Permit A- 'C I TY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2003 -00042
4 ,411 DEVELOPMENT SERVICES DATE ISSUED: 11/21/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1 S134DC 00700
SITE ADDRESS: 11365 SW TIGARD ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: A2.1 VENTS W/O APPL: VENT SYSTEMS:
STORIES: 2 BOILERS /COMPRESSORS HOODS: 2
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: 2,349,000 BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: Y 30 - 50 HP:
GAS PRESSURE: M 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: 9 <= 10000 cfm: 10 OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 16
Remarks: HVAC/New Construction. Project Value: $19,817
Owner: FEES
BAPS TEMPLE Description Date Amount
S BOX [MECH] Permit Fee 11/21/03 $300.96
SAN JOSEE, , C CA 95160
CA
[MECPLN] Plan Rev 11/21/03 $75.24
[TAX] 8% StateTax 11/21/03 $24.08
Phone: 408 - 453 - 6464 Total $400.28
Contractor:
HVAC INC
5188 SE INTERNATIONAL WAY
MILWAUKIE, OR 97222 REQUIRED INSPECTIONS
Phone: 462 Gas Line Insp
Mechanical Insp
Reg #: LIC 50897 Shaft Inspection
Hood Inspection
Duct Inspection
Fire Damper Insp
S.D. Shut -down inspection
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 -0100. You may obtain copies of these rules or direct questio s to OUNC •y calli r •
(503)246-669;,/ / 1
Issued By: AIN ft- eytGL- ,� � !
Permittee Signature: .
V
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
• Mechani,; al Permit Application `- FOR OFFICE USE ONLY
Received �j Mechanical ,/
. Date/By / - 3 / -03/46 Permit No.: VileC 3 - 0004-""
City of and Planning Approval Building
ty Tigard R EC E I V , ;�
Planning
y: Permit No.
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 JJ Date/By 7-1) - D) /6,1P Permit No.
Phone: 503- 639 -4171 Fax: 503- 5g19Ab 1 (ail Post - Review Land Use
) t p. , y IA Date/By: Case No •
Internet: www.ci.tigard.or.us P , e!' l � Contact Juns.: ® See Page 2 for
24 -hour Inspection Request: 503,6 F 1. '" - - -- "'" Name /Method Supplemental Information.
D L NG DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
rz New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
❑ Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling ❑ 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 FJ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning 14.00
Job site address: 11303 T/ tiAA4 Si' 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
' IS TH A✓ Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
R units 12.15
Subdivision: Lot #:706 Other Fuel Appliances
Tax map /parcel #:1.5134 pc,- 00700 Water heater 10.00
. DESCRIPTION OF WORK Gas fireplace 10.00
Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00 1
Wood fireplace/insert 10.00
Chimney /liner /flue /vent 10.00
® PROPERTY OWNER I ❑ TENANT Other: 10.00
Name: • A • �J A • A •s Environmental Exhaust & Ventilation
Range hood /other kitchen equipment 10.00
Address: P. p • (3 Oa L1 116a Clothes dryer exhaust 10 00
City /State /Zip: S A N 3Af& [A 93 b Single duct exhaust
Phone:Ltog -4S0- i sy dy Fax:4o' - 4s3 -0 L3L (bathrooms, toilet compartments,
❑ APPLICANT is CONTACT PERSON utility rooms) 6.80
Name: • p E g I QAT6t. Attic /crawl space fans 10.00
Other: 10.00
Address: • p• (3ay. 4 II 6o Fuel Piping
City/State /Zip: SA ., • g , co% ysi 6 a * *($5.40 for first 4, $1.00 each additional)
**
Furnace, etc.
Phone: -tin -623L I Fax:4pg- 4.5'3 -Q L•3L Gas heat pump **
E -mail: Wall /suspended/unit heater **
CONTRACTO Water heater **
Business Name: yt/t !- / Fireplace **
Address: 5/gg f.._ /Arri4 41T /U4lr4L WRY Range **
BBQ **
City /State /Zip: MI -W(0hl 01- 979,9 - Clothes dryer (gas) **
Phone: LIla2,- LiQ Fax: Other: **
CCB Lic. #: 50 9^ � Total:
g / Mechanical Permit Fees*
�•
Authorized Subtotal: $ I q Pi (} —
Signature: vs� Date: Minimum Permit Fee $72.50 $ 3 dO g 6
A n gs4 Po -- Plan Review Fee (25% of Permit Fee) $ 75:L
(Please print name) State Surcharge (8% of Permit Fee) $ )...L./ 1-.:..1.L.
TOTAL PERMIT FEE $ [4 0 0
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.
is \Dsts \Permit Forms\MecPermitApp doe 01/03
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 Gj' S
S
ducts & vents //
Furnace > 100,000 BTU including ducts a 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 / O 656 6 Sg (1
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 6
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets J, I 360 3 6 0
Each additional outlet /Z 63 ' 776 •
TOTAL COMMERCIAL $
VALUATION: /1, 81?
i:\Dsts\Permit Fiorms\MecPertnitAppPg2.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 M PM BUP
Location ( e 176A Suite MEC Z6,34
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
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 (�
Fire Alarm '^ "
Susp'd Ceiling
Roof ✓ 1��
Other:
Final
PASS PART FAIL
PLUMBING .��
Post & Beam
Under Slab I
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P FAIL
MECHANICAL
Rough -In
Gas Line
Smoke Dampers
- .
4= PART FAIL
- TRICAL •
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: 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