Permit - CITY OF TIGARD
MECHANICAL PERMIT
EVELOPMENT SERVICES PERMIT #: MEC2003 -00176
'�' -Al � I 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/8/03
PARCEL: 1S133DA-00400
SITE ADDRESS: 11030 SW SUMMER LAKE DR
SUBDIVISION: AMART SUMMERLAKE ZONING: R -7
BLOCK: LOT: 026 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
<= 10000 cfm: OTHER UNITS: 1
FURN > =100K BTU: GAS OUTLETS:
• > 10000 cfm:
Remarks: Replace gas furnace and add gas fireplace insert. Gas piping existing.
Owner: FEES
DECK, EARL D AND SHIRLEY E Description Date Amount
11030 SW SUMMERLAKE DR
TIGARD, OR 97223 [MECH] Permit Fee 4/8/03 $72.50
[TAX] 8% StateTax 4/8/03 $5.80
Phone: Total $78.30
Contractor:
D + R HEATING +AIR COND
PO BOX 1292
27251 S DAVE RD REQUIRED INSPECTIONS
CANBY, OR 97013
Phone: 503 - 266 - 1229 Mechanical Insp
Heating Unt lnsp
Reg #: LIC 84489 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 fo th 'n OAR 952 -001 -00
Issued By: A1,,_ .Z4/611, Permittee Signatur -. /
Call (503) 639 -4175 by 7:00 P.M. for inspections - - • ed the next business day
Mechanical Permit Application
Date received:, k-0 Permit no-.: r 3 - 00/7 -6
Ai. A City of Tigard .� � � `J g Projecdappl. no Expire
Ci Address: 13125 SW Hall Blvd, Tigard OR 97223
City of Ti 8 and Phone: (503) 639-4171 Date issued: By:gS Receipt no.:
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 ' Addition/alteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
lob address: /ip I ? ,_irf/, � ,' /> ,e Q /,� 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 fcc.
City /county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: /1/eer/ . /n`a.. AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
Giel d /n#z/ 9454 lai Fee(ea.) Total
Est. date of complet ion / inspection: ,f/ / / q/ G 3 Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? clWes 0 No Air conditioning (site plan required)
Is existing space insulated? l ' Yes 0 No Alteration of existing HVAC system
MECHAN CONTRACTOR Boiler /compressors
! / State boiler permit no.:
Business name:
�o.Q,y� „1 ,/2 C/�/ HP Tons BTU /H
�r'r/
Address: dn� ,,,,,,fa Fire/smoke dampers/duct smoke detectors
City: e','j/ I State r4 I ZIP: 970e3 Heat pump (site plan required)
Phone 7266 i22.9 I Fax: 3753 264E -r, v5 b InstalUreplace furnace/burner BTU /H
Irfcluding ductwork/vent liner 0 Yes 0 No
CCB no.: t54 i1g, Install/replace/relocate heaters — suspended,
City /metro lic. no.: j .?2 ,/y wall, or floor mounted
Name (please print): 7g1 ,�G.yy., Vent for appliance other than furnace
CONTACT PERSON Refrigeration: —
Absorption units BTU/H
Name: Ij -/d ec,49nA/3 Chillers HP
�x�.” /7�
Compressors HP
Address: d-<
Environmental exhaust and ventilation:
City: S tate: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U IUres. kitchen/hazmat
hood fire suppression system .
Name: — a e _L • Exhaust fan with single duct (bath fans)
Mailing address: / /zj 6 • f/ 1)4 (A- Q /,e Exhaust system apart fromheating or AC
-� Fuel piping and distribution (up to 4 outlets)
7 City: / 4 h ate• IP: 9/1 Type: LPG NG Oil
Phone: + ' 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 1
City: I State: I ZIP: Insert — type _
Phone: Fax: E -mail: Woodstove/pelletstove
Other:
Applicant's signat Date: OO Othe
Name (print): „,, ,-.lF.�6¢.
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ 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 $ 7 6
Cardholder signature Amount 440 -4617 (6100 /COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price Total
Table 1A Mechanical Code Qty (Ea) Amt
$1.00 to $5,000.00 Minimum fee $72.50 1) Furnace to 100,000 BTU
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and including ducts & vents 14.00
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
fraction thereof, to and including 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 - 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
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.
is \dsts \forms\mech- fees.doc 10/11/00 .
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Re•uested SCR AM PM BUP
Location D 3 Suite MEC 3 - 6d / 7 (°
Contact Person O-4 J—• Ph ( ) - PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation Access:
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 /iv
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam ./
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
CTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: 111 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