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CITYO F T I G,A R® MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2002-00092
13125 SW Hai' Blvd., Tigard, OR 97223 (503) b39-4171 DATE ISSUED: 3/6/02
SITE ADDRESS- 09860 S'JV SEFtENA WAY PARCEL: 2S114BA-02100
SUBDIVISION: PICKS LANDING NO.2 ZONING: R-4.5
BLOCK! LOT: 118 JURISDICTION: TIG
C1 ASS OF WORK: fALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY CARP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
FUEL TYPES —� p __ 3 HP —� DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP-
FIRE DAMPERS?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + Hp: WOODSTOVES:
FURN < 100K BTU: AIR_HANDLING UhIIrS CLO DRYERS:
FURN -100K BTU: <- 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Vas fireplace insert
Owner: _ FEES
KRISTY NELSON Type By Date Amount Receipt
9860 SW SERENA WAY _
TIGARD, OR 97224 PRMT CTR 3/6/02 $72.50 272002000C
5PCT CTR 3/6/02 $5.80 2720010000
Phone: 503-443-4164 Total $78.30
Contractor:
NW ENERGY& ENVIRONMENTAL SVS
DBA/COMFORT SOLUTIONS
PO BOX 2205 REQUIRED INSPECTIONS
CLACK,AMAS, OR 97015 —` -- —
Gas Line Insp
Phone:503-698-2565 Mechanical Insp
Reg #: LIC 146472 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR
952-001-0080. You may obtain copies of these rules or direct questions to OUNC by,:-alling
(r;n,ii?dF2_g1Rci
Issue By: :Iyl,�,,�w Permittee Signature:
Call (503) 639-4175 by 7,00 P.M for inspections needed the next business day
Mechanical Permit Application
Date rec.,vee. O.Z Permit !
City of Tigard -1
Project/appl.no.: Expiredate:
City ofTigard Addn•st: 13125 SW Hull Blvd.Tigard,OR 97?71
Phone: (503) 639-0171 Date issued: By: Receipt no.: ^_
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permit no.:
family dwelling or accessory U Commercial/industrial U Multi mmily U Tenant improvement
U New construction U Addition/alteration/replacement U Other:
t
Job address: 9 5e /_ Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/a-count no.: profit. Value$ 2 6&&
Lot: Block: Subdivision: 'See checklist for important application information and
Project name: jurisdiction'�i Ice schedule for residential permit fee.
City/county: -7 r 5c d ZIP: r) ? Z Z`f ass, p
Description and!xation of work
)on}premises: _
Fcc(ea.) Total
Est.date of completion/inspection: Description Q1y- Res.only Res.only
Tenant improvement or change of use: —M
Air h.trdlinl unit
Is existing space heated or conditioned?U Yes U Nu _ CFM
Is existingspace insulated?U Yes U No trey—liv 7o ingp an require )
•p' teratiorto .�:rsung H V AC system
1 el
o Tmpr ssors
Business name: State boiler permit no.:
HI Tons BTWH
Address: Vc 7. 1rir smo a damperVilluct smoke detectors
City: ( _'f'r• Slrlc: 'LIP_: )Teat pump(site plan requited)
Phone: , q 2. Fax: E-mail: nsta rep ace irnace turner 3
CCB no.: < Includ,ng ductwork/vent liner U Yes U No
/ 1(�`1 -7 ffns-tareplace/relocateheaters-suspen ,
City/metralie.no.: T-777_ cm Iu ll,<r floor mounted
Name(please print): T :rr a iunce of r than furnace
:Absotptionurii(s
erat on:
BTI 1/14
Name: I ;?� r c /i�ir.,y •sHPAddress: S „r„p ressors HP
City: State: ZIP: onmenta exhaust an ventilation:
Appliance veru _
Phone: fax: E-mail: ryertt auTi sl —
o s, ype. res. itc en azmal
hood Fite suppression system
Name: I' r S /1(e( p"j Exhaust fan with single duct(bath fans)
Mailing address: e?N&0 Tax tT—aust s stem apart from licating or C
City: c,i State: 7.IP_ q 7 Fuelpiping andistribution(up to outlets)
Type: LPG _� NO Oil
Phone: c ' -`f/C Fax: E-mail: Fue t n�cart a t ons over out ets ---
Process piping(sc emat c
Name: Numhcr of.cutlets
1I e�eaipp once or equipment:
Address: _ _ Decorative fireplace
City: State: ZIP: Insert-type iief r
Phone: Fax: E mail: Other:
v pe et stove
App!icrnt's signature:
Name (print):
Not all jurisdictions acepr credit cad+,pleme crel jurisdiction for mare inromation. Notice:ifPermit fee.....................$ --
❑visa UMasterCard permit application Minimum fee................$
Credit cad number _�L_ expires if a pernit is not ob:aincd Plan review(at _ %) $
Expires within 180 days after it has been State surcharge(8%)....$
Name of cadhofWr i�iiTn on credit card accepted as complete.
s TOTAL .......................$ .,—
Cerdhoidersignature _ Amwmt 440.4617OMFC'OMI
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTto
VALUATION: PERMIT FEE: _ Description: Price Total
T
TOT to$5,0Mimum fee$E: Table 1A Mechanical Code ____ OtY (Fa) Amt
$1.00$5,001.00 to-$T0,000.00 $72,50 for the firs.$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,.o and Including 2) Furnace 100,000 BTU+
$10,000.00. Includingducts&vents _ 17 a0
$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 _ 1400 _
$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 theronf,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: Boiler Heat Air
$1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond
fraction thereof. footnotes below. Comp
Minimum Permit Fee$72.50 SUBTOTAL: $ 7) 00K absorb unit
BTU 14.00
1
to 100K
8°h State Surcharge $v 8)3-15 HP;absorb
unit 100k to 500k BTU 25.60
9)15-30 HP;absorb
28'/°Plan Review Fee(oi subtotal) a 35.00
Re wired for ALL commercial ermits
only unit.5 1 mil BTU
--- 9---- ----- - ---�- 10)30-50 HP;absorb
TOTAL COMMERCIAL_ PERMIT FEE: $ unit 1-1.75 mil BTU 52.20
11)>50HP;absorb
J�- - unit>1.75 mil BTU 87.20
ASSUMED VALUATIO_NS PER APPLIANCE:--l--� 12)Air handling unit to 10,000 CFM 10.00 _
- Value Total 13)Air handling unit 10,000 CFM+
Descrlption: _ .! Ea _Amount 17.20
Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler
ducts&vents 10.00 _
Fumace>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
floor mounted heater 17)Hood served by mechanical exhaust
Vent not Included in appllcance 445 10.00
rrnit - p 805 18)Domestic incinerators 17.40
Repair units
<3 hp;absorb.unit, 955 19)Commercial or industrial type Incinerator 69 95
to 100k BTU -
3.15 hp;absorb,unit, 1,700 20)Other units,Including wood stoves
101k to 500k BTU _ 10.00
15-30 lip;absorb.unit,501 k 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 mll.BTU
Alr handling unit to 10 000 dm 658 `- 8'/.State Surcharge 5
Air handlin unit>>0,000 cfm 1,170
Non- evaporate cooler 856 TOTAL RESIDENTIAL PER FEE:
Vent fanan con connected to a sin le duct_ 448 ____
Vent system not Included In 656
a lian._permitFees:
_
Hood served by mechanical exhaust_ t Inspections outside of normal business hours(minimum charge-two hours)
Domestic Incinerator _ 1,170 $62 50 per hour
Commercial or Industrial Incinerator 4 590 2 Inspections for which no lee 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
289 I Ing 14 outlets 360 charge-one-half hour)$62.60 per hour
Each additional outlet _. 63 'stale Contractor Boller Certification required for units>200k BTU.
"Residential A1C requires site plan showing placement of unit.
TOTAL COMMERCIAL $
VALLIATION: _ _- - All New Commercial Buildings require 2 sets of plans.
IWstsUormsUnech-fees,doc 12/26/01
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST
INSPECTION DIVISION Business Line: (503)639.4171 _
BLIP —
Received _ _ _ - Date Requested 3 -,F- AM_ -- PIM_ BUP
Location Suite. --- MEC �Dd 0'OO �1 2
Contact Person ___ _- _ Ph(__-__) —_ PLM —
Contractor_� _ —_—____ Ph SWR _-
BUILDING Tenant( ELC
Footing — ELC
Foundation s
s,
Ftg Drain ELR
Crawl Drain
Slab n Notes: SIT _ �_—
Post&Beam -
Shear Anchors ---
Ext Sheath/Shear —
Int Sheath/Shear
Framing _ �A S � P u S �� T. T l��� ('� l� l___ (ii✓ �. ,L
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 ----- -- - — ---
C etch Basin/Manhole
Stu-m Drain — - -- - ---- — —
Shower Pan
Other: -- - - - ---
Final ------
PASS PART FAIL
MECHANICAL_—._
Post&Beam
Rough-In
Line
SMTWw hampers
1C�-
PART FAILTRICALServiceRough-In
UG/Slab
Low Voltage ----- --___ _—_ -------— -- ---
Fire Alarm
Final F-1 Reinspection fee of$——. required before next Inspect?m. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART _FAIL
F1 Please call for reinspection RE:__._ __— ❑ Unable to inspect--no access
Fire Supply Line
ADA c Exp
Daft
Approach/Sine walk
Othq:
Final DO NOT I1I1MOVII this,Inepeetlon record from the fob slur.
PASS PART FAIL