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15645 SW Old Orchard Pace
CITYO F 1 G"p R D MECHANICAL PERMIT
DEVELOPMENT ,ERVICES PERMIT#: ME02002-00219
13125 SW Hall Blvd., Tigard, OR 97223 (533) 639-4171 DATE ISSUED: 5/28/02
PARCEL: 2511 ODD-04500
SITE ADDRESS: 15645 SW OLD ORCHARD PL
SUBDIVISION: SUMMERFIELD NO.3 Z,I, ING: R-7
BLOCK: LOT: 14; .JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O ADPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS-
FUEL TYPC'S 0 - 3 HP: DOMES. INCIN:
3 15 HP- COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLQ DRYEP5:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UN TS:
FURN >=100K BTU: ^<= 10UJ0 cfm: p� GAS OU i LI
> 10000 cfm
Remarks: Replace gas furnace
Owner:
MOORE, BUD R WYNEMA N Type By Date _ Amount Receipt +
15645 SW OLD ORCHARD PL PRMT CTR 5/28/02 $72.50 272002000C
TIGARD, OR 9722:; 5PCT CTR 5/28/02 $5.80 272002000C
Phone:503-503-620-1532 ---- Total --_ $.78.30_
Contractor:
COLUMBIA HEATING + COOLING INC
8900 SW BURNHAM
TIGARD, OR 97223 REQUIRED INSPECTIONS
Mechanical Insp
Phone:624.2704 Duct Inspection
Reg #:LIC 76359 Final Inspection
PLM 34-175
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of Ore
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 Hays of issuance, or if wc.rk is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth ;n OAR 9:2-001-0010 through OAR 952-001-0080.
YOU may obtain copies of these piles or direct questions to OUNC by calling (503)246-9189.
Issue By: _ Permittee Signature:_ y 1, _
Call (.503) 639-4175 by 7:00 P.M. for Inspections needed the next business day
Mechanical Permit Application
Datereceivcd: Perm, ; lei
City of rj ig -d Project/appl.no.: Expire date:
CiryofTigard Addrefs: 13125 SW Hall Blvd,Tigard,OR 97223
Date issued: By:
Phone: (503) 639-4171 Receipt no.:
Pax: (503) 598-1960 Case file no.: Payment type.
Land use approval: Building permit no.:
U 1 &2 family dwelling or accessory U Commercial/industrial 1 ".111111 f:unik U Tenant improvement
U New construction ditiort/al terat ion/re placement _ H11-1
SOIED6.11
Job address: `ell, :!4 Indicate equipment quantities in boxes below. Indicate tit,dollar
Bldg.no.: Sale no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit. Value$
Lot: Block: Subdivision: 'See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: ZIP: —4--
Description
Description and licati n of ork on premises: 10 1 Mid 111PRO1 lWal Cl I r
lam, 1t _J _ Fcv(ca.) 'Iota!
Gsl.date of completion/, spection; Desch ion (Jity. Res.only Res.onl
Tenant improvement or change of use: Air handlin unit _ CFM---
Is existing space heated or conditioned?U Yes U No it conditioning(site p an regture )
Is existing space insulal-d'"..J U N( terairon of existing HVAC system
o er compressors —
: State boiler permit no.:
Business narne
} r- — r.--ZZ <`� _ HP Toms BT(.NH
Address: i' ao— - fire/smoke dam uci smo a detectors
City: State: C IP: r 2 Reat pump(site plan required).
Phone: ' Fax:'" Email:
Install/replace urnac urner ��. BTU/Il
r Including duetwork/vent liner U Ye. No
CCB no.: Instalrep ace re ocate heaters-suspended,
City/metro He no.: wall,or floor mounted _ —
Nami (please tint): i ent for appliance a er than furnace
e gems on:
Absorption units . BTU/111
HP
Name:
Address: Com ressors HP
a tall exhaust and vent at on:
City: Stale: ZIP: Appliance vent
Phonc: )c Fax: E-mail: hyercx aunt
Hoods,Type res, nc c hazmat
hood fire suppression system
Exhaust fan with single duct(bath fans)
Mailing address: f �/�G� r�/ a Xhausl system art torn heatingor
AC
Cit : State:a ZIP:
ue- p ping andistribution(up to outlets)
Y / _ —__ Type: . _ I.P(3 NG Oil
Phone: fax -Tmnil: nuc , ,n eaT( nal over 4 outlets
HOW rocesspiping(schematicrequired)
Number of outlets
Name: ter listed appliance or equipment:
Address: Decorative fireplace
City: State: ZIP: Insert-type
Phone: Fax: E-mail: oo stove pe et stove
Other:
Applicant's signatur Date:
Name(print):
E2!t-
Permit fee
Na n dl Jurisdictions accept credit card.,pier esu)urtrdic r�rot mac tnformmfion. fee
...............S
O Visa V MaarerCud Notice:This permit application Minimum fee............. ..a ,_ •
expires if a permit is not obtained Plan review(at %) $ -J ---
Credit card number: —4—pr-L.— within 180 days after it has been
iState surcharge(8%) ....s
TOTAL .......................ENamed�ldereua ownon cdit card ec pted as complete. -7
tS _ in
—� Cardboldet siptature i_ Araotail 440-4511(6t001170M)
MECHANKCAL PERMIT FEES
COMMERCIAL FEI: SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE-
Price Total
TOTAL VALUATION: PERMIT FEE: Table 1A Mechanical Code Qty (Ea) Amt
S1 00 to$5,000.00 Minimum fee$72.50 1) Furnace to 100,000 BTU
$5,1)01.00 to$10,('J0.00 572.50 for the first 55,000.00 and includin ducts&vents 14.00
$1.52 for each additional$100.00 or 2) Furnace 100,000 BTU+
fraction thereof,to and Including
$10000-00. includina ducts&vents 17.40
- -- -.
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace
Inc'uding vent 14.00
$1.54 for each additional$100.00 or 4) Suspended heater,wall heater
fraction thereof,to and including
$25 000.00. or floor mounted heater 14.00
-
525,001.00 to$50,000.00 $379.50 far the first$25,000.00 and 5, Vent not included in appliance permit q 80
$1.45 for each additional$100.00 or -
fraction thereof,to and Including 6) Repair units 1?1F
_ $50,000.00. - -
$50,001.00 2nd u0 $742.00 for the first 550, A
000.00 and CheGc all that apply: Boner H'>'' ir
$1 20
thereof_ footnotes below.20 for each additional$100.00 or For Items 7-11,see
fracor ump Gond
romp
_ 7)<3HP;absorb unit 14.00
Minimum Permit Fee$72.5U SUBTOTAL: to 100K BTU -
8)3-15 HP;absorb 25.60
8%State Surcharge $ unit 100k to 500k BTU --
_ 9)15-30 HP;absorb 35.00
--� 25%Plan Review Fee(of subtotal) S unit.5-1 mil BTU ---
Re uired for ALL commercial permits on�r ��. 10)30-50 HP;absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU _ 52'20
11)>50HP;absorb 81.20
unit>1.75 mil _ -
12)Air handling unit to 10,000 CFM 10.00
AgSUMED VALUATIONS PER APPLIANCE:
Value Total 13)Air handling unit 10,000 CFM+
Description: Qt (Ea) Amount 17.20
Fumace to 100,000 BTU,including 955 14)Non-portable evaporate cooler
t0.0U
ducts&vents _
Fumace>100,000 BTU Including 1,170 15)Vent fan connected to a single duct
ducts&vents __ ___ Y 8.e0
Floor fufnace Including vent 955 16)Ventilation system not Included In
Suspended heater,wall heater or 955 appliance permit 110.00 -
floor mounted heater17)Hood served by me, ..tical exhaust
Vent not included in epplicance - 445 10 00
permit -- 18)Comestic incinerators
805
Repair units 17.40
<3 hp;absorb.unit, 955 19)Commercial or industrial type Incinerator
to 100k BTU 69.95
3-18 o 500k BTU absorb.unit, 1,700 20)Other units,Including wood stoves
101k tto 10.00
15-30 hp;absorb.unit,501k to 1 2,?10 21)Gas piping one to fou;outlets
5.40
mil.BTU _
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, 5,725Minimum Permit Fee$72.50 SUBTOTAL: $
>1. mil.BTU 658 e'/.State Surcharge 5
Air hahandlln unit to 10,000 cfm _ -
Alr handling unit>10,000 cfm 1,170
Non-portable evaporate 000ler 656 TOTAL RESIDENTIAL PERMIT FEE: 15
Vent fan connected to a single duct 446
656
m --`--'-
'dent systenot Included In ------ -
a Mance permit _ - - 9th r sec Ions and Fees:
Hood served by mechanical exhaust 656 h Inspections outside of normal business hours(minimum charge-two hours)
_Domestic Incinerator _ 11,170
$et 50 per hour
Commercial or industrial incinerator 4 590 _ 2 Inspections for which no fee is specifically Indicated (minimum charge-half pour)
Other unit,Including wood stoves, 65e $e2.5o par hour
3 Additional plan review required by changes.additions or rev! ons to plans(minimum
Inserts etc. _ - chargeone-half hour)$82.50 per hour
Gas Piping 14 outlets 300_ -
Each additional outlet 83 'State Contractor Boller Certification required for unit}.>200k BTU.
*'Residentt_d IVC requires cite pra r showing placement of unit.
TOTAL COMMERCIAL I S
All New Commercial Bur:dir qs require 2 oats of plans.
VALUATION:
i:\dsts\forrns\rnech-fees.doc 12/26/01
CITY OF TI(,ARD 24-Hour
BUILDING Inspection Line: (573) 639-4175 MST
INSPECTION DIVISION Business Line: (503) 639-4171 BLIP
Received _ Date Req t '_- 4�ll AM__4�_P _ BLIP --- _ __--
Location .___
Suite MEC
Contact Person — –11 Ph -70 PLM
Contractor Ph( -) SWR -- —
BUILDING Tenant/Owner ELC
Footing ELC _
Foundation Access:
Fig Drain F_LR ---__--
Crawl Drain SIT
Slab Inspection Note::
Post& Beam --
Shear Anchors
Ext Sheath/Shear -
IntSheath/Shear
Framing > I���aL n1o,G 2757rF
--
Insulation z z.S78
Drywall Nailing
Firewall
Fire Sprinkler - - --
Fire Alarm
SuF:p'd Ceilins - — —
Roof
nth er: _.-
Fi,ial _
PASS PART FAIL
PLUMBING ---- _— -
Post&Beam
Under Slab --
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
ECHANICAL-�
Pos
Rough-In
Gas Line
Smoke Dampers - ---
n _
PASS PART FAIL -
ICAL
Service
Rough-in —
UG/Slab
Low Voltage
Fire Alarm
Final CI Reinspection fee of$__. ___--_required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
PASS PART FAIL Please call for reinspection RE: Unable to inspect-no access
-SITE [� —__ ---
t-ire Supply Line
ADA Ds Ext-
Approach/Sidewalk -
Other:_—
Final U® NOT REMOVE th8s Inspection record from the Joh si"e,
PASS PANT FAIL