Permit CITY TIGARD MECHANICAL PERMIT
i,'P.I DEVELOPMENT SERVICES PERMIT #: MEC2000 -00394
" �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/5/00
PARCEL: 2S112CB-11700
SITE ADDRESS: 15370 SW 81ST AVE
SUBDIVISION: ASHFORD OAKS NO. 2 ZONING: R -7
BLOCK: LOT: 131 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 associated gas piping.
Owner: FEES
JACKSON, KENNETH S Type By Date Amount Receipt
15370 SW 81ST AVE PRMT CTR 10/5/00 $72.50 2720000000
TIGARD, OR 97224
• • 5PCT CTR 10/5/00 $5.80 2720000000
• Total $78.30
Phone:
Contractor:
G P + W SYSTEMS INC
732 MARBLE RD
WASHOUGAL, WA 98671 -9601 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 360 - 835 -3516 Mechanical Insp
Reg #: LIC 00108176 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 obtain copies of these rules or direct questions to OUNC by ailing 503 246 -9189.
Issu By: �� Permittee Signature:
� __,z� !� -- 9
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
•
_ - Mechanical Permit Application
Date received: Jp - S -D d Permit no.: � -
--no City of Tigard •
Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: / -5 BReceiptno.
Phone: (503) 639 -4171
Fax: (503) 598 -1960 • Case f ile.no.: � Payment type: -- e' .0. NJZ�
Land use approval: Build permit no.:
TYPE OF PERMIT
4 I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
U New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: J 5 3 70 5 al 3 / si- a 6 2 Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
``
City /county: 7 9 /}y d I ZIP: 9 7 a a(( 1& 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: • AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
HVAC:
Tenant improvement or change of use: Air handling unit CFM
Is existing space heated or conditioned? U Yes U No '
Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
State boiler permit no.:
Business name: ( Pi (,v S c 4 /44,s HP Tons BTU/H
Address: 7 3 ,?- 0-1 G tr- la . )2.4 - Fire/smoke dampers /duct smoke detectors
City: t- Cl,q -sh flu /4- State: &11� -I ZIP: 5 y( 1 Heat pump (site plan required)
Phone: 3&0 F 3S 3 S7 (p I Fax: 3 S -S7 /bI E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner 0 Yes O No
CCB no.: / 0 Y /'t!p InstalUreplace/relocate heaters- suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
Refrigeration:
CONTACT PERSON
Absorption units BTU/H
Name: Chillers HP
Compressors HP
Address: Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent .
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: K e n 44-c k $ a /L- Exhaust fan with single duct (bath fans)
• Mailing address: / - 3 ? 0 5 (,v V/ . lL ,(}µ.ms Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City: if fr-L/ State: I OR 1 ZIP: 7 ?„). q Type: LPG NG Oil
Phone: e 0 . 7 - 0 - 7? Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
• Number of outlets / /
•
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type N' - /
W oodstove /pellet stove
Phone: Fax: E-mail: Other:
Applicant's signature: /�,.. ..,/,1 2ti Date: ]p•- 5 00 Other:
Name (print): Nct u1 d. 6 e e 4
Permit fee $ _
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Not Th permit application Minimum fee $ 72, • 5 0
0 Visa 0 MasterCard expires if a permit is not obtained
Credit card number: / / Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ - . SC:)
of cardholder as shown on credit card accepted as complete. �- TOTAL $ ( - 5 0
$ Cardholder signature Amount . 440 -4617 (6 /00 /COM)
•
Commercial Schedule
1&2 Family Dwelling Schedule
ASSUMED VALUATIONS PER APPLIANCE
Description
Furnace to 100,000 BTU Table IA Mechanical Code Qty Price Total
1) Furnace to 100,000 BTU
including ducts &vents 955 including ducts & vents 14.00
Furnace > 100,000 BTU 2) Furnace 100,000 BTU+
including ducts & vents 17.40
including ducts & vents 1,170 3) Floor Furnace
including vent 14.00
floor furnace 4) Suspended heater, wall heater
including vent • 955 or floor mounted heater 14.00
•
suspended heater, wall. heater 5) Vent not included in appliance permit 6.80
or floor mounted heater 955 6) Repair units 12.15
Check all that apply: 'Boiler Heat Air
Vent not included in appliance permit 445 For items 7 -10, see or Pump Cond Qty Price Total
Repair units 805
footnotes 1,2 Comp ••
7) <3HP; absorb unit to
< 3 hp; absorb.unit 100K BTU 14.00 •
HP; absorb
to 100k BTU 955 8) 100k 3-15 500k BTU unit 25.60
3 -15 hp; absorb.unit 9) 15 -30 HP; absorb
unit .5-1 mil BTU 35.00
101k to 500k BTU 1700 • 10) 30 -50 HP; absorb
15 30 hp; absorb.unit unit 1 -1.75 mil BTU _ 52.20
p 11) >50HP; absorb unit >1.75 mil BTU
501 kto 1 mil. BTU • 2310 87.20
12) Air handling unit to 10,000 CFM
•
30 -50 hp; absorb.unit 10.00
13) Air handling unit 10,000 CFM+
1 -1.75 mil. BTU 3400 17.20
14) Non - portable evaporate cooler
> 50 hp; absorb.unit 1000
> 1.75 mil. BTU • 5725 15) Vent fan connected to'a single duct
6.80
Air handling unit to 10,000 cfm 656 16) Ventilation system not included in
appliance permit - 10.00
Air handling unit > 10,000 cfm 1170 17) Hood served by mechanical exhaust
•
Non - portable evaporate coller 656 10.00
18) Domestic incinerators
vent fan connected to a single duct 446 17.40
19) Commercial or industrial type incinerator
Vent syst. not included in appliance permit 656 69.95
Hood served by mechanical exhaust 656 20) Other units, including wood stoves
10.00
Domestic incinerator 1170 21) Gas piping one to four outlets
5.40 •
Commercial or industral incinerator 4590 22) More than 4-per outlet (each)
Other unit, including wood stoves, inserts, etc. 656 Minimum Permit Fee $72.50 SUBTOTAL 751 •
Gas piping 1-4 outlets 360 8 %SURCHARGE UWE= 5 • ' a
Each additional outlet 63 PLAN REVIEW 25% OF SUBTOTAL
t-�
Required for ALL commercial permits only .<;
TOTAL y
a S • V
Other Inspections and Fees: �?
1. Inspections outside of normal business hours (minimum charge -two hours)
572.50 per hour
2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
572.50 per hour
Total Valuation Fee 3. Additional plan review required by changes, additions or revisions to plans (minimum
chargeone -(sad hour) 572.50 per hour
'State Contractor Boiler Certification required
$1.00 to $5,000.00 Minimum $72.50 • ^Residential NC requires site plan showing placement or unit
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
each additional $100.00 or fraction thereof,
to and including $10,000.00
$10,001.00 to $25,000.00 '$148.50 for 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 $50,000.00 $379.50 for the first $25,000.00 and $1.45
for each additional $100.00 or fraction
thereof, to and including $50,000.00
$50,000.00 and up $742.00 for the first $50,000.00 and $1.20
for each additional $100.00 or fraction
thereof
•
`° CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /0 _ ' AM PM BLD
Location / 5 70 5 w fl /5/- il-u-e Suite MEC 2 -GU -1
Contact Person Xi . Ph 'Z.v 7 P 7 7 PLM
Contractor J , Ph 360 _ $1.3f 3,1 4, SWR
BUILDING.. - . Tenant/Owner 740cre ce„, r,. 74,1-4 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
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm •
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
\14 ..t
PLUMBING C Post & Beam Under Slab -
Top Out
Water Service V
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL .
MECHANICAL
Post & Beam
Rough In
moke Dampers
SS PART FAIL
'i
CTRICAL
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 Date AL\OkS Inspector A *. Ext
Other
Final `
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.