11090 SW 95TH AVENUE U
11090 SW 95"' Avenue
CITY OF T'iG.�R® , MECHANIC: '_ PERMIT
PERMIT#: MEC2003-00038
DEVELOPMENT SERVICES DATE ISSUED: 213103
13125 SW Hall Blvd., Tigard, OR 97223 (5031639-4171 PARCEL: 1S135DB-10500
SITE ADDRESS: 11090 SW 95TH AVE ZONING: R-4.5
SUBDIVISION: ASHBROOK FARM JURISDICTION: TIG
BLOCK: LOT: 022
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
BOILERSICOMPRESSORS---
HOODS:
STORIES: -
FUEL TYPES 0 3 HP: DOMES. INCIN:
3 15 HP: COMML INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HF: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 ----AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: s GAS OUTLETS: 2
> 10000 cim..
Remarks: F;,ti.•via.a.e,
c� FEES
Owner:
GOMSTOCK, JOSEPH R Description Date _ Amount
11090 SW 95TH AVE 2/3103 $72.50
TIGARD, OR 97223 I;�\� ; „ i;,i� la, 213/03 $5.80
Total $78.30
Phone:
Contractor:
OWNER
REQUIRED INSPECTIONS
Gas Line Insp
Phone: Mechanical Insp
Reg#: 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 wo,K will be done in accordance with approved plans. This permit will expire if work is
r more than 180 days. ATTENTION: Oregon law
not started within follow rules adopted iys of n the Oregon, or if work Utility Notificatoion Center Those es are set forth i OAR 952-001 00
requires you
Issued By:� '��---- __-.
Permittee Signature: Q�% '`��/�G/C f}l'7d 1'V
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
NLY
�� FOR e a
(r:el!aoical Permit Application Received 2 �. me'i" "'I 2
DateB l Permit No. y���`�3
Planning Approval Building
City' of Tigard Datc/B : PermitNo.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: Permit NoPost-Re ..
Phone: 503-639-4171 Fax: 503-598-1960 Date/B :yw land Use
Date/By: Case No.:
Internet: www.ci.tigard.or,us Contact J See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: Suppyrnental Information.
TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST
kAddition/alteratigq��Iacement
ew construction Demolition Mechanical permit fees'are based in the total value of the work
Other: performed. Indicate the value(rounded to the nearest dollar)of all
_ mechanical materials,equipment,labor,overhead and profit.
CATEGORY OF CONSTRUCTION
1 &2-Family dwelling_ Commercial/Industrial value: S Sec Page 2 for Fee Schedule
Accessory Building Multi-Family RESIDENTIAL EQUIPMENT/SYSTEMS FEE*SCHEDULE
Description t Fee ea. Total
Master Builder Other: — lieatin Conlin
JOB SITE INFORMATION and LOCATION Fur,ace-add-on air conditionin ** 14.00 _
Job site address: Sv 5�' vC Gas neat um 14.00
Bld ./A t.#: Duct work 14.00
Suite#:
H dronic hot waters stem 14.00
Project Name: Residential boiler
Cross street/Directions to job Site: (for radiator or hydropic system)_ 14,00
Gr ew�"Z`J Unit heaters(fuel,not electric)
in wall,in-duct,suspended,etc,) 14.00 _
Flue/vent for any of above _ 10,00
---- —� —
Repair units 12.15
Subdivision: _ _ Lot#: Other Fuel AP Ilances -
Tax map/parcel#: _ Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
y y ` Flue vent(water heater/ as fireplace) 10.00
Log lighter as 10.00
-- Wood/Pellet stove 10.00
Wood fireplace/insert __ 10.00
Chimnc /liner/IlucNcnt 10.00
PROPERTY OWNER--�TENANT Other: 10.00
Environmental Exhaust&Ventilation
Name: Range hood/other kitchen equipment I OAO
Address: 1kciro "'_ saw Clothes dryer exhaust 10.00
City/State/Zip:
-Til
�Fwv:
Single duct exhaust
S1 (bathrooms,toilet compartments,Phone: So
APPLICANT CONTACT PERSON utility rooms) 6.80
Name: Attic/crawl space fans IU.00
Other: 10.00
_Address: _ _ Fuel Piping
� — - _ ••(55.40 for lust 4,$1. each additional
City/State/Zi - — --' Furnace,etc.
Phone: x: _ Gas heat pump "
E-mail: Wall/suspended/unit heater ••
CONTRACTOR Water heater ___ _ •' _
Business Name:
Fire lace "
,�.����'�� _ ., -
-- -UTI
Address: eti _
Cil /State/Zip^_J� -_ Clothes dryer(Bas) •'
Phone: — Fax: , _ Other:
Total:
CCB Lic. #: _
-_ — Mechanical Permit Fees*
Authorized �` Subtotal: S
Signature: �- Date: 1 3° "' Minimum Permit Fee$72.50 _S
Plan Review Fee(25%of Permit Fee S
State Surcharge(8%of Permit Fee S 16 , ---
(Please print name) TOTAL PERMIT FEF.
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri-Counly Bulldlna Industry Servlee Board.
180 days after It hal been accepted as complete. ••Site plan required for exterior A/C units.
i NOstsU'ennu Fbrnt-WecPcrmitArp.doc 01103
Mechanical Permit Application -City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee: _
$1.00 to$5,000.00 Minimum fee$72.50
$5,001.00 to$10,000.00 $72.50 for the first 55,00.0 and$1.52
for each additional$100.00 or fraction
thereof,to and including$10,000.00._
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and
$1.54 for each additional$100.00 or
fraction thereof,to and including
125,000.0.
$25,01.0 to$50,00.0 $379.50 for the first$25,00.0 and
$1.45 for each additional$10.0 or
fraction thereof,to and including
$50000,0. _
$50,01.0 and up $742.00 for the first$50,000.00 and
$1.20 for each additional$10.0 or
fraction thereof.
Assumed Valuations Per A Hance:
—�� Value Total
Descri tion: tFa Amount
Furnace to 10,00 BTU,including 955
ducts&vents
Furnace>10,000 BTU including ducts 1,170
&vents
Floor furnace including vent 955
Suspended heater,wall heater or floor 955
mounted heater
Vent not included in appliance en rniit 445
Re air units _ 805
<3 hp;absorb.unit, 955
to 10k BTU
3-15 hp;absorb.unit, 1,700
101k to 500k BTU
15-30 hp;absorb.unit,501 k to I mil. 2,310
BTU
30-50 hp;absorb.unit, 3,40
1-1.75 mil,BTU
>50 hp;absorb.unit. 5,725
>1.75 mil.BTU
Air handlin unit to 10 00 cfm 656
Air handling unit>10,000 cfm 1 170
Non• ortahlc eve rpo atc cooler 656
Vent fen connected to a single duct 446
Vent system not included in appliance 656
rmit
Hood served by mechanical exhaust 656
Domestic incinerator I+170
Commercial or Industrial incinerator 4,590
Other unit,including wood stoves, 656
inserts,etc. _
(las i in 1.4 outlets J60
Poch additional outlet 63
TOTAL COMMERCIAL $
VALUATION: _ -
0Dsts\Pcrmi1 F0rms\Mecl'crmi1AppPg2.doc OII03
CITU' OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST
INSPECTION DIVISION Business Line: (503)639-4171
BUP s_ _
Received Date Requested _ �_—�__ AM__ PM -- BLIP —
Location ! y ` �-� - Suite MEC 42�3'��-�
Contact Person —_— _. Ph(_— ) ,3l 30 7 PLM —
Contractor_ — Ph(_. ) __ SWR
BUILDING Tenant/Owner _____ __ _._ — --�-- - ELC
Footing ELC
Foundation Access:
Ftg Dr iin % �' �a/%� L- f'r1 4 7 ELR -
Crawl Drain
Slab Inspection Notes: SIT _ --
Post&Beam f`��' ✓v �� � l7 �?-Q I'►-�r-s-w 'c<
Shear Anchors C/G
Ext Sheath/Shear G/ -
Int Sheath/Shear
Framing - ------ - -- -— -- - --— -
Insulation
Drywall Nailing
Firewall _
Fire Sprinkler
Fire Alarm
Susp'd Ceiling - - --- -----.__. __
Roof �
Other: -
Final
PASS PART FAIL
_P_LUMBINC3 ---� __ - -- - -
Post&Beam -
Under Slab -- - ---- -- —
Rough-In
Water Service -- - --- - -- --
Sanitary Sewer
Rain Drains _-
Catch Basin/Manhole _
Storm Drain ---- - -
Shower Pan
Other: --- ------__-__ ----
-------
Final
PASS PART _FAIL
--
Post&Beam
Smoke Dampen -------
PART FAIL
_CTRICAL _
Service
Rough-In - - --- - - --- — - —�
UG/.slab
Low Voltage __-.- —__-- --- --------- __ -_�_
Fire Alarm
Final El Reinspection fee of$- required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL_
81TE_ ❑ Please call for reinspection RE:. _ ___ ❑ Unable to inspect-no access
Fire Supply Line_-
ADA Data,__=__1 ' y ` Inspector -
Approach/Sidewalk
Other:-
Final DO NOT REMOVE this inspection record from the Job alto.
PASS PART FAIL