Permit f• r
A CITY OF TIGARD MECHANICAL PERMIT
�i DEVELOPMENT SERVICES PERMIT #: MEC2003 -00062
± �' I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/18/03
s.-
PARCEL: 2S103CA -04900
SITE ADDRESS: 11550 SW TERRACE TRAILS DR
SUBDIVISION: TERRACE TRAILS ZONING: R -4.5
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: OTR 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: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm:
GAS OUTLETS: 1
> 10000 cfm:
Remarks: I
Owner: FEES
BLACK, GAROLD R NANCY E Description Date Amount
11550 SW TERRACE TRAILS DR [MECH] Permit Fee 2/18/03 $72.50
TIGARD, OR 97223 [TAX] 8% StateTax 2/18/03 $5.80
Phone: Total $78.30
Contractor:
T + K MECHANICAL
11525 SW CANYON ROAD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone: 503 - 626 - 4652 Gas Line Insp
Mechanical Insp
Reg #: LIC 121165 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 fo ow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -00
Iss d By: 1/ j Permittee Signature:! � • •
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business d . y
Mechalu cal Permit Application Received FOR OFFICE USE ONLY
�._ Mechanical
Date/By: 2 / e 03 Permit No.: fC ,.6
P Approval Building
City of Tigard Test Form Planning lanni Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
f� Date/By: Case No.:
Internet: www.ci.tigard.or.us ^„ _1 � Contact �"� W ] t El See Page 2 for
24 -hour Inspection Request: 503 - 639 -4175 Name/Method: 1 Cp. Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
,ddition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
,7 1 & 2- Family dwelling n Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning 14.00
Job site address: 1 I -p Si.. Tit v- r ac e - }rat ( (,' Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Re units 12.15
Subdivision: • Lot #:
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 1 10.00 _
Gies \ ► el tt_ d- G GS -P Flue vent (water heater /gas fireplace) 10.00
C CAS Log lighter (gas) 10.00
, ' Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00 _
PROPERTY OWNER I ❑ TENANT Other: 10.00
Name: (\O, d \Q C I1 r ki
Environmental Exhaust & Ventilation
J R ange h ood/other kitchen equipment 10.00
Address: 0 . `` r • r I Clothes dryer exhaust 10.00
City /State /Zip: — �qrd •
(,,,�.., c 1� , R 3 Single duct exhaust
Phone: I Fax: (bathrooms, toilet compartments,
U ►PPLICANT IstCONTACT PERSON utility rooms) 6.80
Name: Attic /crawl space fans • 10.00
` '''' w Vl "' t ` A Other: 10.00
Address: z_c.> s Co S SI.,) - T U -I-1 wt ' $ AA 3yG1 Fuel Piping
City /State /Zip: h c 0,,_, Q-7 ($5.40 for first 4, $1.00 each additional) **
Furnace, etc. **
Phone: 's 1- L/ Fax: �Q o ^ �� Gas heat pump **
E -mail: Wall /suspended/unit heater ** -
CONTRACTOR Water heater **
Business Name: I,t X- m R Lk Fireplace i **
Address: Zak Co S S f,. (-Fpw3 BBQe **
City /State /Zip: C, \ O \t t -l7 Clothes dryer (gas) **
Phone: 3 "?- 4 4 It-- I Fax: . / R- 8 (S' Other: ** -
CCB Lic. #: 21 ] 6� Total:
1 Mechanical Permit Fees*
Subtotal: $ _
Authorized ' Minimum Permit Fee $72.50 $ f2. SO
Signature: \ � Date: I 0 3 P Review Fee (25% of Permit Fee) $ ®
�/j
State Surcharge (8% of Permit Fee) $ /p
1 1A ) TOTAL PERMIT FEE $ 7 8 . e
(Please print name) I Notice: This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
Mechanical Permit Application - City of Tigard •
Page 2 - Supplemental Information • •
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
$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.
$50,001.00 and up . $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof.
Assumed Valuations Per Appliance:
Value Total •
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955 •
mounted heater
Vent not included in appliance permit 445
Repair units 805
< 3 hp; absorb. unit, 955
to 100k BTU ,'
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU
15 -30 hp; absorb. unit, 501k to 1 mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656
Vent fan connected to a single duct _ 446 •
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL • $
VALUATION:
•
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received _ `e Re�C nested ` _ AM PM BU ' ,
Location / �s� �� Suite M EC ��� 600 6a-
Contact Person / I55 Ph ( ) PLM
Contractor Ph ( SWR
•
BUILDING Tenant/Owner `�� / ;.. . / ELC
Footing
3C/ , D q
Foundation ` ELC f.
Ftg Drain Access: / ' �� ELR
Crawl Drain i // 1 / 6
Slab Inspection Notes: SIT
Post & Beam J ' ��
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear j T'
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling r
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 i'• i
mS oke Dampers
final
RT FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA Date 2 / / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL