11350 SW COTTONWOOD LANE I`
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11350 SW COT'1'ONWWD LANE,
CITYOF T I G A R D MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2002-00027
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4'171 DATE ISSUED: 1/16/02
PARCEL: 1 S 13413D-07005
SITE ADDRESS: 11350 SW COT)ONWOOD LN
SUBDIVISION: ENGLEWOOD NO.3 ZONING: R-4.5
BLOCK: LOT: 230 JURISDICTION: TIG
CLASS OF WORK: ALl FLOOR FURN- EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERSICOMPRESSORS HOODS:
_ FUEL _TYPES _ 0 3 HP: DOMES. INCIN:
I.-PO 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 HAN7,LrNG UNITS OTHER UNITS:
FURN >-100K BT U: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Replace gas furnace
Owner: FEES
SPEAKS, STANLEY M + LGIS J Type By Date Amount Receipt
11350 SW COTTONWOOD LN PRMT CTR 1l16/02 $7'.50 -72002000C
TIGARD, OR 97')_23 5PCT CTR 1/16/02 $5.30 �72002000C
Phone: _ Total y78.30
Contr.:ctor:
CENTRAL VALLEY AIR
630 VALLEYWOOD DR. SE
SALEM, OR 97306 REQUIRED INSPECTIONS
Gas Line Insp
Phone:503-930-8304 Mechanical Insp
Reg #:LIC 127032 Final Inspection
This permit is issued subject to the regulations containe6 in the Tigard Municipal Code, State of Ore.
Specialty Code,3 and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR
952-001-0080. You may obtain copies of the-e rules or direct questions OUNC y c ling
trin,i)?AR-ai Rn
Issue By: _ � L Permittee Signature:
Call (503) 9-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical��erzm.W Aplication `
Dale received: - (� -Oa Peti{bZpp .UOO eZ
City of Tigard Project/appl.no.: Expiredate:
Ciry(if Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 —
Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 599-1960 Case file no.: Payment type:
Land use approval: -_ Building permit no.:
1 &2 family dwelling or accessory U Commercial/industrial U Mulli-family J Tenant improvement
U New construction XAddition/alteration/rept:icement U(.ether:
Job address: /Z9 Tp SC</ rr�y ,»l �,( ��n Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: _ Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit. Value$ —
LAX_: Block: I. bdivision: 'See r.hecklist for important application information and
Project name: jurisdiction's fce schedule for residential permit fee.
City/county: I ZIP: .1
Description and lotdtion of work o premises: oec
� '�'.S �� ✓+e- Pee(ea.) Total
date of complet on/insl>ection: O Deacti Qty. Fee
s.only Res.only
Tenant improvement or change of use:
Is existing space heated or conditioned7A-Yes U No 7Arhan�d1igurift __CFM__
—
Air conditioning(site plan required) -'
Is existing space insulated? es U No Alteration of existing H V AC system___-
or er compressors - -
State boiler permit no.:
Business name: Q,, yr. /q// , Y _ HP Tons HTU/H
Address: �3 C? i e Fire/smoke ampers/duct smoke detectors ----
City: r �cac State: �'>/C ZIP: J " eat pump(site pan require ) -
Phone: 1_3.)-2rLFax; E-mail: I nstal Ureplacefurnac Turner 0�r103TU/H �—
CCB no.: /%) cu Including duciwork/vent liner C7Yes U No
nslal rep ac re ocate heaters-suspended
City/metro lic.no.: L+ wall,or Floor mounted
Name( lease print): vent for appliance other than furnace
e regent ori
Ahsorption units HTII/II
Name: ,�,q- ;t' Tor• •/ ('hitters __-- III' —
Address: ' C'omesso
rrs_--__- HI'
nv ronmenta exhintO and ventl ration:
City: State: ZIP: _ Appliance vent
Phone: Fax: E-mail: — )ryer�cxhaust-- - -- -� --
�o res.kitchenthazinat ---
hood fire suppression system
Name: Iedf T Exhaust fan with single duct(bath tans)
Mailing address: Exhaust system a an from heating or AC
.� . ue piping an s1 ut on(up to outlets)
ZIP: ,L 3
_Type_- Lf(i _L NC
Phone: 9r)• ; Fax E-mail: Fuel ,i un+each ad3itiona over outlets
rocess piping(sc ematic require-J—)
Number cf outlets
71'honc.
1 er appliance or equipment:
Decorative fireplace
State: ZIP: Insert-type Fax: maih ---- Wo stow pc et stove — _ --
Applicant's signature: �� Date: , er.
Name (print):
o Na art)urio&tIons accept cr"I card,,pie=cd jurisdiction fa more lararrrranon. Permit fee.....................$ 74 ,_S-0
❑Viae ❑MuterCard Notice this permit application
Minimum fee................$
Credo card number:_ expires if a permit is not obrained , ,
!Ian review(at _ lh) $
Teti within 180 days after it has been Slate surcharge(Riff) ....$
—lV�-ea . u on accepted as complete.
$ TOTAL . .....................$
chi' �aroam
440.417(GOWCOM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: Price Total
$1,00 to$5,00_0.00 _ 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 healer
_ $2_5,000.00. 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
h •lio,i thereof. _ footnotes below.
Comp •'
Minimum Permit Fee$72.50 SUBTOTAL: $ 7)<3HP;absorb unit
to 100K BTU 14.00
89�e Slate Surcharge $ 8)3-15 HP;absorb
unit 100k to 500k BTU _ 25.60
25'/e Plan Review Fee(of subtotal) 9)15-30 HP;absorb
Required for ALL commercial permits on�r unit.5-1 mil 35.Or
TOTAL COMMERCIAL PERMIT FEE: $ unit
30-50 HP;;absorb
unit 1-1.75 mil BTU 52.20 _
11)>50HP;absorb
unit>1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM
10.00
Value Total
Descri tp Ion: Qty_ Ea Amount 13)Air handling unit 10,000 CFM+ 17.20
Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler
ducts&vents _ _ 10.00
Furnace>100,000 BTU Including 1,170 15)Vent fan connected to a single duct
ducts&vents_ _ _ - 6.80
Floor furnace Including vent _ 955
16)Ventilation system not included in
Suspended heater,wall heater or 955
floor mounted heater a liance permit t
0.00
- -- --
Vent not included In appiicance 445 17)Hood served by mechanical exhaust
ermit 10.00
eair units 805 18)Domestic Incinerators
17.40
<3 hp;absorb.unit, 955 19)Commercial or Industrial h pe Incinerator
to 100k BTU_ _
3-15 hp;absorb.unit, _ 1,700 69.95
od
101k to 500k BTU 20)Other units,including wostoves
10.00
15-30 hp;absorb.unit,501k to 1 2,310 _
mil.BTU 21)Gas piping ora to four outlets
5.40
30-50 hp;absorb.unit, 3,400 _
1-1.75 mil.BTU 22)More than 4-per outlet(each)
-- 1.00
>50 hp;absorb.unit, 5,725
>1.75 mil.BTU_ Minimum Permit Fee$72.50 SUBTOTAL: $
_
AIr handling unit to 10,000 cfm 658 --
Air handling unit>10,000 cfm _1,170 8%State Surcharge $
Non-portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to_a_single duct 446
Vent system not Included In 656
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
Domestic incinerator _ 1,170 1 Inspections outside of normal husiness tours(minimum charge-two hours)
ComCommercial or Industrial incinerator 4,590 X62 ec per Hour
_ Inspections for which no fee is specifically Indicated (minimum charge-half haur)
Othcr unit,Including wood stoves, 656 $62 50 per hour
Inserts,etc. j Additional plan review required by changes,additions or revisions to plans(minimum
Gas i In 1-4 outlets 360 charge-one-half hour)062 50 per hour
Each additional outlet 83
---- ----- 'State Contractor Kollar Certification required for units>200k BTU.
--�ME---' - "'Residential AIC requires site plan showing placement of unit.
COM
TOTAL RCIAL a
VALUATION: `_ _ All New Commercial Buh,lings require 2 sots of plans.
i:\dsts\forms\merh-fees.doc 12/26/01
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
BUP
Receive Date Requested AM PM_ BUP —i
Location 1 �_ �; dYl��4�-r Suite
--- MEC
Contac personPh( ) _` PLM —
Contractor_-_
( ) --__---- -------___ SWR --_--- ----
BUILDING Tenant/Owner _ ELC
Footing _- _ -- -- — ------
Foundation ELC
Ftg Drain
CeSS: - -----__- -_
Crawl Drain _ ELR
----------- -
Slab Inspection Notes:
Post& Beam -
Shear Anchors
Ext Sheath/Shear -----
Int Sheath/Shear --- --__
Framing
Insulation _-
Drywall Nailing � G1fL/��
Firewall --
I=ire Sprinkler ------ t4 'z Civ"7_.� __
Fire Alarm —
Susp'd Ceiling - - - -- —
Roof
Other. ---
Final
PASS PANT FAIL - - - -
PLUMIM —
PooR Beam -
Under SlaD
Rough-In
Water Servico
Sanitary Sevier
Rain Drains - - -
Catch Basin/Manhole ---
Storm Drain
Shower Pan
Other: - -
Final -
PASS PART FAIL - - -
MECHANICAL
Post& Beam —
Rough-In
�S"�mo��rtmperg
5 PART FAIL —
EL CTRICAL -
ervice -- -_ _
--
Rough-In
UG/Slab _
Low Voltage
Fire Alarm -- - -
Final
i
PASS PART FAIL q�Reinspection fee of g to aired before next inspection. Pay at City Hall, 1,125 SW Hall Rlvd
SITE 1 Please call ff !inspection HF
Fire Supply Line
-- _ Unable to inspect- r c ace:ass
ADA
Approach/Sidewalk Date —__ _ Inspector )"Or'4
-- Ext
Other: -
Final - DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
BUILDING PERMIT
CITY OF TIGARD DATEI IS#UED: • 06/26/196 ^-aJ l
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hell Blvd.Tigard,Oregon 07223.8199 (603)830-4171 PARCEL: 1 S 134BD-07005
SITZ:_ IA1 J)HL::j1-). . . c 11--'510 ::W COTTONWOOD LN
SUBDIVISION. . . . a ENGLE. vOD NO. 3 ZONING:R-4. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :230
--------------------------------------------------------------------------------
REISSUE: FLOOR AREAS-------•--- EXTERIOR WALL CONSTRUCTION
CLASS OF WORK. sRZP FIRST. . . . : 0 sf Ns S: E: W:
IYPE OF USE. . . cSF SECOND. . . : 0 sf PROTECT OPENINGS?----------
TYPE OF CONST. :5N . . . : 0 sf N: S: E: We
OCCUPANCY GRP. :R3 TOTAL-------: 0 sf ROOF CONST: FIRE RET? e
OCCUPANCY LOAD: 0 BASEMENT. : 0 sf AREA SEP. RATED:
STOR. o 0 HT: 0 .1=t GARAGE. . . : 0 Sf OCCU SEP. RATED:
BSMT?: MEZZ?: REOD SETBACKS-------- REQUIRED----------------
FLOOR LOAD. . . . : 0 p s f I_EF r: 0 ft RGHT: 0 ft F"I R SPKL: SMOK DET. . .-
DWELLING
ET. . :DWELLING UNITSe 0 FRNTe 0 ft REAR: 0 ft FIR ALRMa HNDICP ACG:
BEDRMS: 0 BATHS: 0 IMP SURFACEv 0 PRO CORR: PARKING: 0
VALUE. $: 3661
Remarks : REPLACING FIRE PLACE
Owners -________________-.___.__.._.____•-------______________ ...__ FEES
STANLEY SPEAKS type amount by date recpt
11350 SW COTTONWOOD LANE PRMT $ 44. 50 JSD 06/26/96 96-281053
PLCK $ 28. 93 BON 06/14/96 96-280645
IIGARD OR 972'23 5PCT $ 2. 23 JSD 06/26/96 96-281053
Phone #: 503-590-2534
Contractor: -_..._.______.____.--••-.---._.---__-___
GEORGE RICE MASONARY INC
P O BOX 924
NEWBERG OR 97132 -----______________________-.--------.---
Phone #c 503--538--4F.37 f 15. 66 TOTAL
Reg #. . a 25055
---- --- REQUIRED INSPECTIONS
------ -
1his permit it issued subject to the regulations contained in the Fir-eplace Insp
Tigard Municipal Code, State of Dre. Specialty Codes and all other Final Inspection
applicable laic. All work will be done in acco^dance with
approved plans. This permit will expire if work 1s not started
within 180 days of issuance, or if work is suspeided for more
than 180 days.
Permittee Signatr.rre
i
Ca l for inspection - 639--4175
y
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite Address:_=!T' )
Subdivision: _Lot# Office Use Only
Valuation: �� �'�' Contact Date 620'k Initials-G7.�.
Result Le P f n,;.
New Construction Only: (Square Footage)
Planck/Rec# �'
House. k- Garage: _ Permit#_ n -U.f
Reissue
Corner Lots' Yt Pl'� Flag Lot? (Fl,) N Map&TL#
Zone
Owner: `--�. - cv S Plat#
Address: `~Ls ��,N Approvals Required
f
�" Planning Setbacks�('� Solar
Engineering
Phone: 5- o - �� Other
Contractor: �C?G c ,,t AsLftems Reguirgd
Address Subcontractors
TrUSS Details
/(J J40 46 V C? Other
P'ione
Contractor's License#_�_0_ 57�5— s - 3& 97
,(attach copy of current Oregon license)
Contact Name: 6 _ off(
Contact Phone: 5'0 - 3 = _3
17
Subcontractors: ArchitectlEngineer:
Plumting. Address.
Mecnanic3l _
(attach copy of current OR Contractors License)
Electrical: Phone:
�� u��f U/dL--r" i�Mti••� 6/'o�/ter Utlf^s%•:/���c�� .L � -��t�/c�
JOB DESCRIPTIO
Applicant Signa re ��1/ t-1,r)PI;parif Phone number c�M3- 2 6-3Y
Received by:
� �_' _ Date Received;
Permit x Accnunt Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD) i Z�
Plumb. Permit (PLUMB)
Mech. Permit (MECN)
`;tate Tax (TAX) _
Bldg: ,1 . 2 3
Plumb:
Mech:
Plan Cueck (PL.ANCK) r'!� _
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA) _
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSOC)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TiF-C)
Industrial TIF (TIF-1)
Inst:tutional TIF (TIF-IS)
L":c:s TIF (TIF-0)
Water Quality (WiUAL)
`Nater Quantity (WQIJANT)
Fire Life Safety (FLS)
Eresiun Cntrl Permit (ERPRMT)
Erosion PlancluUSA (ERPLAN)
�resicn Planck,'COT (EROSN�
TOTALS:
APPk)VED FOR CONSTRUCTION
CIT".-- OF: TIGARD
R ' _ DATE-j/e, 51 9 G
Thq City of Tigard, Oregon, or
/ its e np, not be responsible for
discrepanc'lF, , h m ly appear hereon.
041/
17 cl"C-
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