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MECHANICAL PERMIT
CITY ®F T I GA R D
DEVELOPMENT SERVICES OERMIT#: MEC2001-00448
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 12/10/01
PARCEL: 2S 115AD-04800
SITE ADDRESS: 16700 SW 108TH AVE
SUBDIVISION: DOVER LANDING ZONING: R-4.5
BLOCK: LOT: 031 JURISDICTION: TIG
CLASS OF WORK: At T FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SI- UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HuODS:
_ FUEL TYPES _ 0 - 3 HP: DOMES. INCIN:
IPG 3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP:
WOOD
STOVES:
PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS C
OTHER UNITS:
FURN —100K BTU: <= •10000 cfm:
GAS OUTLETS: 1
> 10000 cfm:
Remai Ks: Gas fireplace insert. Gas line from basement to front room.
Owner: _FEES _
NESVOLD,JUDY ANN Type By Date Amount Receipt
16700 SW 108TH AVE PRMT CTR 12/10/01 $72.50 2720010000
TIGARD, OR 97224 5PCT CTR 12/10/01 $5.80 272001000_0
Phone: Total $78.30
Contractor:
REQUIRED INSPECTIONS
Gas Line Insp
Phone: Mechanical Insp
Reg #: Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This pe►mit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (50.0246-9189.
Issue By: _ Permittee Signature:
Call (303) 639-4175 by 7:00 P.M. for Inspections needed the next business day
Mechanical Permit Application
Date,received: �" -�;. � " Permit no..
City of 'Tigard Ptoject/appl.no.: Expire date:
Cir o1'Ti and Address: 13125 SW Hali Rlvd,Tigard,OR 97223 t' — --
City
Phone: (503) 639-4171 -. Date issued: By: * Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: IN i Wing permit no.:
01 &2 family dwelling or acce,.sory U Commercial/industrial ❑Multi-family ❑Tenant improvement
U New construction U Addition/alteration/replacement U Other
NE
W O'
Job address: , .�(_( _r 1 L' i rr�_� V Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: _ ��Suite no.: — value of all mechanical materials,equipment,labor,,)verhead,
Tax map/tax lot/account no.: profit.Value$
Lot: Block: Subdivision: *See checklist for important application information and
Project name: jurisdictimm',. I'.- schedule for resideniial permit fee.
Citv/rnttnt),• 71P:
Descriptign and locution of work on premise : ,"bi S Flif"Clace 11 19 1r loll
j /1 ) `yl-:�� j tri S, yt,�vu-•�F►[ 'N� Yc'c' '�'l lI�Y•Ie�t.)i 'I�ttstl
Est.date of completion/inspection: I),.criplinn _— epy. Res.only Res.only
Tenant improvement or change of use: Air handling unit CFM
Is existing space heated or conditioned?U Yes U No it conditioning(site plan require )
Is existing space insulated?U Yes U No A teration of existing HVAC system _
Boiler/compressors —
Business name: 71) �L e'r �(' j G State boiler permit no.:
HP I.ns BTU/H
Address: C, it' j ri C I r k ` Fire/smoke damper,,/duct smoke detectors A_
City: r' c. State:"- IP:c 7 Heat pump(site plan require ) —
Phone: JE-mail: Install/rep ace furnacelbumer 3 I Will
CCB no.: 'r Including ductwork/vent liner U Yes U No —
_ nsta repace/relocale eaters-suspended,
City/metro tic.no.: wall,or floor mounted
Name(please print): 1k, Vent for appl lance off el an u ace
e rlgeral tua:
Absorption units_. BTU/H
Name: Chillers- HP
Address:
Compressors HP
Environmentalexhaust and ventillittiout
City: State: ZIP: Appliance vent
Phone: — Fax: E-mail: F!—le eex aunt _
oods,Type res. ttc cn t
hood fire suppression system
Name t i I f�e,1 1, ( Exhaust fan with single duct(bath fans)
Mailing address: ; J(' i ( t'S A) ( �' Exhaust systema art from caun or (:
Cit r� ;-t , , State: � i ZIP: �� ' 7 c
rue,piping ant sir nu on(up to outlets)
Y: — Type ------LI'Ci _ __ NG Oil
I'honc:r Fax: E-mail —Fuelpipingeac a dilv,nalove—r4 outlets
BoomWHIMrocesspiping(schematic require )
Number of outlets
Name: Other 110A app ance or equipment:
Address: txcorativcfircplacc
City: State: ZIP: neem ty
_
Phone: r-a x I E-mail: I Woodstovelpel let stove
Ot cr:
Applicant's signature•. Date: ter:
Name (print): --
all Julctiata cepnli
cri cords,plea r call jwlsdicacat fa marrnn
r infoNnn, Permit fee.....................$
Na aridr
NillU MasterCard Notice:'Phis permit application Minimum fee................$
U Visa expires if a permit is not obtained Plan review(at .— %) $
c'redil card number - —_ __._- SRL within Igo days atter it has been
State surcharge(896) $
–door of car ,deer an rhown nn crr i�1 cad accepted as complete. t
TOTAL .......................
CWih_ r upnlure-- — Aarotml 410.4617(bnWOM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHLDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VAL_UATION_:_ PERMIT FEE: Description: y-�--- Price Total-
$1.00 to$5,000.00 _ Minimum fee$72.50 Table 1A Mechanical Code Qty (Ea) _Amt
$5,001.00 to$10,000.1)0 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional$100.00 or including 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
$1.54 for each additional$100.00 or Including vent 14.00
fraction thereof,to and including 4) Suspended heater,wall heater
$25,000.00. _ 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
$1.45 for each additional$100.00 or 6.80
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
$1.20 for each additional$100.00 or For Items 7.11,see or Pump Cond
fraction thereof. footnotes below. Com • *'
7)<3HP;absorb unit
Minimum Permit Fee$72.50 SUBTOTAL: $ to 100K BTU _ 14.00
- 8)3-15 HP;absorb
8%State Surcharge $ unit 100k to 500k BTU 25.60
9)15.30 HP;absorb
25%Plan Review Fee(of subtotal) $ unit.5-1 mil BTU 35.00
Required for ALL commercial permits onl 10)30-50 HP;absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.20
11)>50HP:absorb
-- unit>1.75 mil BTU 1 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM 10.00
Value Total 13)Air handling unit 10,000 CFM*
Description: Q Ea Amount _ 17.20
Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler
ducts&vents 1000
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 I icluded In
Suspended heater,wall heater or 955 appliance permit 10.00
floor mounted heater 17)Hood served by mechanical exhaust
Vent not included In applicance 445 _ 10.00
ermlt_ _ 18)Domestic Incinerators
.Repair units _ 805 17.40
<3 hp;absorb.unit, 955 19)Commercial or Industrial type Incinerator
to 100k BTU 69.95
3-15 hp;absorb.unit, 1,700 20)("ther ui-Its,Including wood stoves
tOtk 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, .1,4on 22)More than 4-per onuQt(each)
1-1.75 frill.BTU _ 1.00
>50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $
>1.75 mit.BTU _
Air handling unit to 10,600 dm 656 8%State Surcharge $
Air handling unit>10.000 cfm 1,170 _
Non-portable evaporate coder - 656 TOTAL RESIDENT' kL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not Included In 656 - i
_apQlance permit ha ect►ona and Fees
Hood served�nlechanlcal exhaust 656 1 Inspections outside of normal business hours(minimum charge-two hours)
Domestic Incinerator 1,170 $72 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 $72 50 per hour
inserts,etc. 3 Additional plan inview required by changes,additions or revisions to plans(minimum
Gas piping 1-4 outlets __ 360 charge-0na•hall hour)$72 50 rer hour
Each additional outlet 63 'State Contractor Boller Cerlifieatton required for units>200k BTU.
-- �-
TOTAL COMMERCIAL "Residential AIC requires site plan showing placement of unit.
S
VALUATION:
I:\ds1ts\forms\mech•fee9.doc 08/06/01
Ci 6'Y OF TIG RD BUILDING INSPECTION DIVISION! MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
EtUP _
_Date Requested f l AM PM BLD
Location
/ (0 �lIP• Suite MEC , -�� 447
- _
Contact Person Ph S-I 5 (P (D ( PLM
Contractor Ph SWR
BILDING Tenant/Owner ELC
U —__
Retaining Wall ELR
Footing Access: FPS
Foundation
Ftg Drain _ SGN -
Crawl Drain Inspection Notes:
Slab _ SIT - -
Post&Beam T
Ext Sheath/Shear lGI (mac
Int Sheath/Shear � 0 fiL
Framing
Insulation
Drywall Nailing �i4TL�.2
Firewall
Fire Sprinkler --
Fire Alarm
Susp'd Ceiling -- - -- -- - _-
Roof
Misc._ - - - - - — -- - - ----
Final
PASS PART FAIT. ---�-- —
PLUMBING —
Post&Beam
Under Slab --
Top Out
Water Service
Sanitary Sewer —
Rain Drains ---- --- - — — --- -------- ---- -_- _
Final
PASS PAELT FAIL _ - - ---- ------
CH NICA
Poseam — - — ------ ---- -------- --------- —
Rough In __---
Gas Line _._------. ---- ------- —
5moke D�yrri�ers - ------ --- __ - - ----- ------_..--_
i K
ASS) PART FAIL
ELECTRICAL -- ------ — _ --
Service ---- --------_- - ---_—__-_—.- --._----
Rough In
UG/Slab —
Low Voltage
Fire Alarm ---- -- _.--_- - -- --
Final
PASS PART FAIL - ---- - ----—�-
SITE
Backfill/Grading —
Sanitary Sewer
Storm Drain ( j Reinspection feet r$ - required before next inspection Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( ] Please call for reinspy ction RE: __ ( j Unable to inspect- no access
Fire 'apply Line
ADA
Approach/Sidewalk .� / Ext
Other Date 1 --� Inspector___
—_ p --- - ------ -- --
r incl
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.