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CITY OF TeGARD — MECHANICAL PERMIT
V PERMIT #: MEC2001-00352
DEVELOPMENT SERVICES DATE-I,.,UED: 10/9/01
13125 SI - ,iall Blvd., Tigard, OR 97223 (503) 639-4171 PA',.CEL: 2S112CB-14400
SITE ADDRESS: 14943 SW KEN-i 7N DR
SUt3DIVIS"1N: ASHFORD OAKS NO. "'. ZONING: R 7
BLOCK: LOT: 153 JURISDICTION. TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R:3 VENTS W/O APDL: VENT SYSTEMS:
STORIES: BOIL-ERS/COMPRESSORS HOODS:
FUELTYPES_ _ 0 3 HP: DOMES, INCIN:
LPG _ 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 B','U: _ _AIR HANDLING UNITS--- 01 HER UNITS:
FURN >-100K BTU: <= 10000 cfm: J GAS OUTLETS:
> 10000 cfm:
Remarks: Installation of gas fireplace insert with (1)P-jtl3t.
Owner: _ __� '—_ -_FEES
HALDEMAN, MARK,JENNA 'type By Date Amount Receipr
14943 J KENTON r)R, ^RMT CTR 10/9/01 $72.50 2720010000
TIGARD, OR 97224 5PCT CTR 10/9/011 $5.80 272001000')
I.� Total $78.30
Phone:50.1-968-1)788
Contractor: _
HEAVENLY HEA1 DBA P. SHAMBERG
PO BOX CAA
DONALD, OR 97020 REGIUIRED INSPECTIONS
Mechanical Insp
Phone:503-678-3089 Final Inspection
Reg #:LIC 147952
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work w0l be done in accordance with approved
plans. This permit will expire if work is not started viithin 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR
952-DO1-0080. You may obtain copies of these rutas or direct questions to OUNC by calling
(,n'A)9dP,-Q1 Rcl
Issue i1 / j f. i /, __ Permittee Signature: L 4 '( moi i 7 _
Call(503) 6:6-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit 4plication
Gate received: , l C Pernutno.: _ Z
City of Tigard - (' ' Project/appl.no.:
C!
Expire date:
Address: 13 125 S W Hall Blvd.Tigard,OR 1W.1 t
Cirvu/Tignrd B Date issued: By: Receipt no,:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: _ Nuildinft permit no.:
;,b
2 family dwelling or accessory U Commercial/industrial U Multi-farnily J I enarn improvement
v;construction Add ition/alterat.ondreplacement U Other: _
! VALUATION
dress: 3 y � O t� Indicate equipment quantities in boxes hrl,nv. Indicate the dollar
no.: Sui,.c no.: value of all mech1a,qi,ca^l materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit.Value$
la►t: Blfxk: Subdivision: ^� _ *See checklist for important application inlbrmation and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: 7,1P: C� 2
Description and location of work on premises: ! t
t✓ lilt_ Gi4s l-Utt y5A21 _t tr(ea.) total
Est.date of complelion/inspeclion: 7Arhandlingg,
•x•riplinn _— (lily. Res.only RM.only
Tenant improvement or change of use:
Is existing space heated or co ditioned7( Yes UNo ('FM_-_
Aircon itioning(site plat required)
IsexUNo Alteration ofexisting
HVAC system _
n er compressors
Business name: State boiler permit no.:
_ �1ti+t vl __ HP Tons BTU/H
Address. _ �ir smo c damper,,Jductsmokedetectors
City: j jt�,�L tI Starr.: ' zlh'_y [,C., ieat pump(site�an require )
Phone: G(P (D�t� fax: E-mail: nsta rep ncc u� rnace>�rner I
_FCB
ductwork/vent liner U Yes U No
CCB no.: I9_+95 Z nstall/replace/re ocate heaters-suspended,
City/metro lic.no.: —_^ wall,or floor mounted -_
Name(please print): - j l �,,,i; Veno 1,11 app iance of ier rhaf urnace
! Retrigerat of tt:
PFRsoN
Absorption units____ BTUs
Name: c'Idllrrs____,_ __. HP
Address:
-- — Com ressors HP
----IT(
- nv ronmenla exhaust an ventilation:
City: S(ate: ZIP: Appliance vent
Phone: I ir.;nl )rycrcxTiauet ----
0o s,"ype III /res. .itc Ie7 n/Tmat
hood fire suppression system
Name: (4' IL- fNw iN�.0 U.i Exhaust fan with single duct(hath fans) -
x aust s stem apartfmm�eatin or C
Mailing address: �� J .�(,(. L�v'Z�ry tie piping en .t-Ti�-riTiutlon'•ip to outlets)
City: {�� ,, 4 - State: (i'k ZIP: C
r u./_ _-_ 'IN pc LIKI -- IM __ Oil
Phone:r L' , ,5 u I ,i E-mail: furl-n nn 1 e.ch all-J11-10nal over 4 outlets —
process pping(sc ernaticrequirc )
Numherof outlets
Name: 1 er-il+teaipp ince or equ pment:
Address: _ Decorative fireplace
City: Stnte: ZIP: Merl-type
Phone: ax: mail: J WoodMove/pellet stove _
(ri ter:
Applicant's signature:, i / rite: 1 er:
Name (pri:tt): I V1b�IG ►Z r '{IaW,L
Notan jurisdictions nccept credit cants,piece tall Jurisdiction frit mon•inftvmation Permit fee.....................$
U visa U MasterCard Notice:Phis permit application Minimum fee................$
,•spires if a permit is not obtained plan review(al , 96) $ — 4
Credit card number _�_____ _ ___ __� L__- ss ithin ISO days eller it has txcn
tixpirex Y State surcharge(8%)....$
Name of car older as shown on credit car `- accepted as complete. TOTAL . '
C hdder si�nattue nmouut
.r.�. 4411-4817 IBArf)/C Y)Ail,
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
------------ -
--�.-- - ---- Price Total
TOTAL VALUATION: PERMITFEE: Description:
$1.00 to$5,000.00 -� Minimum_,je$72.50 Table 1A Mechanical Code Oty (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 InJuding ducts&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$10,000.00 and 3) Floor Furnace
14.00
$1.54 for each additional$100.00 or Includln vent
fraction thereof,to and Including 4) Suspended heater,wall heater
$25,000.00. or Floor mounted heater 14.00
$25,001.00 lu$50,000.00 $379.50'or 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: Boller Heat Air
$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: $ to 100K absorb unit
to 0UK BTU 14.00
8•/.State Surcharge 8)3-15 HP;absorb 25.80
$ unit 100k to 500k BTU
25%Plan Revlew'Fee(of subtotal) $ 9)15-30 HP;absorb 35.00
Required for ALL commercial ermits onl unit.5- mil BTU _
---�-- �-- 10)30-50 HP;absorb
TOTAL COMMERCIAL PERMIT FEE: $ ^� unit 1-1.75 mil BTU 52.20
11)>50HP;absorb
- - 67.20
unit>1.75 mil BTU
ASSUMED VALUATIONS PER APPLIANCE: 121 Air handling unit to 10,000 CFM 10.00
-� Value Total 13)Air handling unit 10,000 CFM+
Description: _ Q!y 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 95516)Ventilation system not included in
Suspended heater,wall healer or 955 appliance permit 10.00
floor mounted heater 17)Hood served by mechanical exhaust
Vent not Included in applicance 445 10.00
ermit 805 18)Domestic Incinerators
Repair units _ _. _ 17.4n
<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 tour outlets
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 mll.BTU _-
Air handlIno unit to 10,000 cfrn 656 8Y.State Surcharge
Air handling unit>10,000 cfm 1 176 _
Nonn_portable eva orate cooler 658 TOTAL RESIDENTIAL PERMIT FEE: S
Vent fan connected to a single duct 446
Vent system not Included in 656 -
appliance_��i� - other Inspections and iso
Hood served by mechanical exhaust 656 _ t Inspections.outside of normal business hours(minimum charge-two hours)
Domestic inclnerator 1,170 ____ $72 50 per hour
Commercial or industrial Incinerator 4,590 2 inspections for which no fee Is speci;irally indicated (minimum charge-half hour)
Other unit,including wood stoves, 856 $r2 50 per hour
Inserts etc. 3 Additional plan review required by changes,additions or revisions to plans(minunum
_ charge-ono-half hour)$72 50 per hour
Gas piping 1-4 outlets 360
Each additional outlet 83 "State Contractor Boiler Certification required for units>200k BTU.
_ - ".Resldential A/C requires site plan showing placement of unit.
TOTAL COMMERCIAL :
VALUATION: _ All New Commercial Buildings►equi a 2 sets of plans.
I:\dsts\formsvnech-fees.doc 08129/01
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line- 639-4171 -���-
BUP
Date Requested AM PM BLD
-
Location � — Suite MEC
D C/ CG
Contact Person _ � Ph /T S-,`� `� ._ PLM
Contractor Ph SWR _
BUILDING Tenant/Owner ELC _
Retaining Wall i ELR _
Footing Access: �w
FoundationFPS
Ftg Drain �� L _ __.._
(trawl Drain inspection Notes: S';N
Slab -�.= --- -- -- -- -- SIT
Post&Beam
Ext Sheath/Sheaf/
Int Sheath/Shear
g I -----— r Ir v f f' C. 1
Framing i �' � '
Insulation
Drywall Nailing ?
Firewall
Fire Sprinkler ..
Fire Alarm
Susp'd Ceiling -
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post& Beam --- -- - -- --
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL.
MECHANIICAI
Post& Beam --
Rough In
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL - - -----
Service - — —— —
Rough In
UG/Slab _
Low Voltage
Fire Alarm
Final
PASS PhRT FAIL
SITE
Backfill/Grading
Soniter; Sewer
Storm Drain [ J Reinspection fee of$ required before next inspection. Pay,at City Hall, 13125 SW Hall Blvd
Catch Basin [ )Please call for reinspection RE [ )Unable to Inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date /61—//— `►� Inspector Ext
Other
Final
PASS -PAR,r,- FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 63! 175 Business Line: 09-4,
BUP
_Date Requested �U I/L I L1� -----AM- ---PIVI BLD --- ----- -
Location_ fit/ /�-CN rC +<� i-- Suite, EC 1 -_� �1
Contact Person Ph PLM
Contractor Ph — _ _ SWR
BUILDING Tenant/C;wner ELC
Retaining Wall ELR
Footing
Access:
Foundation FPS
Fig Drain SCN -----------
,yawl yarn Inspection Notes:
Slab _— _ SIT
Post& Beam - -- - ---
Ext Sheath/Shear _
Int Sheath/Shear
Framing _ r
Insulation ✓1 �� /
Drywall Nailing _--
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling _
Roof
Misc: -
Final
PASS PART FAIL - ----- --- -- /
PLUMBING
Post&Beam -- - _-_
Under Slab
Top Ot.t - - -
Water Service.
Sanitary Sewer - �—
Rain nrains
Final - - T-
PA,S.S- FAIL - — --
�' ANICA
Ko n
gas --- -- - _ --
Smoke Dampers
0 KS
PART FAIL
ELECTRICAL --
Service
Rough In --
UG/Slab
------------------------- ---
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Back-,ill/Grading -
0aratary Sewer
Storm Drain [ J Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ J Please call for reinspection RE: [ J Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Date 2 Inspector Ext
Other _ --
Final
PASS PART FAIL 00 NOT REMOVE this inspection record from the job site.