13055 SW HAMPTON STREET I
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13055 SW HAMPTON ST ,
C11 t OF T1 GA R D _ MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MF_C2.004-00120
13125 SW Mall Blvd., Tigard, OR 97223 (503) 639-41,71 DATE ISSUED: 3/16/04
PARCEL: 2S 104AC-01500
SITE ADDRESS: 13()55 SW HAMPTON CT
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG
Cl-ASS OF WORK: OTR FLOOR FURN: �Y EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APFL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS_ HOODS:
_ 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: WOODSTOVES.
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: 1 _AIR_HANDLING UNI1-S OTHER UNITS:
FURN >=100K BTU: <= 10000 cfrri: v GAS OUTLETS:
> 10000 cfm:
Remarks: Replace furnace with like kind.
Owner_ -FEES
AUNGIER, LOIS M + Description Date Amount
GEISLER,W PAUL, CO-TRUSTEES ---
11302 SW BARBUR BLVD [MECHI Permit Fee 3/16/04 $72.50
"ORTLAND, OR 97219 [TAX] 8",,State Surchari 3/16/04 ,$5.80
" l ota $78.30
Phone: _ _
Cantractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone: 692-1565 Heating Unt Insp
Final Inspection
Reg #: LIC 5193
This permit Is'ssued 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 952-001-00
199(ed By: � �� Permittee Signature:
Call (503) 639-4175 by 7 00 P.M. for inspections ;i3ed4the next business day
FFICEJISE ONLY
Mechanic.. .emit Application ,� ; � ` ` M.:charica
Date/B O Permit No.: 0Of
City of Tigard Planning Ap oval -- Building --
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review other
Tigard,Oregon 97223 Date/By: _ Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Revicw Land Use
Datt:/B : Case No.:
Internet: www.ei.tigard.or.us Contact Juris.: See Pagt 2 for
24-hour inspection Request: 503-639-4175 Name/Method: Supplemental Information.
TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKI,iST
New construction I Demolition Mechanical permit fees'are based on the total value of the work
Addition/alteration/replacement I Other: performed. Indicate the value(rounded to the nearest dollar)of all
_CATEGORY_OF_CONSTRUCTION mechanical materials,equipment,labor,overhead and profit.
1 &2-Familydwelling Commercial/industrial Value: S See Page 2 for Fee Schedule
Accessory Building Multi-Family _ RESIDENTIAL EQUIPMENT/SYSTEMS FEE!SCHEDULE
Description -- ty Fee ea. 7-utal
Master Builder Other: _ HeatinW .,I..
JOB SITE INFORMATION and LOCATION Furnace-add-on air conditioning" 14.00
Job site address: 130 1') f4/1kVl j Dom_ T' Gas heat pump 14.00
Suite #: Bldg%Apt.#: Duct work 14.00
Project Name: U�/ H dronic hot water s _item 14.00
-� +- — Residential boiler
Cross street/Directions to iob site: for radiator or h dr. rric s stem 14.00
Unit heaters(fuel,not electric)
WO W Vt r T 0 / 3 Z (in wall,in-duct,sins ep nded,etc. _ 14.00
Flueivent(for any of above j 10.00
Subdivision: _�Lot#: Rcnair units _ 12.15
_ Other Fuel Appliances
Tax map/parcel #: _ Water heater 10.00
6ESCRIPTION OF WORK Gas R;cp!2re 10.00
<L Flue vent(_water h:.ster/gaas fireplace) 10.00
Lo li htcr asT 10.00
---- ---- -- — Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/linet/flue'vent 10.00
PROPERTY OWNER TENANT Other:
Environmental Eshauat&Ventllatlon
Name: L (j I S ,/) �(r1J fj j (L _-.__ Range hood/other kitchen equipment 10.00
Address: p.� t�J ju IQN)1/I r0 6� Clothes dryer exhaust 10.00
City/State/Zip: 47 0(2,t� C7 2:a3_ _ Single duct exhaust
Phone:�b) - 2 -1L427 I Fax: _ (bathrooms,toilet compartments,
APPLICANT CONTACT PERSON _ utility rooms) 6.80
fans 10.00
Name: l���1. y4 fit I Attic/crawl space— ------ Other: — -- 10.00 —
Address: FuelT _-
Cit /State/Zl : _ **($5.40 for first 4,$1.00 each additional
Phone. Furnace,etc. '•
' D'- - -AUL 7 Fax: _ ----- Gas heat pub
E-mail- _ Wall/suspended/unit heater •'
CONTRACTOR Water heater
Business Name:Aj2I1,pVj /v/ els+L CD, Fireplace •' ___
Range
Address: l D 33 L? � - AtA-m 1'4 p, t3a ++ --
Cil '/Slate/Zi :—1 W jam') _0(Lc� g)n(C Clothes dryer(gas) '• __
Phone i-0. r' Fax - Other: — _ - '•
CCB Lie. #: ;;le5 3 Total:
Mechanical Permit Fees _
Authorized., Subtotal: S
Signature: _�, -�-.. —_ Date:3-If 1/-oq Minimum Permit Fee$72.50 $
Plan Review Fee 25%of Permit Fee S
(Please print name) State Surcharge(g%of Pemtit Fee _
_TOTAL PERMIT FEE $_
Notice: This permit application expires If a permit Is not obtained within *Fee methodology set by TN-County Building Industry Service Board.
160 days after It has been accepted as complete. ••Site plan required for exterior A/C unit,.
is\I)sts\Perrnit F'orm.'.MecPermitApp.doc 01103
lcchanicajermit Application - City of Tigard
Page 2 - Supplemental Information '
Commercial Fee Schedule: _
Total Valuation: Permit_Fee:
s1.50 12 ES,556.20 _ M' ininwn,fee$72.50
$5,001.00 to$10,000.00 572.51)for the first$5,000.00 and$1.52
for each addi"anal$100.00 or fraction
__ thereof to a,, ncluding$10,000.00. _
$10,001.00 to S25,0woo $148.50 for the first$10,000.00 and
$1.54 for each additional$100.00 or
frac tion thereof,to and including
$25,000,00.
525,001.00 to$50,000.00 $379.50 for the first$25,000.00 and
$1.45 for eac:4 additional 5100.00 or
fraction thereof,to and including
550.000-00-
T-0,00 1,00
50,000.00.550,001,00 and up $742.00 for the first 150,000.00 and
$1.20 for each additional$100.00 or
fraction thereof.
Assumed Valuations Per A lienee: _
Value Total
Description: Qty iia) Amount
Furnace to 100,000 BTU,including 955
ducts&vents _
Furnace>100,000 BTU including ducts 1,170
&vents —
"!ocr fumace including vent 955 _
Suspended h,:ater,wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
<3 hp;absorb.unit, 955
to 100k BTU1 700
3-15 hp;absorb.unit,
101 k to 500k BTU
I5-30 hp;absorb.unit,501k to I mil. 2,310
BTU
30-50 hp;absorb.unit, 3,400
1-1.75 mil.BTU
>50 hp;absorb.unit, 5,725
>1.75 mil.BTU _
Air handlingunit to 10.000 cfm 656
Air handling unit>10,000 cfm 1,170
Non-portable eve rate cooler _ 656
Vent fan connected to a single duct' 446
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or+ndustrial incinerator 4,590 _
Other unit,including wood stoves, 656
inserts,etc. _
Vas piping 14 outlets 360
Each additional outlet _63
TOTAL COMMERCIAL $
VALUATION:
iADs- \Permit FomnUNecPetmithppPg2.doc 01103
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Lane: (503) 639-4171 MST
AM---
�., c� BUP _ -----------------
Received �. l:�Date
,q RP nested
zPM - -- BUP ------ ----
Location __ 1���_��_�--�__�_.-_--14<41�t ? -_----Suite -_ -___ - --_---- @E: Q �
Contact Person Ph ( _s 2P 71 _- U_ 7 PLM
Contractor Ph( - ) -- - - - - - SWR -- --- - --
BUILDING Tenant/Owner _._ - _ - --_-- ELC
Footing
Foundation Access: ELC
C -�- --
Ftg Drain � (,LLzG�.P� � � ELR
Crawl Drain No
slab Inspection tes: � SIT _
- ---
Post&Beam
Shear Anchors --
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation j
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 loll - - -
Sanitary Sewer
Rain Drains --
Catch Basin/Manhole
Storm Drain — -- - —
Shower Pan
Other: �-- --- -
Final -- i- -
PASS PART FAIL —
MECHANICAL _--- — _
Post& Beam
Rough-In 2,
Gas Line
- .
e Dampers
l_ ---
RTRICAL
PART FAIL_ - --
Service
Rough-In
UG'Slab
Low Voltage _—
Fire Alarm
Final Reinspection fee of$— before next ins uirod re
PASS PART FAIL — q pectfon. Pay at City Hale 13125 SW Hall Blvd.
SITE _ Please call for reinspection RE:_ _ Unable to Inspect-ro access
Fire S,jpply Line
ADA
Approach/Sidewalk Inspector
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL