12580 SW GLACIER LILY CIRCLE N
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12580 SW GLACIER LILY
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CITY OF TIGARD
\ MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2001-00417
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 GATE ISSUED: 11/28/01
PARCEL: 1 S 133DA-04500
SITE ADDRESS: 12580 SW GLACIER LILY CIR
SUBDIVISION: AMART SUMMERLAKE ZONING: R-7
BLOCK: LOT: 067 JURISDICTION: TIG
CLASS O"WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O t`PPL: VENT SYSTEMS:
STORIES: BOILERS/CUM PRESS ORS _ 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.
OD
GAS PRESSURE: 50 + HP: DRYERS:CS:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRRYER
O
FURN >=100K BGAS (�UTLETS�
TU: <= 10000 cfm: S UNITS:
> 10000 cfm:
Remarks: Installation of gas furnace.
Owner: _-- _-.-- �— FEES_____
BANTA, HOWARD E AND JOAN A Type By Date Amount Receipt
12580 SW GLACIER LILY CR PRMT CTR 11/28/01 $72.50 272001000C
TIGARD, OR 97223 5PCT CTR 11/28/01 $5.80 2.720010000
Total $78.30
Phone: ------- --
Contractor:
AAA HFATING + COOLING
2915 NE MARTIN LUTHER KING BLS'
PORTLAND,OR 97212 REQUIRED INSPECTIONS
Heating Unt Insp
Phone:284-2173 Final Inspection
Reg #:LIC 222
This permit iS iSSUed subjecc to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laves. All work will he done in accordance with approved
plans. This permit wil! expire if work is not started v 1ithin 180 days of i ,suance, or if work is suspended
for more than 180 Mays ATTENTION: Oregon law requires y(--j to 'ullow rules adopted in the Oregon
Utilify Notification Center. These rul:�-s as bei - -,ih in OAR 952-OC)1-0010 throe gh OAR
952-001-0080. You may obtair. copies of these rules or direct que.stion3 to QUNC by calling
/riflZl dR_01 AQ /
Issue ey- q _yyj- ►�_t' Permittee Signature:
Call (503) 64-3-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
IDatcreceived: Permit no.: /fa�fiYJr!'may/
City of Tigard RECE1W,! - IANNWG `
YmjecVappl.no.: F.xpircdatc:
Cirvoffipard Add,ess: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503) 639-4171Die issued: By: Receipt no.:
Fax: (503) 598-1960 NOV s; 2001 Case file no.: Payment type:
Land use approval: CITY(JE T IGAEID Building permit no.:
TVPE OF PEFYIT
)J I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
U New construction U Additionkilteration/re placement U Other:-JOR SI I-IF INFORMATION _-
1VALUATION' f
Joh address: /a j6 is 6W Cy tic , LILY Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no. Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax loth.ccount no.: profit.Value$ _
Lot: Block; Subdivision: *See checklist for important application information and
Frojectname: NT7ot- Hmk,rN"j-JbA0 „diction's fee schedule for residential permit lie.
City/county: -LOA- 1210 ZIP: c, W11111011901`1 01 INN
-
Descri,)tlon and location of work on premises: I t t
-i--,L AL-L- (4)5 1�U I�fJ�C I ct(t a.) total
Est.date of completion/inspection: Ikar Nion _ Qty. Res.only Res.only
Tenant improvemrnt or change of use:
Is existing space heated or conditioned?U Yes U No Air handlin. unit --__—CFM--
Is existing space insulated?U Yes U No Air conditioning(site plan required)
teration of existing HVAC system _ --
ol er compressors
, State boiler permit no.:
Business name; Lr 1� !\�"i N r r tr bt'f- i N<'r HP —Tons_ BTU/H
Address: 9 1-5 tiJ f M L Ie- ,Tk . �L U t� - — —--
ir•smo c damper. act smo a detectors
City: PO 1z'T C ra N tr) State:Ul2 Z1P: `j 1.2.1 Heat pump(site plan required)
Phone:' 9 u ' 113 1 Fax:, -I S5 1-mail: I nstal/replace furns_ urner`6'f0
r'C0 no.: C,C :� X .2 Including ductwork/vent liner U Yes U No 1 OD
lnstal/rep ace relocate heaters-suspen e- ,
City/metro lic.no.: wall,or floor mounted
Name(please print) �sj l(( (.I ; �[ i' / Vent for a ialr_e other(ban urnace _
cfngeral un:
Ahsomtion units BTU/11
Name: ('hillers HP ---
Atldress: Com ressors fill
:nv ronmenta exhaust an vent at on:
City: state: ZIP_ kj1pliancevent
Phone: j""-mail: Dtyerex aunt
WIM X 1100 s,Type /I res. tc azmat
hood fire suppression system _
Name: 0)P-o>1 , I-!OIAV 1K4-) rY IJ0 Fa r-I Exhaust tan with single duct(bath fans) _
Mailing addrLAC)E 11, L.I t-`( (,j f2 • Ex aun--t sy�stema art Com ficating or AC
uTi�;anddistribution(up to outlets)
City: i G>alti� snue:0>; IP: 9"7a 3 I •f Lf'G NG Oil
Phone: 514-it S-11 Fax: --- Email: yf'c `— -- --
tai rrnn cac a itiona over outlets
rocess piping(sc ematic required)
Name: Number of outlet%
Address: — --
Other listedripe ance or equipment:
_ Decorative fireplace _
City: State: ZII' _ Insert-type
Phone: Fa: E-mail: Woodslove/pci let stove
Applicant's signature: Oi ler^_ Datr. _ Ot er:
Name (print);
Not all puisdictlons accept credit cards,pleas call junsdiction'-,t i nae intortnauon. Permit fee......................
U Visa U MasterCard Notice:This permit application Minimum fee........ ..... .$ 5=�
Credit card numher,,
_ ; ./— expires if a days
a is not as been Plan review(at _ _ %) $ _ _
Fa,trc, within 180 days eller it has been State surcharge(8%.) $ � ' �-
Name of cardholder as s town on credit caul accepted as complete. _ 75--
,
_ _ s TOTAL .......................$
Cardholder sittnatum Ammmt W-4617(NOWOM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 R 2 FAMILY DWELLING FEE SCHEDULE:
- - Description: �Y Price Total
TC rAL VALUATION: FEE: - Table 1A Mechanical Code Gty(Ea) Amt
$1.00 to$5,000.00 Minimum fee$72,50 1) Furnace to 100,000 BTU
$5,001.00 to�1u,G00.00 $72.50 for the first$5,000.00 and Including ducts&vents 14.00-
$1.52 for each additional$100.00 or 2) Fuin^ce.100,000 BTU+
fractior.thereof,to and Including Inclu ling ducts&vents 17.40
$10,000.00. k4)
loor Furnace
$10,001.00 to$2F,000.00 $148.50 for the first$16,000.00 and loc in vent 14.00 _
$1.54 for each additional$100.00 ar us ended heate ,wall heaterfraction thereof,to and including or noon mounted heater 14 00 _
$2:,000.00. 5) Vent not Included in appliance permit
$25,001.00 to$50,000.00 $379.50 for the first$25,000.GO and 6 80
$1.45 for each additional$100.00 or 6) Repair units
fraction thereof,to and including 12,15
$50,000.00. _ -
$50,001.00 and up $742.00 for the first$50,000.00 and ChEck all that apply: Boiler Heat Ali-
$1.20
ir$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 14.00
__ --- to 100K B i U
ASSUMED VALUATIONS PER APPLIANCE: 8)3-15 HP;absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qt Ea Amount g)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 Includin vent 955 _ unit>1.75 mil BTU 87.20
Suspended heater,wail heater or 955 12)Air handling unit to 10,000 CFM
10.00
floor mounted heater
Vent not Included In applicance 445 13)Air handling unit 10,000 CFM+
ennil __r 17.20
Repair units 955 14)Non-portable evaporate cooler
<3 hp;absorb.unit, 1u.00
to 100k BTU 15)Vent fan connected t,a single duct
3-15 hp;absorb.unit, 1,700 F.80 _
1011,to 500k BTU 16)Ventilation system not included in
15-30 hp;absorb.unit,501k to 1 2,310 appliance ermit _ 10.00
mil.BTU _ -- 17)Hood served by mechanical exhaust
30-50 hp;absorb.unit, 3,400 t174O
1-1.75 mil.BTU 18)Domestic Incinerators
>50 hp;absorb.unit, 5,725 _
>1.75 mil.BTU -- 19)Commercial or Industrial type Incinerator
Air he unit to 10,000 cfm 656 69.95 -
Alr handlin unit>10,000 cfm 1 170 20)Other units,Including wood stoves
Non-porta evaporate cooler 656 _ 10.00
Vent fan connected to a single duct 446 - 21)Gas piping one to four outlets
Vtsnl system not included in 656 _ 5.40
a Ilance permit 22)More than 4-per outlet(each)
Hood served b mechanical exhaust 856 t.o0
Domestic Incinerator _ 1 170 _-- Minimum Permit Fee$72.50 SUBTOTAL: a
Commercial or industrial Inciner for _ 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 R,,quiied for ALL commercial permits only
TOTAL COMMERCIAL s TOTAL RESIDENTIAL PERMIT FEE: S
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
;t Additional plan review required by changes,additions or revisions to plans(minimum
charge-one-hr It hour)$72 50 per hour
State Contractor Boller Certification required for units>200k BTU.
"Reridenlisl A1C requires aIle plan showing placement of unit.
i:ldsts\fonns\mech-fees.doc 10/11/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-1-four Inspection Line: 639-4175 Business Line: 639-4171
BUP
Date Requested �AM —PM _ BLD _
Location C>:E:'L ( Suite _ MEC c f 17
Contact Person Ph _ PLM
Contractor O�t�I r' Ph Z / 7 SWR
BUILDING Tenant/Owner
Retaining Wall F!
Footing Access: ---'r
Foundation FPS
Ftg Drain SGN
Crawl Drain [Inspection Notes -- ---- -- ------
Slab - -- ---- - - SIT
Post&Beam -- - ---.- ---
Ext Sheath/Shear
Int SheathlShear
Framing --------
Insulation __Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling _--- --
Roof
Misc: _ _--
Final
PASS E-,AR'r FAIL —
PLUMBING
Post& Beam
Under Slab I _
Top Out
Water Service
Sanitary Sewer -- --- __
Rain Drains
Final -- -- --� — —
PASS PART FAIL
MECHANICAL.
Post&Beam — -- -- -- — --
Rough In
Gas Line ' - -- -------- —
Smoke Dampers
S PART FAIL
ELECTRICAL
Service
Rough In
UG/Slab
Low Voltage ___-_------- ------- -- ---- ----
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading — - - - —"- — -- _--
Sanitary Sewer
Storm Drain [ j Reinspection fee of$` ,required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin I ( ]Please tail for reinspection RE:_ —_� _ ( ]Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk
Other nate Inspector �� �"" _ Ext
FIncl
PASS PART FAIL DO NOT REMOVE this inspection record from the joky site.