15960 SW GREENS WAY a
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15960 SW Greens Way
CITYOF t I GA R D — MECHANICAL PERMIT —
DEVELOPMENT SERVICES PERMIT#: MEC2002-00599
13125 SW Hall Blvd., Tigard, OR 97123 (503) 639-4171 DATE ISSUED: 12/2.3/02
PARCEL: 2S 110DD-00900
SITE ADDRESS: 15960 SW GREENS WAY
SUBDIVISION: SUMMERFIELD ZONING: R-12
BLOCK: LOT: 091 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: I
STORIES: BOILERS/COMPRESSORS HOODS:
_ FUEL. TYPES 0 - 3 HP: — — 00MLS. INCIN:
I_FIG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 -30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: %P.'OODSTOVES:
GAS PRESSURE: 50 •1- HP:
FURN < 100K BTU: _ AIR HANDLING UIJITS CLO DRYERS:
------- OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm_ GAS OUTLETS: 1
> 10000 Cf in:
Remarks: Install vent and pipe for gas insert.
Owner: _ _--------------- FEES _.
O'DRISCOLL. MABEL E Description Date Amount
15960 Sb"J GRCCPJ; "JAY ---- ---- --—
TIGAPP, OR 97224 x\11 (111 1'r1 11111 I rr 12/23/02 $72..50
1 IA x stalc l a 12/23/02 $5.80
— Total $78.39
Phone: -- ----- --- _�.
Contractor:
SUBIJRBAN@F'OME
6014 NE 112TH AVE.
PORTLAND, OR 9:2'_'0 REQUIRED INSPECTIONS
Phone Gas Line Insp`03-257-5438 Mechanicallnsp
Reg #: LIC 143335 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code. :Rate of Ore.
Specialty Codes and all other applicable laws All work will be done in accordance with approved
plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 dayn ATTENTION Oregon law requires you to follow rules adopted in the Oregon
Utility Notirication Center Those rules are set forth in OAR 952-00 1-0010 through OAR
952-001-0100. You may obtain copies o, `hese rules or direct questions to OUNC by calling
(503)246-5699.
Issued By: -- -------- Permittee Signature: r/(Call (503)(503) 639-4175 by 7:00 P.M. for inspections needed the next business day
�A Mechanical Pei mit Application
_
Date receivedr, - O�Oi F'crmitno.: I�.a. 'L �AWMr ,
Cil of Tigard City g ������! 1 ProjecUappl.no.: Expire date:
Citygf'/'igard Address: 13125 SW Hall Blvd,Ti U�
Phone: (503) 639-4171 Date issued: By:�Y Receipt no.:
Fax: (503) 598-1960 DEC 2 U D�C Case file no.: Payment type:
Land use approval: r . I Building permit no.:
I &2 family dwelling or accessory U Commerci,,d/indusu'ial J Multi-family U Tenant -nprovement
U New construction U Add ition/;.lteration/replacemelit U Other:-
1 ' SITE INFORMATION
Job address: j,c 111L `_�Ivy Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no,: I guitv no.: J value of all mechanical materi.Is,equipment,labor,overhead,
Tax map/tax lot/account no.: profit. Value$
Lot: i lock: _ Subdivision _ "See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee
City/county: --- ZIP: - t
Descri ttir:n and locut' n of work oil premise: a I tr t
--
LM Azzr5l"t k 1 is 4 ✓ [ Fee(ea.) Total
Est.date of completion/inspection:
Description qty. Res.only Res.tnhh
Tenant improvement o, change of use:
Is existing space heated or conditioned'?U Yes U No Air handling unj: CFM
Is existinn,space insulated?J Y s U No Air conditioning(site plan require ) —
P' Alteration o existing 11VAC system
lfRler/compressors --
�, v State boiler permit no.:
Business nano.: l 1 1 Y'1 _ lit' __Tons_._BTU/H
Address' �;l- 1 -hr smo e ampers duct smo a detectors - —-- -
City: ," Slate: ZI leat pump(site p an r�egwred)-- ---- - _
Phone � S: _ Faxe- E-mail: Instill/replace furnace/burner —FiTU71T
Including duclwork/vent liner U Yes U No
CCB no: y nsta rep ac•re ocate heaters-suspen c ,
City/metro lic.no.: -s wall,or floor mounted
Nuttte(pleae^print): `� Vent forappliance other than furnace
PERSON e genal on:
Absorption units BTU/Il
Nance: Chillers NP
Address: - C'om ressors HP
- - Snv ronmenla-T(aust rn vent at un:
City: _ Slate: ZIP: _ Appluhncevent
Phone: Fax: E-mail: prycrex haaust— - - -- - -
0o s, 'ypc / res. itc en/tarn- tai --
hood fire suppression system
Nam(: 1` 1 l F:xhuust fan with si igic due:(bath fans)
Mailing address: 1p `� j('�hS :xTiausl system a,art from hT;uin} cin __
City:
Fuelpiping an stn t on lop to. outlets)
I
1 _ State:�1�_. ZIP: type: LPC; NG Oil
Phont!: C Fax I nuliLfuadditional over 4 out outlets
----
rocesspiping(sc emaUercquired)
Nance: Number of outlels
01 her listed appliance or equipment:
Address: _ pecorativefireplace
City: St ZIP: _ -- -- Insert-type —__-_
Phone.: IvaX: :-mail: no wove pc els vc
Applicant's signature: ' Ctl.? - bore: Other. —
Name (print): T ("__.(,--T--- --- —.
Na all jurisdictions nxept credit earls,please call jurisdiction for more inGxmall,m Permit fee...I.................$
expires if a per
U Visa U MasterCard Notice:This permit mhii applications not obtained Mininturn fee................$ 7 a--•_K �
r
Credit cad number. ..---- —_. - �-(_( Plan review(at _! ;6) $
Gxpirer within 180 days after it ha.,been State surcharge(8%) ....$
Name of cadholder as shown on credit card accepted es complete.
Cardholder sigtnature _ Amount
-- � •W0J611 gtutx)/COM)
I, DE 0)\Z,
Commercial Schedule
1&2 f=amily Dwelling Schedule
ASSUMED VALUATIONS PER APPLIANCE Description
Furnace to 100,000 BTU Table 1A Mechanical Code oty Price Total
81
including ducts&vents 955 1)IncludiFurnang tduds o 100d ven sty 14.00
Furnace>100,000 BTU 2) Furnace 100,woBTU4
inducting dada It vents _ _ 17.40
including ducts&vents 1.170 3) Floor Furnace _
(loos furnace - Including vent 14.00
i) Suspended heater,wall healer
including vent 955 or floor mounted healer -p 14.00
suspended heater,w-11 heater 5) vent not Inctuded In. fiance at it 680
or floor mounted heater _ 955 6) Repair units 1215
Check UI that apply 'Boiler Heat Air
Vent not included in appliance permit 445 For Items 7.10,see or Pump Cond Oly Price Total
Repair units _ 805 footnote%1,2 7)< corn
3Hf`,absorb unit to
<3 hp;absorb.unit LOOK BTU 14.00
8)3.15 HP,aboib unit
to 100k BTU 955 look to 500k BTU 25.60
3-15 hp;absorb.unit 9115.30 HP;absorb
unn.5.1 mll BTU 35.00
101k to 500k_BT_U__ 17x)0 10)30-50 HP.absorb -
-- unn 1.1 75 mil BTU 52.20
15-30 hp;absorb.unit 11)i501 It',absorb unit>1,15 mil BTU '
501k to 1 mil.BTU 231007.2°
12)Air handling unit to 10,000 CFM
30-50 hp;absorb.unit ---- 10.00
13)Air handling unit 10,000 CFMr
1.1.75 Frill.BTU 3400 17.20
>50 hp;absorb.unit 14)Non-pndal,N•evaporate cooler _..�- 10.00
>1.75 mil.BTU 5725 16)vent Ian connected to a single dud 6.80
Air handling unit to 10,000 cfm _ 656 8)Ventilation system not included In
appliance perm" _ 1000
Air handling unit> 10,000 cfm 1170 17)Hood served by mechanical exhaust _
Non-portable portable evap orate roller 656 -- 10.00
te)Domestic Mclneralois
vent fan connected to a single duct 446 17.40
19)Commercial or industrial type incinerator
Vent syst.not Included In appliance permit 656 - 69.95
Hood served by mechanical exhaust 656 20)Other units,Including wood stoves v 1000
Domestic Incinerator 1170 21)Gas piping one to lour outlets 5.40
Commercial or industral Incinerator 459n 22) ere than aper outlet(each)
1.00
Other unit,including wood stoves,inserts,etc. 656 Minimum Permit Fee$72.60 SUBTOTAL
Cas piping 14 outlets 360 a%suRcHAnGL
Each additional outlet 63 PLAN REVIEW 25%Or SUBTOTAL
Required for ALL commercial permits only
TOTAL
Olhlu
ar OnspectWne and rear
t inspections oultide or normal business tour(minererm du,ae_tao hours)
172 50 per hour
7 hlspedions kN wtwh no Ice n spenr"ov ow"ied(rnininxlnl dlame hes poi a)
172 Ile per hax
Total yaluali0it -� -- _Ecc `. 3 �.dad.uiraniaar uN,nain,chupnsadditwtinarvownsIcl"m -Offs-
- _ ch*W,nabs#hair)s72 So pa hae
•Stale contractor boiler eartirkaton tequxed
S 1.00 to$5,000.00 Minimum$72.50 ••nesfdordlal Ax reeuees$ae pian slinwinp Wacernnnl or unn
$5,001.00 to$10,000.00 u $72.50 for the first$5,000.00 and S 1.52 for
each additional S 100.00 or fraction thereof,
to and including 510,000.00
$10,001.00 to 525,000.00 �v S148.50 for the first 510,000.00 and$1.54
for cacti additional$100.00 or fraction
thereof,to and including$25,000.00
525,001.00 to$50,000.00 .$379.50 for the first$25,000.00 and$1.45
for each additional$100.00 or fraction
thereof,to and including$50,000.00
$50,000.00 and tip' $742.00 for the first$50,000.00 and$1.20
for each additional 5100.00 or fraction
thereof
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639-4175
MST —_— —_
INSPECTION DIVISION Business Line: (503) 639-4171
// BUP _-- --__-�
Received _____ ---_______ .- Date Requested�_g_-1. —_ _ AM___� PM _ -- BUP
1 —x.5.1! -e��
Location � (off) L<.J Suite_—. MLC
Contact Person Ph(_ ) a S � > __ PLM
Contractor _-- �_-- Ph (_...___--) -_-- - SWR
BUILDING Tenant/Owner ---Tenant/Owner -_ _- ___ ELC ----
Footing ELC
Foundation Access: 7 '
Fig Drain Ly�2/17 ELR --- ----
Crawl Drain _.
Slab Inspec & N .s
ot : SIT _ --- --- -- _--
Post R Beam
Shear Anchors
Ext Sheath/Shear
------------ ----------
Int Sheath/Shear
Framing - - -- - - --- ------- - - ---
Insulation
Drywall Nailing
Firewall
Fire Sprinkler - - --- -- -
Fire Alarm
Susp'd Ceiling --- -- - ------ - -_ --- _ ----— ---
Roof
Other. _ ----- ---
Final
PASS PART FAIT_
LUMBING
Post A Beam
Under Slab
Rough-In
Water Service — ---— -- -----
Sanitary Sewer
Rain Drains --- - ---- ---- —
Catch Basin/Manhole
Storm Drain - ------ --- -- —
ShowerPan
Other:--
Final
ther.__Final
ART FAIL
ECHANI
- - am _—
Rough-In ------ --— — _.
Gas Line
Smoke Dampers --- - ------ — ---- --
i=nlTit-�,
_PASS PART FAIL — - - - -- --- — — -- --- --
RICAL
Service --____-- — -
Rough-In ----
UG/Slab
Low Voltage - -
Fire Alarm
Final Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE [j Please call for reinspection RE -_- _ _-___-__.. Unable to inspect -no access
Fire Supply Line
ADA rn�
Dale _� — _. Inspector L_. j� Ext—
Approach/Sidewalk -
Other
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL