Permit A 1 �
CITY TIGARD MECHANICAL PERMIT
� DEVELOPMENT SERVICES PERMIT #: MEC2001 -00183
"' I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/31/01
PARCEL: 1 S 133DC -08900
SITE ADDRESS: 13225 SW SHORE DR
SUBDIVISION: WINTER LAKE ZONING: R -7
BLOCK: LOT: 019 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: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replacement of gas furnace.
Owner: FEES
BRANDENBURGER, KAREN J Type By Date Amount Receipt
13225 SW SHORE DR PRMT CTR 5/31/01 $72.50 2720010000
TIGARD, OR 97223 5PCT CTR 5/31/01 $5,80 2720010000
Total $78.30
Phone:
Contractor:
SPECIALTY HEATING & COOLING
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 620 -5643 Final Inspection
Reg #: LIC 66578
•
•
v. .
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by
calling (503)246 -9 9
Issue By: Permittee Signature: A/` V 4- YrZath L,LcIJ
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Date received:$ 3/ Q / Permit no.:, •• •if��
u„ .I1
, L ,,.� � City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: M Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 • Case file no.: Payment type:
•
Land use approval: Building permit no.:
TYPE OF PERMIT '
:A 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction e • ddition/alteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE .
Job address: 82496 ,3(4) ore i•1 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: LL I Subdivision: *See checklist for important application information and
Project name:etlayy ,0tt As s r: - • jurisdiction's fee schedule for residential 'permit fee.
City /county: --rja4e./- (,t) s I . 4 7 9. a- - 1 & 2 FAiMILY DWELLING PERMIT FEE SCHEDULE
De rription and lo cation of work on premises: ,P .Ill G � AND COMMERICAL/1NDUSTRIAL EQUIPMENTSCHEDULE
� A 1 /V1 aC"'e�
Fee(ea.) Total •
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? 0 Yes O No • Al rati conditioning xi ta plan required)
Is existing P Alterati of existi HVAC system
MECHANICAL CONTRACTOR Boiler /compressors.
. State boiler permit no.: •
Business nametS •14. 4 . f/ 0 ♦ a {Y1, 1?G HP Tons BTU/H _
Address: Q S c� �" v (.v �1 S' f ! Fire/smoke dampers/duct smoke detectors
City: T$'C[i vv I State: o ,e.1 ZIP: 9 7, 9.3 Heat pump (site plan required)
Phone&03( kca Faxs9fs p 7 /(j' - mail: Install/replace furnace/burner CX y/H
CCB no.: e„4.5 7 Including ductwork/vent liner 0 Yes No
Install/replace/relocate heaters - suspended,
City /metro lic. no.: f e cec wall, or floor mounted •
Name (please print): • s rirA.., • . els Vent for appliance other than furnace
CONTACT PERSON Refrigeration: _ -
Absorption units BTU/H
— Name: /4_ Tit Lee N r Y1 1 (/ A Chillers HP
Address: ?S,2- $' , SCJ . 7i1 et s r. Compressors HP
Environmental exhaust and ventilation:
City: -7-7 d I Sta e: C2 I ZIP: q 7,71.4-2 Appliance vent
—
Phone's 3 6,10 -66 ' Fax: 59g olI g' E -mail: Dryer exhaust
OWNER Hoods, Type 1/11/res. kitchen/hazmat
hood fire suppression system
Name: 44,//ii ,a J ,(� . , Exhaust fan with single duct (bath fans)
Mailing ad Tess: !3 1(A) �1t9 re CJ f Exhaust system apart from heating or AC
/ I State_ I ZIP: q 7.� Fuel piping and distribution (up to 4 outlets)
City: / y� (Q Type: LPG NG Oil
Phones Q• SG Fax: E - mail: Fuel piping each additional over 4 outlets
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/pellet stove
Other:
Applicant's signs ure: j4 xzk c 4 I Date: S4a r f i ()r Other .
Name (print): 4. sgiA144 •
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
0 Visa 0 MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount
440-4617 (6/00 /COM)
•
t �
r.
Commercial Schedule •
1 &2 Family Dwelling Schedule
ASSUMED VALUATIONS PER APPLIANCE
Description
Furnace to 100,000 BTU Table IA Mechanical Code Oly Price Total
1) Furnace to 100,000 BTU
including ucts & 955 nts
g including • duds & vents 14.00
Furnace > 100,000 BTU 2) Furnace 100,000 BTU+
including ducts & vents 17.40
including ducts & vents 1,170 3) Floor Furnace
including vent 14.00
floor furnace 4) Suspended heater, wall heater
including vent 955 or floor mounted heater ' 14.00 •
suspended heater, wall heater 5) Vent not included in appliance permit 6.80
or floor mounted heater 955 6) Repair units 12.15
Check all that apply: 'Boiler Heat Air.
Vent not included in appliance permit 445 For Items 7 -10, see or Pump Cond Qty Price Total
Repair units 805 footnotes 1,2 Comp '-
p 7) <3HP; absorb unit to
< 3 hp; absorb.unit 100K BTU 1
8) 3 -15 HP: absorb unit
•
to 100k BTU 955 100k to 500k BTU 25.60 •
• 3 -15 h p; absorb.unit 9) 15 -3o HP: absorb
unit .5-1 mil BTU 35.00
101k to 500k BTU 1700 10) 30-50 HP: absorb .
unit 1 -1.75 mil BTU 52.20
15-30 hp; absorb.unit 11) >50HP; absorb unit >1.75 mil BTU
87.20
501k to 1 mil. BTU 2310 12) Air handling unit to 10,000 CFM
30 -50 hp; absorb.unit 10.00
13) Air handling unit 10,000 CFM.
1 -1.75 mil. BTU 3400 17.20
> 50 hp; absorb.unit 10.00
Non - portable evaporate cooler 1000
> 1.75 mil. BTU 5725 15) Vent fan connected to a single duct
6.80
•
Air handling unit to 10,000 cfm 656 16) Ventilation system not included in
appliance permit 10.00
Air handling unit > 10,000 cfm 1170 17) Hood served by mechanical exhaust
10.00
Non - portable evaporate coller 656 18) Domestic incinerators
vent fan connected to a single duct 446 17.40
19) Commercial or industrial type incinerator
Vent syst. not included in appliance permit 656 69.95
Hood served by mechanical exhaust 656 20) Other units, including wood stoves
10.00
Domestic incinerator 1170 21) Gas piping one to four outlets
5.40
Commercial or industral incinerator 4590 22) More than 4-per outlet (each)
1.00
Other unit, including wood stoves, inserts, etc. 656 Minimum Permit Fee $72.50 SUBTOTAL
Gas piping 1-4 outlets 360 8% SURCHARGE viffig REM
PLAN REVIEW 25% OF SUBTOTAL `'""``, j: f` .
Each additional outlet 63 Required for ALL commercial permits only ,'''__% �[
. TOTAL
Other Inspections and Fees:
1. inspections outside of normal business hours (minimum charge -two tours)
572.50 per hour
2. Inspections for which no lee is specifically indicated (rninimum charge -hail tour)
$12.50 per hour
Total Valuation Fee 3. Additional plan review required by changes, additions or revisions to plans (minimum
Wrgeone -half hour) $72.50 per hour
'State Contractor Boiler Certification required
$1.00 to $5,000.00 Minimum $72.50 - Residential A/C requ res site plan showing placement of unit
$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 .
$50,000.00 and up $742.00 for the first $50,000.00 and $1.20
for each additional $100.00 or fraction
thereof
•
*CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested J �v • Z Z AM / 3 0 PM BLD
Location /.3 -7- S 54i 52 � -& d Y Suite MEC J/-G u f pi 3
Contact Person 4d f ur/ 574 3 � G 3 PLM
Contractor �/ ' SWR
�,
BUILDING Tenant/Owne ai� A / -rG �fr ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear r—
Framing /• h a/ �� y e 6/-e•
Insulation
Drywall Nailing I'-(n7; h y {l- r )'ifG. S/Ar
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
MECH
Post & Beam
Rough In
Gas Line
moke Dampers
VIVI470 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk , �
Other Date 4 't ZZ " G> Inspector 2 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
A 1 �
CITY TIGARD MECHANICAL PERMIT
� DEVELOPMENT SERVICES PERMIT #: MEC2001 -00183
"' I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/31/01
PARCEL: 1 S 133DC -08900
SITE ADDRESS: 13225 SW SHORE DR
SUBDIVISION: WINTER LAKE ZONING: R -7
BLOCK: LOT: 019 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: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replacement of gas furnace.
Owner: FEES
BRANDENBURGER, KAREN J Type By Date Amount Receipt
13225 SW SHORE DR PRMT CTR 5/31/01 $72.50 2720010000
TIGARD, OR 97223 5PCT CTR 5/31/01 $5,80 2720010000
Total $78.30
Phone:
Contractor:
SPECIALTY HEATING & COOLING
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 620 -5643 Final Inspection
Reg #: LIC 66578
•
•
v. .
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 obtain copies of these rules or direct questions to OUNC by
calling (503)246 -9 9
Issue By: Permittee Signature: A/` V 4- YrZath L,LcIJ
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day