Permit ._ _ •
, 4 1 .1 CI TY O F TIGARD MECHANICAL PERMIT
I, DEVELOPMENT SERVICES PERMIT #: MEC2003 -00264
AIL- III 13125 SW Hall Blvd., Tigard, O R 97223 (503) 639 -4171 DATE ISSUED: 5/22/03
PARCEL: 2S104CD -10200
SITE ADDRESS: 13611 SW TRACY PL
SUBDIVISION: HILLSHIRE ESTATES NO. 2 ZONING: R -7
BLOCK: LOT: 101 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: 1
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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 2
Remarks: Add gas piping for (2) outlets (range & BBQ) and venting for range hood.
Owner: FEES
CERBONE, ROBERT + DEBORAH Description Date Amount
13611 SW TRACY PL [MECH] Permit Fee 5/22/03 $72.50
TIGARD, OR 97223 [TAX] 8% StateTax 5/22/03 $5.80
Phone: Total $78.30
Contractor:
PROGRESSIVE AIR
9708 SW 59TH
PORTLAND, OR 97219 REQUIRED INSPECTIONS
Phone: 246 Gas Line Insp
Mechanical Insp
Reg #: LIC 35227 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
require ; • : - ow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
Iss , - d By: _ J _ d�, Permittee Signature: k 7 11( -- t1
for inspections ne de t e next business da
Call (503) • 39 -4175 by 7:00 P.M. fo p day
Mechanical Permit Application Received , FOR OFFICE USE Mechanical ONLY , •
5 i i , .
, Date/By: "40,9 Permit No.: 1'1 5 -10
C. of Tigard Date/By: Planning Approval
• Building
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
A
Date/By: Case No.:
Internet: www.ci.tigard.or.us _A e I Contact jwis•75 0 See Page 2 for
24-hour Inspection Request: 503-639-4175 '-'-'" ''' Name/Method: ' / / L A' - Supplemental Information.
- v'T' . .; - , : ' = :.;',',:"..,;, -:' ' ..,:' - - 4 i ,;,,: ;‘ - , : ';;,:.` •;`::,;;; ;;;COMMEIR:CIALTEE,iSCHEDUEE';',USVCRECKLISW;
ID New construction 0 Demolition Mechanical permit fees* are based on the total value of the work
'Addition/alteration/replacement 111 Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY:OF CONSTRUCTIOW ' "••'
mechanical materials, equipment, labor, overhead and profit.
-'''s- :',- , `„,;
g I & 2-Family dwelling 0 Commercial/Industrial Value: $ 1360 See Page 2 for Fee Schedule
[II Accessory Building 0 Multi-Family ,;FtESIDENTIALEQUIPMENT/SYSTEMS.FEE* SCHEDULE:T.;
Description I Qty I Fee(ea.) I Total
El Master Builder 111 Other: , , , Heating/Cooling ..'
JOB SITE INFORMATION ind ' ' :',.'. Furnace - add-on air conditioning** 14.00
Job site address: /3,1/ . 5 (..3 - 7 -7 ,-0 es( p 1 Gas heat pump 14.00
Suite #: 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
6 1 C4 I 1 A &A" +Ct "A Unit heaters (fuel, not electric)
(in wall, in-duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Repair units 12.15
Subdivision: Lot #: , - - Other Fuel Appliances - -. " . . .
Tax map/parcel #: Water heater 10.00
; : , 10'.,,i,'''.:= EiESCRIPTICiN .0E-VORK ;:: : : .. ' ' Gas fireplace 10.00
cici A r , 1,.( .e - a otti-id..s Flue vent (water heater/gas fireplace) 10.00
Log lighter (gas) 10.00
ue n 4 r al •._ I., ove-A Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
;D-PROPERTYDWNER „: ,.':,%;-,' ; r I 0:TENANT .: ::-' ,..-- ” .1, -. Other: 10.00
Name: 1.<6.6 Ce r ban e_.. ,- - ,. , Environmental Exhaust &Ventilation'
Range hood/other kitchen equipment / 10.00
Address: i 36 i(
,, 1 ,, Clothes dryer exhaust 10.00
City/State/Zip:7 f c OK 7 7,X01-3 Single duct exhaust
Phone: sox s90 gt_zo 6 Fax: (bathrooms, toilet compartments,
APPLICANT:, ,`: - , - ;: - ... ' el=1CONT ;,.' utility rooms) 6.80
Name: tr, ,,, Ge.c.,/, Attic/crawl space fans 10.00
Other: to.00
Address: ct7o g S to S FuelPiping
City/State/Zip: pc ,f1,,,,a o 2. ?al? **(S5.40 for first 4, $1.00 each additional)
Furnace, etc.
Phone: ,5 ;,q 0 9.9c.) Fax: 5'01 ,2 (73•7
Gas heat pum ** p **
E-mail: - Wall/suspended/unit heater **
CONTRACTOR:',: ' : ' ',71 , ':: : ''. l'' ' '' Water heater **
Business Name: 0,-09 r e s s lye A ,- Fireplace **
Address: 0 s,.-- c!. c...., 5-9 Range i . **
**
City/State/Zip: po r - ft ..e.( 0 g. 9 7 X t 9 Clothes dryer (gas) **
Phone: ,..),Li k, 0.70:2 Fax: Aq G /7O7 Other: **
CCB Lic. #: Total: g
" . 'Mechanical Permit Fees*
Authorized • /
•
Date: 3--07.1_03 Subtotal: $ '7,A . ---
Signature: ,t, • . Minimum Permit Fee $72.50 $
it\ gOoc.L4%, Plan Review Fee (25% of Permit Fee) $
(Please print name) • State Surcharge (8% of Permit Fee) $ -*, ie
TOTAL PERMIT FEE $ .7'• 5e,
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri-County Building Industry Service Board.
180 days after it has been accepted as complete. **Site plan required for exterior A/C units.
i: \Dsts \Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total'Valuation , ' .Permit,Fee: r , .. .
$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.
A ssumedNaluations,,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:
is \Dsts\Permlt Forms\MecPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
• BUP
Received Date Requested 7 f 13 AM ✓ PM BUP
Location / a) /( Suite alp 2 603 - z702 6
Contact Person Ph ( ) PLM 2.Pv 3 - co 2.6
Contractor (S.12--E4 Ph ( ) 33 SWR
BUILDING Tenant/Owner ELC 3 - 06 �s
Footing
Foundation EL
Access:
Ftg Drain Access: � � ' s Tie r7 ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors •
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
1LUMB11pG
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains •
Catch Basin / Manhole
Storm Drain
Shower Pan
PART FAIL
_. , ' ANICA
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
■�7T FAIL
,
Roug -In
UG/Slab
Low Voltage
Fi - Alarm
Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line y
ADA Approach/Sidewalk Dat / / ` ��� Inspector Est
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL