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or • *,- t quest • • C by
calling (503)246- 189.
Issue By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections nee ed the next business day
•
Mechanical Permit Application
A Date received: / 26/4/ Permit no.: i k" /- 000, 4
Y '
City b of Tigard • • �� � � Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By;.ff FReceiptno.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Paymenttype:
Land use approval: Building permit no.:
TYPE OF P:1011T
1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction % Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
2 \ Job address: (0 Z3() 51 co L 5 *- 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: jurisdiction's fee schedule for residential permit fee.
City /county: WA-c.., I ZIP: 9 l zZ 3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: M DVE , G a5 AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
1- r0`t- Fee(ea.) Total
Est. date of completion/inspection: I - -30 Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? ❑ Yes ❑ No Air handling unit CFM
space insulated? ❑ Yes ❑ No
Air rati conditioning (site plan
Is existing C syste
g P Alteration of existing HVAC system
1N'IECIIANICAL CONTRACTOR Boiler /compressors
^.) ( - State boiler permit no.:
Business name: d Go
HP Tons BTU /H
2 ‹ Address: S4 , -- E- Fire/smoke dampers/duct smoke detectors
City: I State: I ZIP: Heat pump (site plan required)
Phone: I Fax: I E -mail: Install/replace furnace/burner BTU /H
CCB no.: Including ductwork/vent liner 0 Yes U No
Install/replace/relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: Chillers HP
Address: ComFressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U lures. kitchen/hazmat
hood fire suppression system
Name: 0L. " `'`—) e I Exhaust fan with single duct (bath fans)
Mailing address: 'L S' &-ail- 57 Exhaust system apart from heating or AC
Cit I Stat ere_ I ZIP: q '� zz3 Fuel piping and distribution (up to 4 outlets)
Y T C + Type: LPG NG Oil
Phone: '03 (..'3% 124 a- Fax: E - mail: Fuel i ing each additional over 4 outlets
ess pip g (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: x• I E - mail: Woodstove/pellet stove
A Applicant's signature 1 a i Other:
I Date: � ( Other
Name (print): f w6-1
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7 , S a
Notice: This permit application Minimum fee $
0 Visa 0 MasterCard
/ expires if a permit is not obtained Plan review (at %) $
Credit card number: Expires w ithin 180 days after it has been
p State surcharge (8%) .... $ S ,Pog
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $ 7 I'', 3 /�
.
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+ 17.40
$10,000.00. including ducts & vents
$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
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
Air handling unit to 10,000 cfm 656 19) Commercial or industrial type incinerator
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
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 Boller Certification required for units >200k BTU.
** Residential A/C requires site plan showing placement of unit.
i:\dsts \forms\mech- fees.doc 10/11/00
CITY GF TIGARD BUILDING INSPECTION DIVISION •
MST - '
2,4-Hour Inspection Line: 639 -4175 Business Line: 639 -4171
q9.67 Q BUP
Date Requested 2 -� U AM ' PM BLD
Location /G 2-3d f w s A' 5 L Suite MEC 2&v/ - v)°- .3
Contact Person ‘JG � !'i 'i1w-e 4 Ph ‘;37 v PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:C a / en d ° / Slab # / SIT
Post & Beam /� _ c
Ext Sheath /Shear /mac A. x mil/ 7
Int Sheath /Shear /
Framing / . Uk- Co k
Drywall on
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof Coee s 4:1A-i
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
•
Top Out
Water Service — — 5.110-76 ' J(
/77Q 06 604s 7�ai �•
Sanitary Sewer
Rain Drains
Final
PASS • T FAIL
(MECHANICA
Post & Beam
Rough In
Gas Line
S n P Dampers
- ill►
) PART FAIL
CTRICAL
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 °2 I R lb I I � Ext
Other D a t e
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.