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15870 5W ROYALTY PKWY
CITY OF T I G A R D MECHANICAL PERMIT
DEVEL DPI.,ENT SERVICES PERMIT#: MEC2003-00231
13125 SW H.• Livd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/6/03
PARCEL: 2S1 1 OCC-00100
SITE ADDRESS: 15870 SW ROYALTY PKWY
SUBDIVISION: KING CITY NO 3 ZONING:
BLOCK: LOT: 010 JURISDICTION: KIN
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:
STORIES: BOILERS/COMPRESSORS HOODS:
FUEL TYPES 0 3 HP: 1 J DOMES. INCIN:
3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
CLO DRRYERYERS
FURN < 100K BTU: 1 __AIR HANDLING UNITS CS:
OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace furnace and AC. AC cannot he placed in the required setbacks
Owner: FEES
COOPER, FAYE E Description Date Amount
15870 SW ROYALTY PKWY IMLCIIJ permit Fec 5/6/03 $72.50
KING CITY, OR 97224 IAte81%State'rax 516/03 $5.80
Phone: Total $78.30
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone: 692-1565 Heating Unt Insp
Cooling Unt Insp
Reg #: LIC 5193 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR
952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246-66
Issued By. �_. t Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Date received: Pernut no..
City Of Tigard Project/appl.no.: Expire date: -
CiryofTigard Address: 13125 SW Nall Blvd,Tigard,OR 97223
Date issued: By: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case rile no.: Payment type:
Land use approval: _ _ Building permit no.:
U I &2 family dwelling or accessory U Commercial/Industrial U Multi-family U1'enant improvement
U New construction )E�6ddition/alteration/replacenlent U Other:
Job address: Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit.Value$
Lot: Block: Subdivision: _ "See checklist for important application information and
Project name: iL: � '; jurisdiction's fee schedule for residential permit fee.
City/county ZIP: _ z _ I & 21 %NI IIA' DWELLING III 101y FEE SCIIED1111
De cription and locatio of work on premises: 4t t
A is Com_ Fcr(ea.) I otal
Est.date of completion/inspection: __ __ Dewription tr). Res.oIII Res.oul}II
Tenant improvement or change of use:
An h:ulJlwg unit —CIT1
Is existing space heated or conditioned?U Yes U No - -- -
Air conditioning(site plan required)wl
Is w
iing space insulated' U Yes U No tcration of existing C system
Boi cr compressors
� ,�, ( ,<rt State boiler permit no.:
Business name:
HP Tons BTU/li
A d d rcs s C7.1,-(? �), FireAmo c dampers/duct smoke detectors
City: POAl IATIS(ate•- )Q ZI eat pumpA (site p an requrre )
Pltotte(�d t�-( Fa /I-K -X- E-mail. nsia 1/rep ace urnace urner
- Including ductwork/vent liner U Yes U No
CCB no.: nsta rep ace relocate heaters-suspended.
City/metro lic.no.: ' wall,or floor mounted
Nae( lease Vent orappliance ocr than furnace
Refrigeration:
mprint):
Absorptionunils _ BTU/11
Name: Chillers - NP
Address: ? �`, L Cnnp,ressors ._ -- 111'
:nv ronmenta exhaust an ventilation:
City: -L,, -'1 State: IP. Z Appliance vent
Phone . l Fax E-mail: )ryerex
00 s, ypc res. itc c azmat
hood fire suppression system
Name: ) 7. �? Exhaust fan with single duct(bath fans)
x aunt s stem apart from heating or AC
Mailing address: 7 14), ti �ti -
Cit t " State ��� ZIP: )Z� Fuelp p ng�ndistribution(up to outlets)
Y: - Typc: a_1_11G —_ N(. Oil
Phonc. , 1 1" Fax: F. mail: uc pi,in car t additional crvcr outlets
Process piping(schematicrequired)
Number of outlets _
Name:_ 4 _—r _ ter Red appliance or equ ptin
Addtrss: Decorative fireplace
City: Statc: — Z;VInsert-type
stove
Phc,ne: Fox: ---- —
I: nulil:
_ (Xher:
Applicant's signature:' �,_.- Date,c other _
Name(print): )L,L,
Not all jurisdictions scrept credit cards,please call Jurisdiction Gx mac Infomatiat. Permit fee ...............$
Notice:this permit application Minimum feeee................
$
U Visa U MasterCard expires if a permit is not obtained
Credit rad number: —__-- .___ -- days F> rest within I80 dafter it hes been Plan review tat — %)
tech days tete. State surcharge(8%) ....$
. .i I d older u shown on credit card ecce S P P
TOTAL .......................$
—" Ctttdhdtkr slysattue
Amount! 4404617(61011COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: Price Total
$1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,OCO BTU ,}
$1.52 for each additional$100.00 or! including ducts&vents L- 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
$1.54 for each additional$100.00 or including vent 14.00
fraction thereof,to and including 4) Suspended heater,wall 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
$50000.00. 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 Coor mp Pump Cond
_ fraction thereof. footnotes below.
Minimum Permit Fee$72.50 SUBTOTAL: a to 1 100K 7) 00K absorb unit
BTU 14.00
-- - --- - 8)3-15 HP;absorb
8%State Surcharge $ unit 100k to 500k BTU 25.60
25%Plan Review Fee(of subtotal) 9)15 HP;absorb
a unit.5--11 mil BTU 35.00
Required for ALL com_merciai ermit only 10)30-50 HP;absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.20
absorb
BTU _ 8720
ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM 10.00
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
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 955 - 16)Ventilation system not Included in
Suspended heater,wall heater or 955 appliance permit 10.00
oor mounted heater -. - 17)Hood served by mechanical exhaust
ent not Included in applicance 445 10.00
permit805 - 18)Domestic Incinerators 17.a0
Repair units -
<3 hp;absorb.unit, 955 19)Commercial or Industrial type Incinerator 69.95
to 100k BTU _�-.
3-15 tip;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 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 mil.BTU _
Air handlingunit to 10,000 cfm 656 8%State Surcharge $
Air handling unit>10,000 cfm_ 1,170
Non-portable evaporate cooler 656 - TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not Included in 656
a pflanCe emlll Other Ins ectlons and Fees:
Hood served by mechanical exhaust 656 1 Inspections outside of normal business fours(minimum charge-two hours)
Domestic Incinerator1,170 $62 50 per hour
Commercial or Industrial Incinerator 4,590 2 Inspections for which no fee is specifically indicated (minimum charge-half 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 I In 1-4 outlets 380 charge-one-half hour)$82 50 per hour
Each additional outlet 83 'St. Contractor Boller Certification required for units>200k BTU.
'Residential A/C requires site plan showing placement of unit.
TOTAL COMMERCIAL $
VALUATION: All New Commercial Buildings require 2 sets of plans.
1:\dsts\forms\mech fees.doc 12126101
SEE 35MM
ROLL # 20
FOR
OVERSIZED
DOCUMEN11 T
05/06/2003 09:47 5036393771 CITY OF KING CITY PAGE 02
Mechanical Permit Application
---�• Datcrccrived:�� v-C 3 Ptnnitno.: �.
City of Tigard Proleet/appl.no. Bspimdate;
Cirl,ofDRarrl Address: 13125 SW Hall Illvd,Tigard,OR 97223
Thune: (503) 639.4171 Date issued:
A;,: Recelptno.:
Frnx: (503)598-1960 Case file no.: Prymenttype:
Land use approval:
Building permit no.:
_..___ ____ ._._�a�=_� — .
U I &2 family dweliing or accessory U Cummercial/iudustnvrl U Multi lustily I TCriunt nillmwerrtcnt
U Nc%v construction ; kdditiort/alteradon/replacement U Other.
INFORMATION t
lob address: Indicate equipment quantities in bot es below.Indicate the dollar
Bid$.no.: Suite no.: value of all mechanical matettials,ei uipmertt,labor,overhead,
Tart tna tart lot/amount no.: profit.Valu-S _
LAW Block: Subdivision: 'See checklist for important applia+tion information and
F`mejeot natal — -- e-- jurisdiction's fee schedule for resid ntial permit fee.
City/t:ounty — - ZIP_
N. ctiption ttrtrl loeatlo of work nn prrmisea 4EW1 .. Q
s
AC1R.-C.6�1'.1•DI'11 rel-�"�? t�rclea.) fatal
Fit.date of_rnmpletion/inspection: - ._- __IselATihinrt- t Hm.nniv Itn.onl
Tenant improvement or rhange of use: I
13 existing space.heated or conditioned?U Yes U Nu Air handling unit (FM
_ neon iuomng sltepinni —
IS existing space insulated?U Yes U Nn Alt-astionof existing HVAU system
At el compraquril
$u8iftefiGnarric:.6g, StAte holler permit no.:
lip Tons B111lt1
Address: - Fuelamo RMPONduetsmo o etectun
c'i State 71F: eat um (site p an utred)
Phone Fn _ { firmall: nate rep acefurnac wrner._._ �
-- Including ductworklvent liner U Yes t.t No
('C$no.: nits rep)ac rflocateheatera-auspet
aw—
City/metm tic.no.: `�( - wall,ar floor mounted
Name(plcaoe riot): cnt nr a, fiance o er an futtiace
r �rnt or:
Absorption units III CAI
NamChillers_ --, Hl
ComAddressl -An—� my ssrna t4
roomeetn ezhausl�� ieatil V m:
Pity: - 1 State: . Al hancevent ---�- -
1'honi Fax: >smail: nryeret tausi -- -
�€le s, TI111rea kitcTir�6ZinAt. ...__
� hc�d fire suppresslott systrm -
Name. \ 1 _ tixhaunt fan with sin le duct(Imth fano,i -
Mailing address: t,--�')0 l.J tz roust 6 au rn a ntt nom heating or,C --
aeil h p nP as �lstr pt.rn lip l0 4 wt ets
City: � � Ste ZIP: fv _ LPG NO ,.011
F-mail: a inn c+icTnT3unnalovei7vu IFla a If ts- _
n'es.p p nt ischcti+ArT iequ�rc )—
Name: Number of nuticra
---_- . -- __ er lit —ppUam •nr� pmeot:
Addmen Uecorauvefir leer
City: tBle: Z1I': Insert-typo
Phone: - I? l^r Woodstavelpoiet stove
Applicant's signature:' Dace:C � 0WOM
--
�+a an frtadiodm re.q,cxdr cans,rk.r r>fl j+Mrdtctlm for eau!tohtmrdoe Penwt fee. ...... ...........$
U Vista O MacruCant Notice:'chis permit applioetion Minimum fl e_..............$ Z S
ith
Oral and aambw - wMiva permit
if a is not obtained 96)
win 190 days atter it has ban flan mview(at $
State sumht rge(11%)....Z O
— $ a Rionw actgrted ea complete. TOTAL... ........
..u-4E.....S�
1:
CITY OF TIGARC 24-Hour
BUiLDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503) 639-4171
-//,R- /d 3 BLIP - —
Received --_._ Date Requested AM — PM BUP
Location _. -_ � �� g 7,Q Pk-c-)�t Suite_- MEC,,-
Contact
EC:.Contact Person __ __— Ph( _) -__ - PLM
Contractor -___- --_ _ Ph( ) SWR -
BUILDING Tenant/Owner ._- - ELC -
Footing -' O5725 7 ELC
Foundation Access:
Ftg Drain ELR —_-_
Crawl Drain
Slab Inspection Notes: ( - SIT -_
Post&Beam - - ""`, � Lam¢_Z_ _
Shear Anchorsve
Ext Sheath/Shear - --
Int Sheath/Shear y / ���uG �� c/i�•�
FramingC_,.�i1F� L__/r•� ••� �.:lb � /7 Z i iii
Insulation
Drywall Nailing -�
Firewall
Fire Sprinkler - - -
Fire Alarm _
Susp'd Ceiling
Roof
Other. - --- -
Final _
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 -- - - --- --- ------- ---_—
Post �i_
Rough-In - -!
Gas Line
Sr Dampers(Ii
AS ' PART FAIL
E MCTRICAL
—_ -
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 [] Please call for reinspection RE: Unable to inspect-no access
Fire Supply Line
ADA Date '7- Z `� - Inspector — Ext_
Approach/Sidewalk
Other
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL