Permit r �
a °a
CITY TIGARD MECHANICAL PERMIT
PERMIT #: MEC2003 -00037
irk DEVELOPMENT H BMENg Tigard, SERVICES 639 -4171 DATE ISSUED: 1/29/03
PARCEL: 2S 103AB -00403
SITE ADDRESS: 11285 SW WALNUT ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: 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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace furnace with like kind.
Owner: FEES
CLOUD, CLAUDIA G Description Date Amount
11285 SW WALNUT [MECH] Permit Fee 1/29/03 $72.50
TIGARD, OR 97223 [TAX] 8% StateTax 1/29/03 $5.80
Phone: Total $78.30
Contractor:
CARSON OIL COMPANY INC
3125 NW 35TH
PO BOX 10948 REQUIRED INSPECTIONS
PORTLAND, OR 97296-0948
Phone: FAX 227 - 8521 Heating Unt Insp
8516 Final Inspection
Reg #: 00008388
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 'ermit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ° T' NTI •N: Oregon law
require e - • ollow rules adopted in the Oregon Utility Notification Center. Those -s set brth in OAR 952 - 001 -00
i ; I �f ,� -I , Permittee Signature: � A
I sued By: : .L g /r \
C_ a - 03) •39 -4175 by 7:00 P.M. for inspections ne-ded the next business da\
", a
Mechanical Applicati ®n
Date received: / a'/ Permit no.: iez,Sao3��37
11' i City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
A 1 & 2 family dwelling or accessory 0 Conimercial/industrial U Multi- family 0 Tenant improvement
U New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: A,1 'Tr 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: (Block: ISubdivision: *See checklist for important application information and
Project name: C 4„,..) jurisdiction's fee schedule for residential permit fee.
City /county: - , 1 ZIP: g 3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and ocation of work on premises: �. 1 C e. AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
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? ((Yes U No Air ctng unit CFM
Air conditioning (site plan required)
Is existing space insulated? 1Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: A P c B n / ®, L- r State boiler permit no.:
HP Tons BTU /H
Address: ) 26 Jib) 3 � Yhr1 Li Fire/smoke dampers/duct smoke detec s _
City: 7 I Stateog_ I ZIP: 9 7 Heat pump (site plan required)
Phone: 22 L / p50 d I Faxa 152 / I E -mail: InstalUreplacefurnace/burner - f" BTU /H
7 O Including ductwork/vent liner 2( Yes O No I
CCB no.: ?.3 Install /replace/relocateheaters suspended,
City /metro lic. no.: Er 7 5 wall, or floor mounted
Name (please print): f ti G is ,.f S 7 I d Vent for appliance other than furnace
.1 CONTACT PERSON Refrigeration:
Absorption units BTU /H
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
-
OWNER Hoods, Type U IUres. kitchen/hazmat
hood fire suppression system
Name: CA- A u di I- L4 6 Exhaust fan with single duct (bath fans)
Mailing address: // 5
.5"
W AL A( 5.r. Exhaust system apart from heating or AC
City: 1-i �r0 State: D 2 ZIP: 91 2 23 Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: 15 Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment: i
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: I F I E -mail: Woodstove/pelletstove
Other:
Applicant's signature ax: ' ,,� 0$ , , ,� I Date: / a.-o3 Other:
Name (print): ,, [ g k AI�j STen/ .
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
CI Visa l7 MasterCard Notice: This permit application 0
Minimum fee $ 7a
P lan review (at %a
Credit card number: / / expires if a permit is not obtained ( %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ 6,6'0
Name of cardholder as shown on credit card accepted as complete. TOTAL $ 7 g n
Cardholder signature Amount 440-4617 (6/00/COM)
MECHANICAL PERMIT FEES k
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: 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) Furnace 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 Fumace
$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
to 100K BTU 14 00
ASSUMED VALUATIONS PER APPLIANCE: 8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount 9) 15 -30 HP; absorb
Furnace to 100,000 BTU, including 955 unit .5-1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents 11) >50HP: absorb
Floor fumace including vent 955 unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM
floor mounted heater 10.00
Vent not included in applicance 445 13) Air handling unit 10,000 CFM+
permit 17.20
Repair units 805 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 10.00
to 100k BTU 15) Vent fan connected to a single duct
3 -15 hp; absorb. unit, 1,700 6.80
101k to 500k BTU 16) Ventilation system not included in
15-30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00
mil. BTU 17) Hood served by mechanical exhaust
30 -50 hp; absorb. unit, 3,400 10.00
1 -1.75 mil. BTU 18) Domestic incinerators
>50 hp; absorb. unit, 5,725 17.40
>1.75 mil. BTU 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfrn 656 69.95
Air handling unit >10,000 curl 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21) Gas piping one to four outlets
Vent system not included in 656 5.40
appliance permit 22) More than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: $
Commercial or industrial incinerator 4,590
•
Other unit, including wood stoves, 656 8% State Surcharge $
inserts, etc.
Gas piping 1-4 outlets . 360 25% Plan Review Fee (of subtotal) $
Each additional outlet 63 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION:
Other Inspections and Fees:
1 Inspections outside of normal business hours (minimum charge -two hours)
$72 50 per hour.
2 Inspections for which no fee is specifically indicated (minimum charge -half hour)
$72 50 per hour
3 Additional plan review required by changes, additions or revisions to plans (minimum
charge- one -half hour) $72.50 per hour
* State Contractor Boller Certification required for units >200k BTU.
** Residential A/C requires site plan showing placement of unit
iAdsts\formsknech- fees.doc 10/11/00
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /� .w AM PM 1' BUR
Location // Z g.- U) J�yil -1J � Suite MEC 69? ?3 237
Contact Person -/A. Ph ( ) � gSOO PLM
U 3
Contractor Ph ( ) X Z g 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
Fi rewal l ,
Fire Sprinkler
Fire Alarm
Susp'd Ceiling •
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
FAIL
E H
Post& Beam •
Rough -In
Gas Line
Smoke Dampers
n
�i
PART FAIL
EL 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 f /y /�3 r
`R Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL