10490 SW CLYDESDALE PLACE R
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10490 SW Clydesdale Place
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CITYOF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC20017RQ059
DATE ISSUED: 2/16/01
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
PARCEL: 25103S10:sAA-03500
SITE ADDRESS: 10490 SW CLYDESDALE PL.
SUBDIVISION: CLYDESDALE ZONING: R-4.5
BLOCK: L01. 015 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VEN'rS W/O ADPL: VENT SYSTEMS:
STORIES: _ BOILERS_11COMPRE_S_SORS 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.
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: _ AIR HANDLING UNITS OTHER
DRYERS:
FURN �=100K BTU: <= 10000 ctrn r` S OU UNITS: 1
> 10000 cfm:
GAS OUTLETS:
Remarks: Installation of woodstove insert in masonry fireplace
Owner_ _FEES
LEWIS, GARY JAMES + DAWNA L T� .ype By Date Amount Receipt
10490 SW CLYDESDALE PL --
PRMT CTR 2/16/01 $72.50 272001001,E
TIGARD, OR 972.23 SPCT CTR 2/16/01 $5.00 272001n00c
Phone: �, __� Total $78 30
Contractor:
UWNFR
REQUIRED INSPECTIONS
Woodstove Insp
P'ione: sinal Inspection
Reg #:
This permit is issued ;ubject to the regulations contained in the Tigard M,-nk.ipal Code. State of Ore.
Specialty Codes and ail oilier applicahle laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
'sou may obtain copies of these rules or direct questions to OUNC�by call's (503)246-9189.
Issue By: L(`t_'_ Permittee Signature: t
Call (5 3) 639-4175 by 7:00 P.M. for inspections needed• A next business day
Mechanical Permit Application
"Datereceived: a io c� Permit no. - o _�
City of Tigard
g Project/appl,no.: Expire date:
Ciry r f7'ig -d Address: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: _ Payment type:
Land use approval: Building permit no.:
X!,,&' 2 family dwelling of aca.essory U Commerc ill/industrial U Multi-family Ll Tenant improvement
U New construction U Addition/alteralion/replacement U Other:Jolt SI IT INFORNIA]ION O.NIMERCIAL
VALUATION
Job address: CL`(U D/�1.� PLAIC4- Indicate equipment quantities in boxes below.Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax mapdax lot/account no.: profit.Value$
Lot: Block: I Subdivision: *See checklist for important application information and
Project name: 1 jurisdiction's fee schedule for residential permit fee.
City/county: 'TI( /}fLU ZIP: at"t 223
Description and location of work on premises: ri C,t t 1
oQQG-rQ,jC INS T IN mut tt2�{ J'i� ptwt►c� I ee(ea.) total
Est.dote of eompletion/inspection: ),,I/, n I , Zov I _ - lkycti iun Uty. Rr�,only Rte..onl>
Tenant improvement or change of use:
Airhandlingunit _ CFM _
Is existing space heated or conditioned'?;&Yes U No ��o�., ng u g(site plan require ) — -
Is existing space insulated?�'es 0 No -, Iterationo existing H VACsyste, -
!totmpressors --- ---
Business name: Stele boiler permit no.:
- - -- --- - - _ HP —_Tons B1'U/H
Address: •tr smokcdampers/duct smoa detectors ---
City: _ Stale: ZII' eat pump(site plan required)
Phone:— Fax:-- E-mail• Install/replace
frnacurr.,r
--�— - Including ductwork/vent liner U Yes U No
CCB no.: _ Insta rep ac re ovate heaters-suspen e , -
C y _ wall,or floor mounted
Cit /metro lie.no.:
----
Name(please print): enifor�qtr lance of ur than furnace
ciAgerat on:
Name:
Absorption units _- _ BTU/14C J , I� r > C:hillers--- - Hp --
Address: G L 5Db1 E lA C Compressors_— _ Hp
.nv ronmenta ex nst an vent lat on:
Cily: State:U)2 21P:�'1�2'�j Appliance vent
Phone:>c 5r 3 Fux:r� �Ct7,�_ E-mail• 'Tie'' ;se vv; n)ryerr—x7iaust-�— --- - _
7�t»da;Type res. tic a azmat -
hood fire suppression system
Name: _� _-- Exhaust fan with single duct(bath taus)
Mailing_address: ^x ousts stem a art from heating or AC
City: State: L!P: uel p p ng and distribution up to 4 outlets)
-- Type: --_LPG NG -- Oil
Phone: Fax: E-mail Fuel pipingeach additions over 4 outlets -
T14 Ig roempiping(sc ematicrequ rc )
Name: Number of outlets
- ---- ter listid app ance or eyn pment.
Address: _ __ _ _ Decorative rtre lace
City: Sldte:— ?.IP: nsent-t arl
Phone: ax: 1mail: ctovece et stove
Applicant's signatu1 _04t� !'�atc:
Name(print):
Nix all Judedieaom accept cn dlt etads,pkaae cal!jud, -tion fa mote infmnvi,N, Permit fee.....................$ a�'
U Visa U Maaterrard Notice:This permit application Minimum fee................$ _ 72
Ctedn card number _ expires if a permit is not obtained Plan review(at — %) $
re,
gx within 190 days after it has been
State surcharge(896) ....$
Name cett�drr es shown an credit card $ accepted as complete. TOTAL .,$ -1 A
-Canihnider aignaturc Amount W4617(WWOM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 r& 2 FAMILY DWELLING FEE SCHEDULE:
T_O_T_AL VALUAT_I_ON: FEE: - Description: - Price Amt
$1.00 t_o$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code --__ Qty {Ea) Amt
1) Furnace to 100,000 BTU-
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and inrluding ducts&vents 14.1)0
$1.52 for each additional$100.00 or 2) Furnace 100,000 BTU+ -
fraction thereof,to and including including ducts R vents 17.40
_ $10,000.00. __ ---- -- -
$10,001 00 to$2_5,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace
$1.54 for each additional$100.00 or including vent _ 1400 -
fraction thereof,to and including 4) Suspended heater,wall heater
_ $25,000.00. or floor mounted heater 1400
----._- -- --------...----
- ---- -- - --
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included in appliance perm)
6 60
$1.45 for each additional$100.00 or -
fraction thereof,to and including 6) Repair units
12.15
$50100000. -r50,o7of._oo_ind 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
L_- ---
fraction thereof. footnotes below. v Cornp*
7)<3HP;absorb unit
to 100K BTU
ASSUMED VALUATIONS PER APPLIANCE: 8)3.15 HP;absorb -
Value Total unit 100k to 500k BTU _ - 25 60
Description: Ott (11.a) 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 9TU 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
Suspendod 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,)00 CFM+
17.20
RRepmr units - __ 805 _ 14)Non-portable evaporate cooler
3 hp;absorb.unit, 955 _ 10.00
to 100k BTU ---- 15)Vent fan converted 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 10.0(1
1-1.75 mil.BTU 725 - ---- 18)Domestic Inclf+erators 17.40
>50 hp;absorb.unit,
>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 11,170 __- -- 20)Other units,!ncluding wood stoves
_N :ort
onable evaporate cooler 656 . 10.00
Vent fan connected to a single duct 446 -_ 21)Gas piping one to four outlet
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 Incineratorer _ 1,170 ?2
_ Minimum Permit Fee 572.50 SUBTOTAL: $ 5v
Commcial or Industrial Indnerator _ 4 590
Other unit,Including wood stoves, , 658 r,�- -- - 8%State Surcharge $ 5 Bo
Inserts,etc. _
Gas I in 1 4 outlets 380 25'/.Plan Review Foe(of subtotal) $
Each additional outlet 83 Required for ALL commercial permits only '-
TOTAL COMMERCIAL s 4 TOTAL RESIDENTIAL PERMIT FEE: sr�'✓�
VALUATION: --------------
-�- Other Inepectlons and Fsas
1 Inspections outside of normal business hours(minimum charge-two hours)
$72 50 ix;r hour
2 Inspections for which no fee is specifically Indicated (minimum charge-half hour)
$72 50 por h)ur
3 Additional plan review required by changes.additions or revisions to plans(minimum
charge-one half hour)$72 50 per hour
'State Contractor Boller Carilficatlon required Tor units>200k BTU.
-Residential AIC requires site plan showing placement of unit.
i\dsts\forms\merh-fees.doc 10/11/00
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST
Date Requested_ BUP-7�-0 AM PM BLD
Location U
_-C� Suite MEC -7 L?e
Contact Person _ �> yy D 5 Ph ��i^��i�Sl Awl, PLM
r'ontractor Ph �5^ & SWR
BUILDING Tenant/Owner t' k !!571 L/73,3 4� ELC —
Retaining Wall ELR
Footing
Foundation Access: FPS
Ftg Drain - —
Crawl Drain Inspection Notes: SGN
Slab �d-��� —
Post& Beam — -- SIT
Ext Sheath/Shear
Int Sheath/Shear — --
Fi:iming
Insulation -- '—
Drywall Nailing _
Firewall ---_
Fire Sprinkler
Fire Alarm --
Susp'd Ceiling
Roof ----
Misc:
Final — �— --- ------- — --------
PASS PART FAIL
PLUMBING — -----
Post& Beam _—
Under Slab
Top Out — ----- — A
Water Service
Sanitary Sewer
Rain drains
Final -- i -- ------ --
FASS PART FAIL
os .earn -- —Gas Line
Line -- _
Smo Dampers —
,#X—SSD PART FAIL
ELECTRICAL — — -- —
Service _
Rough In -- ---
UG/Slab
Low Voltage -- --'—
Fire Alarm
Final — --
PASS PART FAIL
SITE - -- --"-
Backfill/Grading
Sanitary Sewer
Storm Drain ( )Reinspection fee of$_—_ 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 // - J — cJ r Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.