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CITYOF T'G A R D MECHANICAL_PERMIT
DEVELOPMENT SERVICES PERMIT 4: MEC2004-00252
DATA ISSUED: 5/7/2004
1:125 SW Hal; Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S101AB-00302
SITE ADDRESS: 07105 SVS' ELMHURST ST
SUBDIVISION, ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT — FLUOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W!O APPL: VENT SYSTEMS:
STORIES: _ BO_ILERSICOMPRE_SSORS HOODS:
FUEL_TYPES — 0 - 3 HP:� DOMES. INCIN:
LPG y 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 OTHER UNITS
FURN -100K BTU: <= 10000 cfm: GAS OUI LETS:
> 10900 cfm:
Rein irks: (las furnaace replacement.
Uw net: _ ------------- FEES —
NORDLING, DALE +JO ANNE TRS Description Date Amount
7410 SW VIRGINA SII ('I II i'crmit Fee 5/7/2004 $72.50
PORTLAND, OR 97219 1'\x I X State Surchart 5/7/2004 $5.80
Total $78.30
Phone: 503-024-9747 --
Contractor: _
PIONEER GAS FURNACE
3615 NE BROADWAY
PORTLAND, OR 97232 __ REQUIRED INSPECTIONS
Heating Unt Insp
Phone: 503-249-5000 Final Inspection
Reg#: LIC 36102
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialt), Codes
and all other applicable laws All work will be done in accordance with approved plans. This permit will expire if,,)O is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC by L;allin(t
(503)246-6699.
Issued 8y� �` (�L _ Permittee Signature:
/ Call (503) 639-4175 by 7:00 P.M. for it,spections needed the next business day
Mechanical Permit Application
Date receivedr�7 Permit
City of Tigard ProjecUappl.no.: Expire date:
Cit of Tt urd Address: 13125 SW Hall I OR 97223
Y 8 Date issued: Receipt no.:
Phone: (503) 639-4171 RECEIVED
Fax- (503) 598-1960 Case ide no,: Payment type:
Land use approval: MAY Building permit no.:
r &2 family dwelling or accessory ' 11 klWWhx:hcial/industrial U Multi-family U Tenant improvement
New construction VAddition/alteration/replacement U Other: __
JOP.-N1T�1NFOlRMAT1ON. COMMERCIU
Job address: 77 JOS S)tD t Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: I Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax m_ap/tax lot/account no.: profit.Value$
Lot: Block: Subdivision: *Sec checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: r-d ZIP: Z,Z
Description ane ,c ion of work on premises:
htv(ra.) Total
Es date of completion/inspection: Descrlpt[on _ (r). Res.or I Iter.onl
Tenant improvement or change of use.:
Is existing space heated or conditioned?U Yes U No Air hanandlin unit _ CFM
u con ton ng(sitc iii ryu rc )
Is vxkting spare insulated?U Yes U No �terat on o ex sting IIS' %i_system
L.Wl'cr compressors
boiler permit no.:
Business name: e_ r ncic�'. __ HP —Tons BTU/H
Address: ' - LCA 1 t1_ •ire lino a dampers/duct smoa actectors
City -{ _j Stnlc 7.t. r'7.73 ienl pump(site plan requircce
Phone y ax: ) Install/replace furnace/ urn
CCB no,: ho-w_ Including durtwork/ven n es U No /4 f
_. nstn rep ace re ocnte caters-suspen e ,
17ity/metro lic.no.: 34,0, wall,or floor mounted
Name(plrase print): e4 _ eat ora 1 ance other t anurna- c�e
CONTAUF PFRSONRefrigeration:
Absorption units BTU/I
Name: Chillers— HP
Address: 1Compressors HP
.� r
EuMonmental exhaust and ventilation:
City: State: ZII' Appliancevent
Phone: Fax: E-mail: Drycicxhausl _
ooc s, ype res.kite c inzntat
r hood fire suppression system
Name: e-01!4L �r,n Q r- h'n _ Exhaust fan with single duct(bath fans) _
Mailing address: KA__C Exhaust system apart from heating or AU
City: _ Stat . ZIP Fuelpiping andistribution up to outlets)
- - Type: 1,1'G NO Oil _
Phon 7 I',i+ Is mall:
ZEiping each additional over 4 outlets
rocess piping(sc emat c required)
Name: Number of outlets
Other 11RAM appliance or equipment:
Address: _ _ Decmativefirc lace _
_ State: ZI F': Insert-type
City:
Phone: ax' a11: ext sloe pe el stove
•r OIhcr.
Applicant's signature. Date: S•- Ut er: _
Name(print):
Nor all jurldictiau accept credit earth,please call linidiction for more innnntmnm Permit fee.....................$ _��__
U Vise ❑MasterCard Notice:'fhir pcnnil application Minimum fee.................$ Z
ox
/ / pires if a permit is not obtained Plan review(al _ %)
Credit card number_ __�
Expires within I RO days after it has been -
State surcharge(896)....
Name or car of r u shown on credit cr—ii—� accepted as complete. $ _
s TOTAL .. .. .................
Cardholder signature — --- Amount 4404617 1b0a/COM1
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWF!LING FEE SCHEDULE-
TOTAL VALUATION: PERMIT FEE: Table
M _ Prim Total
$1.00 to$5,000.00 minimum foe$72.50 Table na Mechanical Code oty (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first 55,000.00 and 1) Furnace to cis& 0 BTU
includingducts&vents -14.00---
$1.52 for each additional$100.00 or 2) Furnace 100,000 BTU+
fraction thereof,to and Including Includingducts&vents 17.40 _
$10 000.00. Floor Furnace
10,001.00 to$25,000.00 $148.50 for the first$10,000.00 an(' 3) Includin vent 14.00
$1.54 for each additional$100.70 or 4 Suspended heater,wall heater
fraction thereof,to and Including ) P 14.00
$25000-00. or floor mounded heater
25,001,00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not Included in appliance permit 6,80
$1.45 fo.each additional$100.00 or -
fraclio,i thereof,to and including 6) Repair units
12.15
$50,$_50.0-L-10$_50.0-L-10.00.
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 Comp Pump Coad
traction t1.4reof, footnotes below.
7)<3HP;absorb unit
Minimum Permit fee$72.50 SUBTOTAL: $ to 100K BTU 14.00
8•/.State Surcharge $ - e)9-15 HP;absorb 25.60
unit 100k to 500k BTU
25•/.Plan Review Fee(oi 9)15-30 HP;absorb 35.00
subtotal) $
unit.5-1 mil BTU _-
_ Required for ALL commerclal permits only 10)30-50 HP;absorb
TOTAL COMMERCIAL PERMIT FFE: $ 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 1000
Value Total 13)Alt handling unit 10,000 CFM+
Description: Q Ea Amount 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 appliance permit 10.00 _
floor mounted heater _ 17)Hood served by mechanical exhaust
Vent not Included in appliance 445 10.00
permit - 18)Domestic incinerators
Repair units __ 805 17.40
<3 hp^sibsorb.unit, 955 19)Commercial or Industrial type incinerator
to 100k BTU __ _ 69.95 _
3-15 hp;absorb.unit, 1,700 20)Other units,Including wood stoves
101k to 500k BTU 10.00
15-30 hp;absorb.unit,501k to 1 2,310 21)Gas piping one to four outlets
mil.BTU __ 5.40
.10-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each)
1-1.75 mil.BTU _ 1.00
>50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $
>1.75 mll.BTU
Air handling unit to 10,000 ofm 656 8%State Surcharge $
Air handlin unit>10,000 cfm _1_.170
Non-portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 448
Vent system not Included in 658 --
a Ilance arm il - Other Ina ectlons and Fees:
Hood served b mechanical exhaust 658 Inspections outside or normal business hours(minimum charge two howl)
Domestic Incinerator _ 1,170 ,..__ $62 50 per hour
Commercial or industrial Incinerator 4,590 2 Inspections for which no fee Is specifically indicated (minimum charge-half hour)
Other unit,including wood stoves, 656 $62 50 per hour
Inserts etc. - 3 Additional plan review required by changes,additions or revisions to plans(minimum
Gas I In 1 4 OUlIelS _ _ 380 charge ,.te-hall hour)$62 50 per hour
Eadt additional outlet - 63 ----- •State Contractor Boller Certification required for unit>200k BTU.
-- - **Residential A/C requires site plan showing placement of unit.
TOTAL COMMERCIAL $
VALUATION: All New Commercial Buildings require 2 sets of plans.
1:ldsts\formsWech-fees.dor. 02111102
CITY OF TIGARD 24-Hour
BUILDING Inspection Lbie: (503)639-4175 /MST
INSPECTION DIVISION Business Line: (503)639-411
L`c�/
Received Datg Requested (allAM_ � _ PM BUP _
Location __ Suite 6E
02 ��-.SS
Contact Person ___.-.- Ph( ) _�T PLM
-
Contractor _-._-__.- .__-__ Ph( ) --_ SWR -
BUILDING Tenant/Owner _ ELC �'R
Footing ELC
Foundation Access:
Ftg Drain ELR _
Craw!Drain
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing --- -- -- --
Insulation � r��7
Drywall Nailing �''�� � -
Firewall
Fire Sprinkler -- - `----
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final -- ----- - 1
ASS PART FAiL T
PLUMBING
Post&Bearn Ilk
Under Slab ----------
Rough-In
Water Service ----- - -----
Sanitary Sewer
Rain Drains ----- -- -- --- ----
Catch Basin/Manhole
Storm Drain -
Shower Pan
Other: - - -�- - - -
Final
PASS PART_FAIL - -
MECHANICAL_ --- ----- --- ----__-_-_--
Post 8 Beam N„- Ili
Gas Line
Smoke Dampers -- - ---_ -
(fina
PASS ART FAIL - -- ---- - ”- ----
__ RICAL_-__-
Service
Rough-In --- - __-- _-
UG/Slab
Low Voltage -
Fire Alam
Final ❑ Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE F_� Please call for reinspection RF:--. , Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date- \ - Inspector
Other:
Finai DO NOT REMOVE this Inspection record from the Job site.
PASS PA7T FAIL