Permit •
V
CITY TIGARD <" �p MECHANICAL PERMIT
Aft DEVELOPMENT SERVICES PERMIT #: MEC2003 -00503
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/15/03
PARCEL: 2S111 DC -05000
SITE ADDRESS: 15671 SW SUMMERFIELD LN
SUBDIVISION: SUMMERFIELD NO.7 ZONING: R -7
BLOCK: LOT: 350 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: 1
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:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 2
Remarks: Install tankless hot water heater, gas line to fireplace. 11/20/03, adding gas fireplace insert.
Owner: FEES
NELSON, GARY /SANDRA Description Date Amount •
15671 SW SUMMERFIELD LN
TIGARD, OR 97224 [MECH] Permit Fee 8/15/03 $72.50
[TAX] 8% StateTax 8/15/03 $5.80
Phone: 503 639 - 9539 Total $78.30
Contractor:
HEARTH & HEATING SPECIALIST
251 S. BRIDGE ST.
SHERIDAN, OR 97378 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Mechanical lnsp
Reg #: LIC 155309 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 -00
( y: 1 ■ Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for inspections ne- 'ed the next • siness ay
...
r •
Mechanical Application
Ali.
Date received /S D 3 Permit no.: //0 3 - 0, 3
'`Y:f��1! City of T><' !_ Project/appl.no.: Expire date:
City of Tigard Address: 13125 S '„ ii' °.1 : '" 01E431223 Date issued: By: St Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598-1960 AUG 1 5 2003 Case file no.: Payment type:
Land use approval: Building permit no.: T /l,
TTY OF i 1GARD
IYPE OF PERMIT - . '
I & 2 family dwelling or accessory 0 Commercial/industrial O Multi family ❑Tenant improvement
New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: A A 11 -= MA I N FM Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ •
Lot: IBlock: ISubdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: at/41 , L I ZIP: .9 51 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
2 escnGptton apd Iocatipn ofi on premise : /w AND COMMERICAL /INDUSTRIAL EQUIPMENT SCHEDULE
2w� o-f f / .. , /' , • 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 handling unit CFM
g p Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
,: "- - Boiler /coin ressors
AIEGIiA]\ICAL CONTRACT(�li.: __` Boiler/compressors
name: i t, / State boiler permit no.:
�1 �'Sl<f�Y / — HP Tons BTU /H
Address: s' . A rlinEMVX Fire/smoke dampers/duct smoke detec tors
City: , / ,/ J � � ZIP: ‘frArgi�� Heat pump (site plan required)
Phone � �� 03 '' ' - �3 � ax: Email: InstalUreplacefurnace/burner BTU /H t
D `rte C7 Including ductwork/vent 0 Yes¥.No
CCB no.: /5-5- a -5 InstalUreplace/relocate heaters - suspended,
City /metro lie. no.: ° 5 ) - d wall, or floor mounted
Name (please print): Vent for appliance other than furnace J
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: 2( 771.e._ eetits6 S S Chillers HP
�c/ cS Coin ressors HP
> Address: G � Environmental exhaust and ventilation:
City: • I State V( I ZIP: q'1 373 Appliance vent
Phone: a _; -S ax: 5r/3 -75i ;i; -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
` hood fire suppression system
Name: /44/ ' /' / C5 .ei Exhaust fan with single duct (bath fans)
Mailing address: / /5(07 / s' ,. ...ee, (�7i'-' Exhaust system apart from heating or AC
City: S ZIP: (1:22-1.7 Fuel piping and distribution (up to 4 outlets)
Y I tatei7 I Type: LPG N Oil
Phone: (p f Fax: E -mail: Fuel el piping each additional over 4 outlets
Process piping (schematic required) _
Number of outlets
Name: 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 signature: I Date: Other
Name (print):
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
/ / expires if a permit is not obtained Plan review (at %) $
Credit card number: Expires within 180 days after it has been
State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $ ' 7K 3 l)
Cardholder signature Amount 440 -4617 (6/00/COM)
MECHANICAL PERMIT FEES '-
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT 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) Fumace 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
$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
Minimum Permit Fee $72.50 SUBTOTAL: $ to 100K BTU 14.00
8) 3 -15 HP; absorb
8% State Surcharge $ unit 100k to 500k BTU , 25.60
9) 15 -30 HP; absorb
25% Plan Review Fee (of subtotal) $ unit .5 -1 mil BTU 35.00
Required for ALL commercial permits only 10) 30 -50 HP; absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1 -1.75 mil BTU 52.20
11) >50HP: absorb
unit >1.75 mil BTU 87.20
12) Air handling unit to 10,000 CFM
ASSUMED VALUATIONS PER APP LIANCE: 10.00
Value Total 13) Air handling unit 10,000 CFM+
•
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in applicants 445 10.00
permit 18) Domestic incinerators
Repair units 805 17.40
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101k to 500k BTU 10.00
15 -30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: $
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge $
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not included in 656
appliance permit Other Inspections and Fees:
Hood served by mechanical exhaust 656 1. Inspections outside of normal business hours (minimum charge -two hours)
Domestic incinerator 1,170 $72.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge - half hour)
Other unit, including wood stoves, 656 $72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimun
inserts, etc. charge -one -half hour) $72.50 per hour
Gas piping 1 outlets 360
Each additional outlet 63 * State Cohtractor Boiler Certification required for units >200k BTU.
** Residential A/C requires site plan showing placement of unit.
TOTAL COMMERCIAL $
VALUATION:
is \dsts \forms\mech- fees.doc 08/06/01
CITY OF TIGARD 24 -Hour • _
BUILDING Inspection Line: (503 3 MST
INSPECTION " ' Business Line: (503 -4171
�j BUP
Received ) 1122 � I Date Requested 11 / 2 - 1 A3 AM 5 / PM BUP
Location 1 5 Co 0 e y' - ite 42 _ � 3
Contact Person aa,(r' �A A) -e ( Sc3Y1 ) (O. — T 5 - S9 d 0 U 4 f1 7
Contractor ( S ) 774 ? SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain \ ELR
Crawl Drain
Slab Inspec ieri Notes: vtS + 1 I SIT
Post & Beam 1 OS ' r J
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear I\ . Q� SecQ
Framing
Insulation v /a 7 ( - "� p
Drywall Nailing ! /
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
=ART FAIL
Post & Beam r I i
Under Slab
Rough -In i�
Water Service l,f
Sanitary Sewer
Rain Drains '
Catch Basin / Manhole
Storm Drain ' V
Shower Pan
Other
IMP PART FAIL
MECHANICAL
Post & Beam
Rou•h-In
•l • • - Dampers
PASS PART FAIL
- RICAL
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: 0 Unable to inspect — no access
Fire Supply Line
)
Approach/Sidewalk Date 1 Z` Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL