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12580 SW GLACIER LILY CIRCLE N Ul W O v, G3 r- D n m r r- i i 1 i i d 12580 SW GLACIER LILY v 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.