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CITYOF `CIGAR® _ MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2001-00182
DATE ISSUED:
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 2511 2001
PARCEL: S110DD-09700
SITF ADDRESS: 15765 SW HIGHLAND CT
SUBDIVISION: SUMMERFIELD NO.6 ZONING: R-7
BLOCK: LOT: 313 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPAt'C7 GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: _ BOILE_RS/COMPRESSOR_S_ _ HOODS:
FUEL TYPES _ 0 - 3 HP: 1 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: CLO DRYERS:
FURN < 100K BTU. AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU. <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Installation of exterior A/C. Cannot be placed within required setbacks.
Owner: _FEES _
WICK, DON H + ELLEN Type By Date Amount Receipt^
15765 SW HIGHLAND CT PRMT CTR 175/31/20( $72 50 272.0010000
TIGARD, OR 9722.4 5PCT CTR 05/31/2 )( $5.80 2720010000
Total $78.30
Phone:
Contractor: _
SPECIALTY HEATING & COOLING
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Mechanical Insp
Phone:620-5643 Final Inspection
Reg#:LIC 66578
This permit is issued subject to the regulations contained in the Tigard Municipal Cede, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
fir more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
t,lility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080.
You may obtain copies of these rules or direct questions to OUN;, by calling (503)246-9189.
G'
Issue By: rr .,� + �,A4, Permittee Signature: � ,( � ��
Call 503) 639-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Datereceived: • ! Permit no.
City of Tigard Project/appl.no.: Expire date:
Cavol'Tigurd Address: 13125 SW Hall Blvd,Tigard,OR 97223 - -
Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE1PERMIT
I &2 family dwelling or accessory U Commercial/industrial ❑ Multi-family ❑'Tenant improvement
U New construction V Addition/alteration/replacement U Other:`z —
JOS SITE INFORMATION1 1• 1 r
D
Job address: /,'j 7CeS � �I/d v, -r Indicate equipment quantities „boxes below.Indicate the dollar
Bldg,no.. Suite no.: value of all mechanical materials,equipment,tabor,overhead,
Tax map/tax lot/account no.: profit.Value$ _
Lot: Block: I Subdivision: 'See checklist for important application information and
Project name: IC-K. jurisdiction's fee schedule for residential permit fee.
City/county. �p r - V ZIP: I & 2 FAMILY DWELLING PERMIT FEE SaIEDULE-
Description and location of work on premises:
_ � I icl�r.) lariat
Est.date of completion/inspection: Description qty. Res.only Res.om,
Tenant improvement or change of use:
Is existing space heated or conditioned?--VFKes U No Air handling unit CFM
Air conditioning(site plan require )
Is existing space insulated? es I]No
Altera of extsnng VA system`—�
Boiler/compressors
Business nam yrs (� 4 h State boiler permit no.:
HP Tons BTU/H
Address: 6 1 Ld7 eyvim'T Fire/smoke dampers/duct smoke detectors
City: 1 Gt') rState:p IZ P:q 7.;A;13 Heat pump(site plan require ) '-
Phone h05rEH Fax59��J/ E-mail: nsta rep ace urnac urner /
CCB no.: 5 7 — Including ductwork/vent liner U Yes U No -
Instal rep I ac re ocate heaters-suspended,
City/metro lic,no.: / _ wall,or floor mounted
Name(please print): T y►1,q YJ l i?I-G eat or n lance other than furnace
PERSON e gerat on:
Absorption units_—_ BTU/H
Name: 1-1 I-e", n '7")P- Chillers--_— IIP
Address: (75`9, $' / Sr Com ressurs_ IIP
Environmental ex ust am vents ation:
City: n, Stae:c ZIP: 0 70�4`7 A,,oliancevent
Phone: -3 (rip- fax: E-mail: )ry 7 ex Taust
Hoods,Type ires. itc eN azmpt
hood fire suppression system
Name: LL j L , Exhaust fan with single duct(bath fans)
Mailing address: 5'7 SW / -.t- Ex6austs stem a art from heating or AC
City: tate:�j/(/ ZIP: ue piping andistribution(up to outlets)
- Type: LPG —_ NG Oil
Phone: E-mail: Fue i in each a ditiona over 4 outlets
Process piping(schematic required)
Name: Number of outlets
Other listed app ance or equipment:
Address: Decorative fireplace
City: State: ZIP: Insert-type
Phone: Fax: E-mail: oa
s
tov pe let stove
Applicant's sign ure: Ot er
H ! am t H:
Name
--
(print): G itf f ,(
Nat all jurisdictionsaccept credit cards,please roll jurisdiction for more information. Permit fee.....................$
U visa Ll MasterCard Notice:This permit application Minimum fee................$ L tiT
Credit card number expires if a permit is not obtained
/ / Plan review(at — %) $
Expires within IRO days suer it has been State surcharge(8%) ....$
Name of cardholder as shown on credit cord accepted as complete. � 3U
_ s TO'T'AL .......................$
Cardholder tipature Amount
440-4617 tr>/OtUCOMi
Commercial Schedule 1&2 Family Dwehing Schedule
ASSUMED VALUATIONS PER APPLIANCEDescrtphon
[Furnace
----- TanIeIAMechanical Cod
_ Oly I Prka Total
rnace to 100,000 BTU 1) 1" mace to i00,000BTU
955 i ldudinq duds d vents I4.u0
cluding ducts&vents lj Fumsce 100,000 eru.
>100,000 BTU including duels a vents11.101,170 3) Flour Fumace11dudinq ducts&vents Includ na vent
00
floor furnace 4) Suspended healer,wall healer 1400 -
9.`S5 or floor mounted healer
including vent 680
5) vent not included hl appliance pemul
suspended heater,wall heater 12.15 _
955 s Re air units
or floor mounted heater Check all that apply 'Boller Heal Air
For Items 7.10,$ae or Pump Cond Oly Price Total
Vent not included in appliance permit 445
footnotes 1,2 Cam
801; 7).3HP,absorb unit to
Repair units 100K BTU 14.00
<3 hp;absorb.unit B)3.15 HP,absorb unit
955 100k to 500k BTU 2560
to 100k BTU 9)15-30 HP;absorb
unit.5-1 mil BTU 35.00 _
3-15 hp;absorb.unit 10)30.50 NP,absorb
L
500k BTU _ 1700 and 1.1.75 mil BTU52.2p;absorb.unit 11)>SONP;absorbuna$1.75and BTU87.201 mil.BTU 2310 12)Air handling unit to 10,000 CFM10.00
p;absorb.unit 13)Air handling unit 10,000 CFM. 17 20
il,BTU 3400 —
14)Non-portable evaporate CnOlef 1000
>50 lip,absorb.unit 15)Vent fan connected to a single dud
> 1.75 mil.BTU 5725 s.eo
656 16)Ventilation system not included in 1000
Air handling unit to 10,000 cfm ■ pilance fiennfl
Air handling unit>10,000 Cirri 1170 17)Hood served by mechanical exhaust
Non-portable evaporate culler 656 16)Domestic incinerator
11.40
vent fan connected to a single duct 445 19)Commeldal or Indudrld type 1n n.,.W
eggs
Vent s sy 1.not Included in appliance permit 656 20)Other units,Indudmg wood stoves 10.00
1000
Hood served by mechanical exhaust 21)Gas Piping 0;;10 lour oulkle
Dornest.;Incinerator 1170 5.40
Commercial or industral Incinerator _
4590 22)More than 4-per outlet(each) 100
Other unit,Including wood stoves,inserts,etc. _ 656 -W-1111WmW Pe""""ee$72'50 6%�uHclwace
Gas piping 1-4 outlets 36('
PLAN REVIEW 25Y.r,r SURTO AL
Each additional outlet 63 Required for ALL commercial permits only
TOTAL
Olhar ksepte6em and fee$:
1 Inapalsbro 01a$iae dl namfl busmesf hdxs(n, rn charge Mo hour$)
f 7290 p!r Mur
2 Inspedefn$lar whrdl rte ice n spearcallY,rditaleU(mxllmlml y,,$rgeMa Iwlrc1
$t2 so per hart
Fee 2 Add,ka al p an rev ew.egare. Y changes adodems a rows ms to pans Im umum
[Dial V81Ua110t1 — cnargea .hadhourlsr2wvarhour
'Stale Caw,aer e,Bober Cenelntim"'m"ed
••gniklMual AIC reap,@$$sa Plan$hawrq Plsca` a t nl u.d
S 1.00 to$5,000.00 Minimum$72.50
55,001.00 to 510,000.00 $72.50 for the first$5,000.00 and$1.52 for
each additional S 100.00 or fraction thereof,
to and including$10,000.00
$10,W1,00 to$25,000,00 5148.50 Cor the first$10,000.00 and$1.54
for each additional$100.00 or fraction
thereof,to and including$25,000.00
$25,001,00 to i%000-00 5379.50 for the ftrst$25,000.00 and S 145
for each additional$100.00 or fraction
thereof',to and including' -9,000.00
550,000.00 and up 5742.00 for.hc first$50,000.00 and S I.ZCi
for each Additional$100.00 or fraction
there, _
_L
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3
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CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24-Hour Inspection Line: 639-417,5 Business Line: 639-4171 ----�
f BUP
- Date Requested f.=J 81 AM PM ! BLD --_Location Suite 7� L i t� Iry+�_ CT- -_-^_ Suite _ ---� &E-% 2041 - t7b t�2 _-
Contact Person _ _ -_- _ Ph _- -, PLM _
Contractor Ph SWR
BUILDING ------ Ienant( r ELC
OWn _-
Retaining Wall ELR _
Footing Access: -
Foundation FPS
Fig Drain S"iGN
Crawl Drain Inspection Notes: ' CFQ- 14 NbOh� -
Slab --- - --- --- ---- - S I T
Post&Beam --�-
Ext Sheath/Shear
Int Sheath/Shear -
Framing �U C-,)
- -.. __.----
Insulation
Drywall Nailing (Y? �j.Q
Firewall
Fire Sprinkler -
Fire Alarm l
Susp'd Ceiling -- `--�"�^ LCL -1� C.�ivy _ �7^!`Q-,G- �-C_ J' ---
Rout -
Misc
F inal
PASS PART FAILPLUMBING A-41
--
'�
Post R Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final ----- - ------ - -----
PASS PART FAIL
MECHANR:WL. _
Post& Beam t -----.-----__-_�-_ -_--- _Y _ -
Rough In ) j
Gas Line -- -- -- ----
Smoke Dampers
ASS' ' PART FAIL
_CTRICAL - - -- ------- ---
Service
Rough In ----------- . - - --- , - --
UG/Slab -- ------ - --------
t_ow Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading ----- - - - -- -------___.___- - _ ---- ---
Sanitary Sewer
Storm Drain ( )Reinspection fee of$ -_---__required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( )Please call for reinspection RE ( )Unable to inspect no access
ADA
Approach/Sidewalk
Other Date _ 6 __-_-_Inspector L_ '�-- - Ext~�?r
Final ^~ -
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.