Permit CITY OF TIGARD MECHANICAL PERMIT
; ,1 4 DEVELOPMENT SERVICES PERMIT #: MEC1999 -00467
,.� I I 13125 SW Hall Blvd., Tigard, OR 97223 (5 639 -4171 DATE ISSUED: 10/28/1999
PARCEL: 2S 105DB -00500
SITE ADDRESS: 15180 SW SUNRISE LN
SUBDIVISION: ZONING: R -7
BLOCK: LOT: JURISDICTION: URB
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: 1
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of gas insert and gas piping.
Owner: FEES
WHITE, LEON D AND CAROL A Type By Date Amount Receipt
15180 SW SUNRISE LANE PRM4 DST 10/28/19c $50.00 99- 319404
TIGARD, OR 97224 5PC2 DST 10/28/195. $4.00 99- 319404
Total $54.00
Phone:
Contractor: •
SCOTT A. SHAMBURG HEATING LLC
380 SUNSET CT
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 625 -3828 Woodstove Insp
Reg #: LIC 126881 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 obtain copies of these rules or direct questions to OUNC by
calling (503)246 -•
Issue By: Ar% Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
•
(;�IT`,:OF TIGARD Mechanical Permit Application Recd By °k#
✓ 13125 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171, x304 VC5 Date to DST �i
Print or Type Permit # Cc�97 "��G�
Incomplete or illegible applications will not be accepted Called
Name of Development/Project Description
Table 1A Mechanical Code Qty Price Amt
S treet Address - Suite# A) Permit Fee 16.00
Job 1) Furnace to 100,000 BTU
Address ss /570 p r� Sea 71q /� � , c� including ducts & vents see footnote 1,2 9.65
Bldg# City/State Zip 2) Furnace 100,000 BTU+
/, Q/O/ O 7,.:2 V including ducts & vents see footnote 1,2 12.00
Name (or name of busines( 3) Floor Furnace
Owner eGry Z 401 de- including vent see footnote 1,2 9.65
Mailing Address 4) Suspended heater, wall heater
�� QS Q /J L ✓� or floor mounted heater see footnote 1,2 9.65
5) Vent not included in appliance permit 4.75
City/State Zip - Phone Check all that apply: 'Boiler Heat Air
For items 6 -10, see or Pump Cond Qty Price Amt
Name (or name of business) footnotes 1 , 2 Com ""
/ 6) <3HP;absorb unit to
a s Q-CJa ii , e 100K BTU 9.65
Occupant Mailing Address 7) 3 -15 HP;absorb unit
100k to 500k BTU 17.65
City /State Zip Phone 8) 15 -30 HP; absorb
unit .5 -1 mil BTU 24.15
Contractor Name 9) 30 -50 HP; absorb
LC L L c ^n / , unit 1 -1.75 mil BTU 36.00
�/!C!/rJ(J�L/L /lp / lu l�c-C� 10) >50HP; absorb unit
Prior to permit Mailing Address ✓ �� ,, >1.75 mil BTU 60.15
issuance, a copy /99/3 f Ae r L /� 'e.' � 11 Air handling unit to 10,000 CFM
of all licenses city/State Zip Phone 5sca 7.00 •
are required if /d-k /Q�12 02 y7o6a- toga 12) Air handling unit 10,000 CFM+
expired in COT Oregon Const. Cont. Board Lic.# Exp. Date 11.85
database /aki,e/ 13) Non - portable evaporate cooler
Architect Name 7.00
14) Vent fan connected to a single duct
or Mailing Address 4.75
15) Ventilation system not included in
• appliance permit 7.00
Engineer City /State Zip Phone 16) Hood served by mechanical exhaust
7.00
Describe work to be done: 17) Domestic incinerators
12.00
New 0 Repair 0 Replace with like kind: Yes O No 0 18) Commercial or industrial type incinerator
Residential tY Commercial 0 48.25
19) Repair units
Additional information or description of work' 8.40
� �-/LL ( 345 �A..5es� 20) Wood stove /gas FP/other units /clothe dryer /etc. / 7 00 / 0 O
NOTE: For Commercial projects only; Units over 400 lbs. require 21) Gas piping one to four outlets
structural gas calcs. See footnote 1 1 3.75 3
Type of fuel: oil 0 natural gas 0. O electric 0 22) More than 4 -per outlet (each) .75 !$ice
Minimum Permit Fee $50.00 SUBTOTAL ,247.75
I hereby acknowledge that I have read this application, that the information 8% SURCHARGE -
given is correct, that I am the owner or authorized agent of PLAN REVIEW 25% OF SUBTOTAL y r
the owner, that plans submitted are in compliance with Oregon State laws. Required for ALL commercial permits only
TOTAL ,71--------
Signature of Owner/A Date
Other Inspections and Fees:
/a--.2?-9. � J 1. Inspections outside of normal business hours (mininum charge -two
0 "16;b}/. tact Person Name ( Phone hours) $50.00 per hour
/ 2. Inspections for which no fee Is specifically indicated (minimum
Li .6/9 Sff�h726ec �G' C� 9. - 53 ,3- charge -half hour) $50.00 per hour
Foonotes for commercial projects only: 3. Additional plan review required by changes, additions or revisions to
1. Provide full schematic of existing and proposed gas line and pressure. plans (minimum charge -one -half hour) $50.00 per hour
2. Provide drawings to scale showing existing and proposed mechanical
*State Contractor Boiler Certification required
units.
"Residential A/C requires site plan showing placement of unit
I:\mechperm.doc rev 7/19/99
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/p BUP
Date Requested (d( ? 1 � 1 (? AM V PM BLD
Location / 18O StA) - /yl �s,c., /'i'L.■ Suite MEC /? -CV '7
Contact Person � ..a.yvt, Ph 4Oc )S 3 PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access: •
Foundation S /- _ 1 _ � 1 " g6k� � FPS
Ftg Drain ' T U SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
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
Rou In
G as
Smoke Dampers
( • • • 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
Other Date ( ) I Inspector /f. � Ext,/
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.