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Permit C ITY OF TIGARD MECHANICAL PERMIT iI DEVELOPMENT SERVICES PERMIT #: MEC2001 -00385 <.� - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/31/01 PARCEL: 1 S136AA -00801 SITE ADDRESS: 10380 SW 71ST AVE SUBDIVISION: ZONING: R -4.5 BLOCK: LOT: JURISDICTION: TIG 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: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: LPG 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: 1 FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1 > 10000 cfm: Remarks: Installation of new gas insert and gas piping. Owner: FEES COLOMA, DALE A + CHARLOTTE K Type By Date Amount Receipt 10380 SW 71ST AVE PRMT CTR 10/31/01 $72.50 2720010000 TIGARD, OR 97223 5PCT CTR 10/31/01 $5.80 2720010000 Total $78.30 Phone: Contractor: BELL HEATING 15550 SE PIAZZA AVE CLACKAMAS, OR 97015 REQUIRED INSPECTIONS Gas Line Insp Phone: 503 - 656 -1184 Mechanical Insp Reg #: LIC 447 Final Inspection PLM 3 -286PB 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 i - suance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to low rules adopted in the Oregon Utility No • = • • Center. Those rules are set forth in OAR 952 -001 1014 through OAR 95 :81-0080. Yo q ay ob - • •ies of these rules or direct ques on- • OUNC by calling f. A19dR -Q1RQ � Issue By: • "'fill • / � //„.% Permittee Signature: Call (503) 63 ' -4175 by 7:00 P.M. for inspections nee. • d he ext business day - A Mechanical Permit Application Date received: /, ,,g/ 4/ Permitno.: /.4,,GD/. evgg 44- ,J I City of Tigard Project/appl. no.: Expire date: CityojTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Phone: (503) 639 -4171 Date issued: By: I Receipt no.: Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: Building permit no.: l'11'E OF PERM I1 1a1 & 2 family dwelling or accessory O Commercial/industrial U Multi - family O Tenant improvement O New construction O Addition/alteration /replacement O Other: .1011 SITE INF010E1110N COi1N9ERCIAL VALUATION SCHEDULE Job address: l0 3 go 5s4, 7 It A ye, 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/account no.: profit. Value $ . Lot: Block: Subdivision: *See checklist for important application information and Project name: C + G — 60 c.0 jurisdiction's fee schedule for residential permit fee. City/county: iti ZIP: R 7 z I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE Description and location of work on premises: AND CONIMERICALIINUUSTRIAL I QUIPi 1ENi'SCIIEDULI 6, k 5 Pi .r -p1 4 - ' C Fee(ea.) Total Est. date of completion/inspection: Desert . i on Qty. Res. only Res. only Tenant improvement or change of use: C ' ■ -- Is existing space heated or conditioned? O Yes O No Air handling unit CFM Air conditioning (site plan required) IIIII Is existing space insulated? O Yes O No Alteration of existing HVAC system IIII 191:C11:1NICA1. CONTR:1CT01Z State boiler boilerp permit no.: ,■■ Business name: � tater ermit . A Al N , I HP Tons BTU/H Address: - 5 - 5 0 S E ' t , z , AiL - Fire/smoke dampers/duct smoke detectors - City: �Lk C K R M -r F ax: E-mail: ate: p /L ZIP: q 7 S Heat pump (site plan required) : Phone: So; • Install/replace furnace/burner BTU /H I I ' Including ductwork/vent liner O Yes O No CCB no.: +-ldt InstalUrepla " relocate heaters- suspended, II City/metro lic. no.: wall, or floor mounted Name (please print): A D 2.[—cv S � G t pi Vent fora • 'Hance other than furnace i CON FACI PERSON Absorption units BTU/H III Chillers HP MO Co ressors HP = Address: i � � _ a , . nmeu ust an . ven 11 . I on: ■ -- r EMS ZIP: Appliance vent _ Phon o • - - ., 9 3 Fax: E -mail: Dryer exhaust ME OWNER Hoods, Type I/ Il/res. kitchen/hazmat ■ __ hood fire suppression system Name: 0. , 1 2_1_0 - rr, C'o c,o vt y1 Exhaust fan with single duct (bath fans) - Mailing address: 0 I W I S -r , Exhaust s stem • • art • • m heatrn: or AC I= NZI e p p , : an I n '*r t on up to ' ou ets e- ZIP: 7 2:2_3 Type: LPG X NG Oil MI Phone: 503 2 y - l Zy Fax: E -mail: Fuel . i . ing each additional over • outlets MN _ ENGINEER ' ' , p p (schematicrequired) - IM =MI Name: Number of outlets I er I app t or eq pment: ■ - Address: Decorativeftreplace City: State: ZIP: Insert - type — . Mii — I Ma Phone: Fax: E -mail: Woodstov pellet stove Other: Applicant's signature j • • /,', j D ate: , , , t 1 er: Mill Name (print): 54,., m , r `� - Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ O Visa O MasterCard Notice: This permit application Minimum fee $ 'I 2..5 Credit card number: / / expires if a permit is not obtained Plan review (at %) $ Expires within 180 days after it has been State surcharge (8%) .... $ 5. 9)0 Name of cardholder as shown on credit cars $ accepted as complete. TOTAL $ 7830 Cardholder signature Amount 440-4617 (6/00/COM) MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: FEE: - Description: Price Total $1.00 to $5,000.00 Minimum fee $72.50 - - Table 1A Mechanical Code Qty (Ea) Amt $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Fumace to 100,000 BTU $1.52 for each additional $100.00 or including ducts & vents 14.00 fraction thereof, to and including 2) Fumace 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 Fumace $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: Boiler Heat Air $1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond fraction thereof. _ footnotes below. Comp* ** 7) <31 :absorb unit ASSUMED VALUATIONS PER APPLIANCE: - to 100K BTU 14.00 8) 3 -15 HP; absorb Value Total unit 100k to 500k BTU 25.60 Description: Qty (Ea) Amount - 9) 15 -30 HP; absorb Fumace to 100,000 BTU, including 955 unit .5-1 mil BTU 35.00 ducts & vents - 10) 30-50 HP; absorb Fumace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20 ducts & vents - 11) >50HP: absorb Floor fumace including vent 955 - unit >1.75 mil BTU 87.20 Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM _floor mounted heater - 10.00 Vent not included in applicance 445 13) Air handling unit 10,000 CFM+ _ermit _ 17.20 Repair units 805 - 14) Non - portable evaporate cooler < 3 hp; absorb. unit, 955 10.00 to 100k BTU - 15) Vent fan connected to a single duct 3-15 hp; absorb. unit, 1,700 6.80 101k to 500k BTU - 16) Ventilation system not included in 15-30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00 mil. BTU 17) Hood served by mechanical exhaust 30 -50 hp; absorb. unit, 3,400 10,00 1 -1.75 mil. BTU 18) Domestic incinerators >50 hp; absorb. unit, 5,725 17.40 >1.75 mil. BTU Commercial or industrial type incinerator Air handling unit to 10,000 cfm 656 - 69 Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves Non - portable evaporate cooler 656 - 10.00 _Vent fan connected to a single duct 446 - 21) Gas piping one to four outlets Vent system not included in 656 5.40 appliance permit - 22) More than 4-per outlet (each) Hood served by mechanical exhaust 656 - 1.00 Domestic incinerator 1,170 - Minimum Permit Fee $72.50 SUBTOTAL: $ Commercial or industrial incinerator 4,590 - Other unit, including wood stoves, 656 . 8% Surcharge $ inserts, etc. - Gas piping 1-4 outlets 360 _ 25% Plan Review Fee (of subtotal) $ Each additional outlet 63 _ Required for ALL commercial permits only TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $ VALUATION: Other Inspections and Fees: 1. Inspections outside of normal business hours (minimum charge -two hours) $72.50 per hour. 2. Inspections for which no fee is specifically indicated (minimum charge -half hour) $72.50 per hour 3. Additional plan review required by changes, additions or revisions to plans (minimum charge-one -half hour) $72.50 per hour * State Contractor Boiler Certification required for units >200k BTU. ** Residential A/C requires site plan showing placement of unit i:\dsts\forms\rnech- fees.doc 10/11/00 . ` f .F - CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 - 4171 BUP Date Requested 1 -7 AM 1,131-V1 BLD Location /D3 go - 71 r ' - C Suite MEC 02(X)7 60_1 Contact Person Q1j/L'C Ph 09 – 8 3 5 PLM Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing ONE -INNe , I Occ c./ Insulation Drywall Nailing �� Sv1 v his,/ / viz' L4 h/ Firewall �O _ __ Fire Sprinkler / A 7 ;r1 o A I S ►�J� _ . Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In as Smoke Da pers '9 +� / S P ��:1L , . EL - CTRI Service Rough In UG /Slab Low 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 /1- f- a/ Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CI1 OF TIGARD BUILDING INSPECTION DIVISION MST 24 - Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested /( ( AM PM BLD Location /0 E13 7/.Zis * e___ Suite _ MEC ;L 7f 0 c3 �� Contact Person Ph a 0 7 $ , ,S PLM Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing O,S" ( S. 5.7 S Insulation - Drywall Nailing >� v7 -2n..c AC�<: ✓ /J- Firewall n Fire Sprinkler /'A 56 vcS c , 'Zi A- -/LZrti Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL ��� PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains Final PASS PART FAIL MECHANICAL Post & Beam Rough In erartr SS.•, Dampers vat PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access Fire Supply Line ADA / 11-/A Approach /Sidewalk Date 11 t7/ Inspector Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.