Permit •
A .
CITY OF TIGARD MECHANICAL PERMIT
� Y j l�; A DEVELOPMENT SERVICES DATE ISSUED: 1/18/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT #: MEC2001 -00020
PARCEL: 2S1 10 BA -06800
SITE ADDRESS: 12036 SW WILDWOOD ST
SUBDIVISION: SHADOW HILLS NO.2 ZONING: R -2
BLOCK: LOT: 051 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: 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: 1
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of new gas range and associated gas piping.
Owner: FEES
SMITH, S CHARLES Type By Date Amount Receipt
PO BOX 230831 PRMT CTR 1/18/01 $72.50 2720010000
PORTLAND, OR 97223 5PCT CTR 1/18/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
ED'S CUSTOM PLUMBING
DAVID LEACH .
25480 BALD PEAK RD REQUIRED INSPECTIONS
HILLSBORO, OR 97123
Gas Line Insp
Phone: 503 - 644 -1374 Mechanical Insp
Reg #: LIC 52900 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 � - 9 2- 001 -0080.
You ma obtain •pi- of ese rules or direct questions to OUNC • , - ing (50 : -• :9.
Issue 1' I !/ 4 Permittee Si nature: 9 !' / , �'
Call � (503) 639 - 4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
. Date received: / Permit no.:Hfe -
r �
,, ' !4 City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PER1'ILI'
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial O Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other.
JOB SITE IN1'OR11ATlON COiMNI RCIAL VALUATION SCHEDULE
Job address:
_ 7 /,a / ", ndicate 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: Subdivision: 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Descriptio',I d location of n k on prem - • s: _. AND COi' lMERIC: L /I NDUSTRIAL EQUIPMI NTSCIIEDULE
— _�._ -,ye L.J.r Fee(ea.) Total
Est. date of completion/inspection: Desai. ' on Qty. Res. only Res. only
Tenant improvement or change of use: r AC: ■ --
Is existing space heated or conditioned? O Yes ❑ No Air handling unit CFM
Air conditioning (site plan required) _
Is existing insulated? 0 Yes 0 No Alteration of existing HVAC system MI
1\7ECI CON7RAC "fOR . : teroomprer
tmit ,■■
Business name: /,i� State boil permit no.:
'� ��� HP Tons BTU/H
i
Address: - Fire/smoke dampers/duct smoke detectors _
EtrigV M ZIP: 4 7,51/ rr' Heat pump (site plan required) Mili
Phone: e' E -mail: Instal replacefurnace/burner BT ■ --
CCB no.: �� Including ductwork/vent liner O Yes ❑ No
Instal re or • relocate heaters-suspended, ■ _ -
City/metro lic. no.: wall, or floor mounted
Name (please print): Vent for a r r liance other than furnace -
CONhAC "1' PERSON b� :::uni ■ --
Absotpdonunits BTU/H
� .1 Chilies HP � ��
Address: Co �ressors HP
•
lumen e ust an van on: ■
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER • Hoods, Type I res. kitchen/hazmat ■ _ —
f hood fire suppression system
/. ' �1 / / Exhaust fan with single duct (bath fans) -
Mailing address: Exhaust system a ' art from heating or AC =
e pp ga r. i i , . � upt�$utets
City: State: ZIP: Type: LPG - NG `a1� Oil
Phone: Fax: E -mail: Fuel 'ii ing each additional over 4 outlets I
ENGINEER ' , * p p .g (schematic required) ■IN1111■1111■
Name: Number of outlets -
CI Address: ' er 1 `app or e9 r parent: ■
Decorative
City: State: ZIP: Insert -type —
Phone: Fax: E -mail: 1T oodstov pe : stove i
Applicant's signature: Date: Other a! va O. ' ��`'
Name (print): -
Not all jurisdictions accept credit cards. please call jurisdiction for more information. Permit fee $ _
O Visa O MasterCard Notice: This permit ap Minimum fee $ 7,g r 5 U
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been State surcharge (8%) .... $ 5 . 0
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $ '
Cardholder signature Amount 17 (6100/COM)
MECHANICAL PERMIT FEES '*
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 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
ASSUMED VALUATIONS PER APPLIANCE: to 100K BTU 14.00
Value Total 8) 3-15 HP; absorb
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 furnace 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
15-30 hp; absorb. unit, 501k to 1 2,310 16) Ventilation system not included in
mil. BTU appliance permit 10.00
30-50 hp; absorb. unit, 3,400 17) Hood served by mechanical exhaust 10.00
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725 18) Domestic incinerators 17.40
mil. BTU 19) Commercial or industrial type incinerator
Air handling handling unit to 10,000 cfm 656 69.95
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656 20) Other units, including wood stoves
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 Boiler Certification required for units >200k BTU.
** Residential A/C requires site plan showing placement of unit.
I: dsts\forms\rnech- fees.doc 10/11/00
_CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / — Z Z AM PM BLD
Location / Z v 36 5 w ) Suite MEC 2e/0i-
Contact Person Ph /Y / 3 7c/ PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing ( 42 'I/ AMLL4.4 LL: i 44 Av4,LA416'
Insulation
. Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
Post & Beam
Rough In
Dampers
Final
PASS PART AI
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm -
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date /— Z 2— a/ Inspector E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
-CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
/ BUP
Date Requested / 5 ' AM PM BLD
Location /20 3 6 $ c i 144 , ' 4JVo d Suite MEC / —" -" Z-63
Contact Person Ph �t(-11 PLM
Contractor Ph SWR
BUILDING Tenant/Owner /' / .1 S.t / 4 / ti ELC
Retaining Wall 40121W1 h"• ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: '-Z; 6-
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
Post & Beam
Rough In
- Dampers
• RT FAIL
-
41111-111
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call r reinspection RE: [ ] Unable to inspect - no access
ADA
Other oach /Sidewalk Date 1 Q Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection cord from the job site.