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CITE' OF TIGARD MECHANICAL PERMIT
[DEVELOPMENT SERVICES PERMIT#: MEC2002-00025
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 1/15/02
PARCEL: 2S103DB-02200
SITE ADDRESS: 13425 SW GENESIS LP
SUBDIVISION. GENESIS ZONING: R-4.5
BLOCK: LOT: 018 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR TURN: UVAP COOLERS:
TYPE OF USE: SF UN T HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENT. W/O APPL.: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS_ _ HOODS:
FU_FL TYPES 0 - 3 HP: J DOMES. INCIN:
(;AS 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: AIR H_ANDLINC UNITS
OTHER UNITS. 1
FURN >='IOOK BTU: <= 10000 cfm: v
>
GAS OUTLETS:
10000 cfm:
Remarks: Installation of gas fireplace insert.
Owner: -- FEES
ROBBINS,BRADFORD R + NANCY K Type By Date Amount Receipt
13425 SW GENESIS LOOP 5PCT CTR 1/15/02 $5.80 272002000C
TIGARD, OR 97223 PRMT CTR 1/15/02 $72.50 272002000C
Total $78.30
Phone: -- -
Contractor:
HOME FIRE STOVE
1695 ST NE
SALEM, OR 97301-1370 REQUIRED INSPECTIONS—
Mechanical Insp
Phone:503-364-6339 Final Inspection
Reg 9:LIC 48630
This permit is issued subject to rhe regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will exp're if work is not started within 180 days of issuance, or if work is suspended
for more than 1 F days. ATTENTION: Oregon law requiro.is you to follow rules adopted in the Oregon
Utility Notification Gen'.er. Those rules are set forth in OAP. 952-001-0010 through OAR
952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling
l�fl'�17dR_Q1AQ , � �
s�
Issue 8y: Gf.r�L Permittee Signature: (_t
Call (503)6739-4175 by 7:00 P.M. for inspections needed the next business day
a Mechanical-Permit A+,pplicat en
Date received: / �. Permit no.:NEC 9,b -040
City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By4j�> Receipt no.: I
Phone: (503) 639-4171
Fax. (503) 598-1960 Case file no.: Payment type:
Land use approval: Buiwmg permr no.:
=&2cfamtirly dwelling oraccesso-. U Commercial/industtial U Multi- amily U Tenant improvement
ction U Adr/ition/alteratuon/replacement U Other:
F&I I Ull j 0 1 LIU 10 UIII a
Job address:/ //,:�� '5. 1,,) (' 1tj")_") , e`{ J Indicate equlpnic„t quantities in boxes below.Indicate the dollar
Bldg,nn.: j I Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit.Value$
Lot: Block: Subdivision: *See checklis, for important application information and
Project name: jurisdiction's fee schedule for residential hrrnniI fcc.
City/county: ZIP: EE �
Description and location of work on premises: C ILK
[vv(ea.) Total
Est.date of completion/inspection: i t ;y Ilkstri ion ONY. Res.only Res.only
Tenant improvement or change of use: Tron
nit CFM
Is existing space heated or conditioned?CJ Yes ❑No ng(site pan require )
Is existing space insul:ded?U Yes U N( xlsttngHVAC ysiernssors
Stale boiler permit no.:
Business nuns E 77t a .t 2(1 t� ALJ
___ lip Tons BTUH
Address:16• C /V, C 1105- a ampers uct smoke actectotfi _
City' ' StZIP: .?el Heat purap(sne plan require ) _
Phone: . L•4-4.>.5 y IFax:34• -/CS Email: nsta replaceurnace urner /} 1
---— Including ductwork/vent Inner U Yes U No
CCB no.: C Install/rep acre orate heaters-suspends
City/metro lic.no.: — wall,or floor mounted
Name(please print): I�; Vent fora iance other than furnace
e i je al on:
Absorption units--- BTU1"
Name: Chillers Hp
Cum ressors IIP
Address: -,nv ronmenta ex us'an ventilation:
City: --J—s —tate: ZIP' Appliance vent
Phone: Pax: E-mail: 7;fl
aust _ —
ypc f/ res. ttc et azmat
suppression system
Nance: /J r_cL6t� )�ti.t Le /L e "/' . ,�a--' an with single duct(bath fans) _ L
Mailing address: !j ,7 �� �1 ' stem a art from teaun or C
City , tate, : ZIP: / 7—,� 's' ng an n- on(t.p to out ccs)tl LPGNG (.)il
Phone: b ,. Fax: ' -6t'�'t E-mail: b r y �'c _'.' ueac a Toone ever 4 outlets
Process piping T-7ematicrequired)
Number of outlets
Name:
t er c app or eqpm—T--enl:
Address: _ Decorative fireplace
City: State: ZIP: nsert--type -�
Phone: ax: ail: oo sto^ pe et stove —
Applicanl's signature: �t, f. i -Bate: C ,� t t er:
Name (print): N't NL k Int !u I i 1N -5
Not all)udadktlow;rep reedit cards,please cut)urirli.aon fm more lnfartna8on. Permit fee.....................$ 0� 552.
U boa U MasterCard expire: {n permit not obtain Minimum fee................$
Ordit csd number: __ _.___-�� _ expires if n permit a not as a en Plan review(ret _ %) $Stat
pap Re— within I NO days after it has been
-- Worst of c Iden.�i shown on c t— , t c�— - accepted as complete. TO ALsur ..... . (8�1. ..$ —
S TOTAL ..... ...... .........$ �_
Cardholder signature Amount 446-0:7(6MWOM)
MECK" ';ICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: _PERMIT FEE: Description: _ J~ Price Total
$1.00 to$5,000.00 Minimim fee$72.50 Table 1A Mechanical Code Qb' (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 includingducts&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$10,000.01.and 3) Floor Furnace
$1.54 for each additional$100.00 or Includingvent 14.00
fraction thereof,to and Including 4) Suspended heater,•v-ill heater
$25000.00. 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 6,80
$1.45 for each additional$100.00 or _--
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: Boner Heat Ah
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
fraction thereof, footnotes below. Comp
Minimum Permit Fee$72.50 SUBTOTAL: $ 7)<3HP;absorb unit
l0 100K BTU 14.00
8%State Surcharge $ 8) 15 absorb 25.60 _
unit t 100kk t to 500k BTU
25%Plan Review Fee of subtotal 9) HP;absorb
) $ unit
.5-1
Required for ALL commercial permits only .5-1 mil BTU 35.00
--- 10)30-50 HP;absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.20
11)>50HP;absorb
unit>1.75 mil BTU 8
- 7.20
ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM10.00
Value Total 13)Air handling unit 10,000 CFM+
Des
crl lion: Q Ea Amount 17.20 V
Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler
ducts&vents 10.00
Furnace> 100,000 BTU Includlny 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 healer 17)Hood served by mechalical exhaust
Vent not Included in applicance 445 10.00
permit 18)Domestic incinerators
Repair units 805 17.40
<3 hp;absorb.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 outlet-,
mil.BTU 5.40
30-50 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 mil.BTU
Air handling unit to 10,000 cfm 656 8%State Surcharge $
Air handling unit>10,000 cim 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 permit
Hood served b mechanical exhaust 856 Other Mpections o and fees:
_�_ 1 Inspections outside of normal business hours(minimum charge-two hours)
Domestic Incinerator _ 11170 $02 50 per hour
Commercial or Industrial Incinerator 4,590 2 Inspections for which no fee is specifically indicated (minimum charge-hall 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 piping 1-4 outlet4_ 380 charge-one-half hour)$62 50 per hour
Each additional outlet 63 Stale Contractor Boiler Certification required for units>20Lk BTU.
TOTAL COMMERCIAL $r ' Residential.wC requires site plan showing placer.ient of unit.
VALUATION: All New C^:Tmercial Buildings require 2 sets of plans.
1:\fists\forms\mech-fees.doc 12/26/01
CITY 4F TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639-4171
SUP -
—
Received -Date Requested_��3 AM ___ PM .._ SUP
Location Suite - - MEC �,hG a OG'=►►•�?
Contact Person _ --_____ Ph( ) -_ PLM
Contractor. Ph(--) SWR
BUILDING — TenanVP!Tpr ��✓�'� �} v � ELC
Footing S d O J�CJ
ELC
Foundation -_-_ -
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT - - -_
Post&Beam
Shear Anchors _
Ext Sheath/Sheaf
Int Sheath/Shear
Framing
Insulation
Drywall Nailing - - -
Firewall
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling
Roof
Other: _
Final —
PASS PART FAIL - _ ---- - --- -- _ -- - -
PLUMBING —
Post 8 Beam —
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
Final --
PASS PART FAIL
MECHANICAL _--
Post 8 Beam
Rough-In --- ---- - --
Gas i_ine
Smoke Dampers --- - - -- --------- -_-- - -- --- ----
ti!n '
�PART FAIL ---
ELECTRICAL--- -- - --- -- ----- _--- ----
Service
Rough-In _
UG/Slab
Low Voltage -- — ----- --- --.. ------- -
Fire Alarm
Final Reir epection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE_ __� Please call for reinspection RE: ,_-_ [j Unable to inspect--no access
Fire Supply Line
ADA Dae 4 Inspector
Ext
Other:
_
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 –
BUP _—
�1 77 Date Request/ed 1"2-1=ql� —AM PM _ BLD r/
Location -� / Suite MEC
Contact Person Y61LA% _VY' FILM
Contractor _ _ Ph SWR _
BUILDING TenanVOwner ELC e _
Retaining Wall ELR
Footing Access: FPS
Foundation --
Ftg Drain SGN
Crawl Drain Inspe;;tion Notes:
Slab __ _
Post&Beam
Ext Sheath/Sheari�-
Int Sheath/Shear
Framing —
Insulation ) 5;
Drywall Nailing % � t�► 't ^�"zr: r� '
FirewallZ cq7A
Fire Sprinklery
Fire Alarm
Susp'd Ceiling `s
Roof
Misc: -
Final
PASS PART F AIL - --
PLUMBING _
Post&Beam
Under Slab --
Top Out
Water Service
Sanitary Sewer
Rain Drains —
Final
P P*K FAIL _ --- --- - -
MEC ANICAL-
Post& Beam /
Sr1�nk�r;ampers —_- —-- -
,pAai ; 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 I I Please call for reinspection RE: ( J Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk pate /�' Z/__ Inspector r.__-- -Ext
Other _!
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY O F TIGARD MECHANICAL
DEVELOPMENT SERVICES PERMITPERMIT #. . . . . . . : MEC98-05617:
13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 DATE ISSUED: 12/16/98
PIARCEI.-..- C"'SI03DB-02200
SITE ADDRESS. . . : 1.34215 SW GENESIS LP
SUBDIVICION. : GENESIS ZONIIqG-. R -4. 3
BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :018 JURISDICTION: TIG
CLASS OF WORK. . :ALT FLOOR TURN. . . . : 0 EVAP COOLERS: 0
TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCY GRP. . :R3 VENTS W/O APPIL: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
FUEL TYPES-------------- 0-3 HP. . . . : 0 DOMES. INCIN: 0
.GAS 3-15 HP. . . . : 0 COMML.. INCIN. 0
MAX INPUT: 0 BTU 15-30 14P. . . . : 0 REPAIR UNITS: 0
FIRE DAMPERS?. . : 30-50 HP. . . . : 0 WOODSTOVES. . : 0
GAS PRESSURE. . . 50-f HF'. . . . : 0 CLO DRYERS— : 0
NO. OF AIR HANDL-ING, UNITS OTHER UNITS. .-
TURN ( 100K BTU: 0 10000 cfm : 0 GAS OUTLETS. :
FURN ) =100K BTU. 0 > 10000 cfm : 0
Installation of gas piping and gas fireplace logs to two *2"
fireplaces.
Owner,: FEES --_._----_--_—_.
BRAD ROBBIN & NANCY ROBBIN type amount by date r-eept
13425 SW GENESIS LOOP, PRMT $ 25. 00 DLH 12/16/98 98-311589
TIGARD OR 97223 55PCT $ 1. 25 DLH 12/16/98 98-311589
Pone #: 598-8505
Contract or,: ________________--___-------_____
JOHN 0 BRANCH FIREPLACES A. MDR
JOHN OSCAR BRANCH
PO BOX 23698 26. 25 TOTAL
TIGARD OR 97281
Phone #. 620-0255
Reg #. . : 003958 REOUI RED INSPECTIONS
This permit is issued subject to the regulatinns contained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechani.^al Insp
applicable lars. All work will be done in accordance with Final. Inspection
approved pllan, . This permit will expire if work i.s not started
within 180 d.jys of issuance, or if work is suspended for more
than 180 dans. ATTENTION: Oregon law requires you to follow rules
adopted by ie Oregon Utility Notification Center. Those rules are
set forth in DAR 952-00I-00I0 through DAR You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246-1187.
......................
Tssl-te By : 416 Permittee 9ignatur,et
....4-4-++4................�,-+++4•....................4... +/... ++++++++++++t•+++++
Call 639-4175 by 7100 p. m. for inspections nepded the next business day
..........................................4-+++4+-$.............L......4..........
Check
CITY OF TIGARD Mechanical Formit Application Plan Ch
Recd h Z.� =�
13125 SW HALL BLVD. Commercial and Residential Dale Rec'd2__:V%�?
TIGARD, OR 97223 Date to P.E.
(503) 639-4171, x304 � Date to DST
Print or Type Permit#
Incomplete or illegible_applicati_ons will not be accepted called — --
Name of Development/Project Description --
Table 1A Mechanical Code Qt Price Amt
Job Street Address —Sunetl A) Perrriit Fee 10 60
Address LI 2, 5 � �jCr�+}�_ ') Furnace to ducts
& 0 BTI$
„ including ducts&vents
Bldg ceylstate Zip 2) Furnace 100,000 BTU+
-72-23 including ducts&vent. 7,50
Name(or n me of buAr.ess) 3) Floor Furnace
Owner J`/J including vent _ 6.00
3
MeigAddress a~� U 4) Suspended heater,wall heater��- �w / �r3�3 (��n or floor mounted heater 6.00
(
_ 5) Vent not included in appliance permit
chIstate ZIP Phone _ 300
U) CHECK ALL 'Boiler Heat Air
Ne a(o me of business) THAT APPLY or Pump Cond Qty Price Amt
( `v. Com '•
r,)<3HP;absorb unit to
Occupant Mailing Address 100K BTU 600
7)3-15 HP,absorb unit
CRY/State Zip Phone 100k to 500k BTLJ 11.00
8)15-30 HP,absorb
Contractor Name --- unit 5-1 mil BTU — Y — 15.00
9)30-50 HP, absorb
�v� unit 1-1.75 mil BTU 72.50 _
Prior to permitMalling Address 10)>50HP;absorb unit
Issuance,a copy 9 >1.75 mil BTU I J 1 37.50
of all licenses CnyrState �+ ZIP Phone 11)Air handling unit to 10,000 CFM
are required if ,Cr v--/ /7L 4.50
expired in COT o Const Cont,Board LIc.N Exp.Date — 12)Air handling unit 10,000 CFM+
database -0 -:21 7,50
Architect Name 13)Non-portable evaporate cooler
4.50
or Manlnq Address -- - 14)Vent fan connected to a single duct
3.00
15)Ventilation system riot included in
EngineerCltylstaIs 7"lp Phone appliance permit 4.50 _
16)Hood served by mechanical exhaust
Describe work to be done: 4.50 _
17)Domestic Incinerators
New O Repair O Replace with like kind: Yes O No O 7.50 _
Residentlat j Commercial O 18)Commercial or Industrial type Incinerator
� 30.00
Additional Information or description of work: — 19)Repair units
/9/ t /> r 'r/ /' t �9 S P//p///G4.50
6W.'r > //Pf f/Ff(� (,.n(�� 20)wood stove
4.50
J) F/Af"T'F-7 el L 21)Clothes dryer,etc.
4.50
Type of fuel oil O natural gas LPG O electro,O 22)Other units
4.50 :'• �Z1
I hereby acknowledge that I have read this application,that the information 23)Gas piping one to four outlets
given is correct,that I am the owner or authorized agent of r� 2.00
the owner,that plans submitted are in compliance with Oregon State laws. 24)More than 4-per outlet(each)
.50
SIZnaturppf Owner/Agent Date
Minimum Permit Fee$25.00 SUBTOTAL Q 1
5%S'JRCHARGE �'
ntact Person Name Phone PLAN REVIEW 2.5%r�F SUBTOTAL
�` Requited for ALL commercial permits only
c C) — V 2o- 02- .> _ _ ---- -- TOTAL
— 'State Contra;tor Boiler Certification required
"Residential FIC requires site plan showing placement of unit
I\mechperm.doc rev 07/20198