Permit I
CITY OF TIGARD _ MECHANICAL PERMIT
WrA DEVELOPMENT SERVICES PERMIT #: MEC2000 -00468
" - ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/4/00
V PARCEL: 1S133DD-06900
SITE ADDRESS 12636 SW WLN_TERLAKE D.RD
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 ZONING: R -4.5
BLOCK: LOT: 108 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: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 1
FURN > =100K BTU: < =10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of zero clearance gas stove.
Owner: FEES
BOME, RONALD + JONI Type By Date Amount Receipt
12636 SW WI NTE RLAKE DR PRMT CTR 12/4/00 - - - $72.50 2720000000
TIGARD, OR 97223 5PCT CTR 12/4/00 $5.80 2720000000
Total $78.30
Phone:
Contractor:
OWNER
REQUIRED INSPECTIONS
Gas Line Insp
Phone: Mechanical Insp
Reg #: 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 ' ' Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You ay obtain copis of thes- rul or direct questions to ( • C by 03)246 -9189.
Issu By: £ _ # ! I � , � /, kJ/ ! Permittee Signatur �, S -�__
all (503 • ' • -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Date received: /, -0U Permit no::M 4 l0 g
i i
Sys - I �
,�-';,� �, City of igar Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
0 New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: / Z6M. S 4/ Ja / • - Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ •
Lot: Block: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: l'i /--,27 I ZIP: 9 7 2 7 3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and loc of work on premises: 7 AND COMMERICAL /INDUSTRIAL EQUI PM ENT SCI IEDULE
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 ❑ No Air handling unit CFM
g p Air conditioning (site plan required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system -
MEClIANICAL CONTRACTOR Boiler /compressors
Business name: �+ /� State boiler permit no.:
CIO)), HP Tons BTU/H
Address: Fire/smoke dampers/duct smoke detectors
City: I State: I ZIP: Heat pump (site plan required)
Phone: I Fax: I E -mail: Install/replace furnace/burner BTU /H
CCB no.: Including ductwork/vent liner 0 Yes O No
Install/replace/relocate heaters- suspended,
City/metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
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 II/res. kitchen/hazmat
hood fire suppression system
Name: H E. Iv 5 i /3!)1/6„, Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distrib ion (up to 4 outlets) /
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each addi onal over 4 outlets
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace .
City: State: ZIP: Insert-type
Phone: k _ra�'s><'' E -mail:
Woodstove/pellet stove
' Other: 6- C.L,4AQA+�C.f. Gyrs ` g. / 'r /Q.
x Applicant's sign s 1 . Date: Other:
Name (print):
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa O MasterCard Notice: This permit application Minimum fee $ , '9.S 0
expires if a permit is not obtained Plan (at %
Credit card number: an review ( %) $
Expires within 180 days after it has been State surcharge (8 %) $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440 -4617 (6/00/COM)
MECHANICAL PERMIT FEES -- .. �, y
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price Total
Table 1A Mechanical Code Qty (Ea) Amt
$1.00 to $5,000.00 Minimum fee $72.50 1) Furnace to 100,000 BTU
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and including ducts & vents 14.00
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
$10,000.00.
fraction thereof, to and including 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
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 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 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 cfm 656 69.95
Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves /
Non - portable evaporate cooler 656 / 10.00 /t7 .
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 Pem}i ee $72.5 SUBTOTAL: $ sd
Commercial or industrial incinerator 4,590 / 'o
Other unit, including wood stoves, 656 8% State Surcharge $ 5 to
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: $. 50
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.
is \dsts \forms\mech- 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 g— 1 Z AM PM BLD
Location / �D � C S� �i�r 1Q /4 0/ Suite
MEC 7.cfiu -,GU 4/6P
Contact Person TiPA - Ph 57) 3 - SL} 'ys7 HPLM
Contractor g"‘ Ph . s31 -7 SWR
BUILDING Tenant/Owner Pi # ca,/ 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
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
c.illECHANICA
1
Rough In r
71117. fir' ff
o • - • - mpers
SS 'ART FAIL
ICAL
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 Date / 4V� /a Inspector
Ve
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.