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Permit CITY OF TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2001 -00140 ���� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/1/01 PARCEL: - 2S112CB -17100 SITE ADDRESS: 15111 SW 83RD AVE SUBDIVISION: HAMPTON COURT ZONING: R -7 BLOCK: LOT: 020 JURISDICTION: TIG CLASS OF WORK: ALT 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: 1 DOMES. INCIN: 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 UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Installation of exterior A/C unit. Unit cannot be placed within the required setbacks. Owner: • FEES MARK DOBSON Type By Date Amount Receipt 15111 SW 83RD AVE PRMT CTR 5/1/01 • $72.50 2720010000 TIGARD, OR 97224 5PCT CTR 5/1/01 $5.80 2720010000 Total $78.30 Phone: 503- 968 -9041 Contractor: SPECIALTY HEATING & COOLING V 9528 SW TIGARD ST TIGARD, OR 97223 REQUIRED INSPECTIONS Final Inspection Phone: 620 -5643 • Reg #: LIC 66578 • 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 cosies of these rules or direct questions to OUNC by calling (503)246 -9189. Issue By: I /ANAL,I, _ Permittee Signature: . 4Q r1 Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day Mechanical Permit Application Date received: �� Q/ Permit no.: /yee / —OON i n I . - n • � i! City of Tigard Project/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 - 1960 Case file no.: Payment type: Land use approval: Building permit no.: TYPE OF PERMIT ' if 1 & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi- family ❑ Tenant improvement New construction r Addition/alteration/replacement ❑ Other: JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE . Job address: /5j/ 5k) 45 / / 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: IBlock: I Subdivision: *See checklist for important application information and Project name: p ' a AO 0 -rti - jurisdiction's fee schedule for residential permit fee. City/county: (( Gri1 (4)4s `j I ZIP: c/ )� 4/ 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE Description and location of work on premises: j P1 / AND COMMERICAL/INDUSTRIAL EQUIPMENTSCIIEDULE Fee(ea.) Total Est. date of completion /inspection: Description Qty. Res.only Res. only Tenant improvement or change of use: HVAC: Is existing space heated or conditioned? WYes 0 No Air handling unit CFM Air conditioning (site plan required) 1 Is existing space insulated? Peres 0 No • Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors Business name � 1yr� -L i � f/ 4 •4 / �� h HP Tons BTU /H G State boiler permit no.: �" _ / Address: C/ 6 6 C � � LL S r Fire /smoke dampers/duct smoke detectors City: T6'ai q' I State: C -I ZIP: q 7,9 g3 Heat pump (site plan required) Phone' So3(PA066y,4FaxS9� O �/ (S'I'E -mail: Install/replace furnace/burner BTU /H Including ductwork/vent liner 0 Yes O No j CCB no.: t,4. 7 ' InstalUreplace/reloc ate heaters- suspended, City /metro lic. no.: 112 96 wall, or floor mounted Name (please print): a r/Y1i4. ' -f--K els Vent for appliance other than furnace CONTACT PERSON Refrigeration: __ Absorption units BTU/H Name: KA. T 1 Lee N [ vi , e 4 Chillers HP Address: ?S • $' Ste R' S % Envi Compressors HP ronmental exhaust and ventilation: City: ritaAG, I Sta :()e I ZIP: q 7,44- -3 Appliance vent Phone;03 6,20 -6 ' Fax: 559roJ!8' E -mail: Dryer exhaust OWNER Hoods, Type U lures. kitchen/hazmat hood fire suppression system Name: trial g do Al O "W Exhaust fan with single duct (bath fans) ' I' Exhaust system apart from heating or AC Mailing address: /5/// SG() g rQ mil/ ' Fuel piping and distribution (up to 4 outlets) City: "7904 d I State :0-k I ZIP: 9 7 9--9-1/ Type: LPG NG Oil Phone: G -- 0 q ( Fax: E -mail: Fuel piping each additional over 4 outlets Process piping (schematic required) Number of outlets Name: . Other listed appliance or equipment: Address: Decorative fireplace City: State: I ZIP: Insert -type Phone: I F I E -mail: Woodstove/pellet stove � Other: Applicant's signature: ide//yt j � ` 4' Date: ti / 2/4 Other: Name (print): �i9.74,F Lc 111 S 0 Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7v?. s ❑ Visa ❑MasterCard Not Th permit application Minimum fee $ / expires if a permit is not obtained Plan review (at _ %) $ Credit card number: Expires within 180 days after it has been , ,PO State surcharge (8 %) .... $ S Name of cardholder as shown on credit card accepted as complete. TOTAL $ '7 P , 3 C7 $ Cardholder signature Amount 440-4617 (6/CO/COM) Commercial Schedule 1 &2 Family Dwelling Schedule ASSUMED VALUATIONS PER APPLIANCE Description Furnace to 100,000 BTU Table to Mechanical Code Qty Price Total including ducts & vents 955 1) Furnace 9 8 00 en s - 14.00 Furnace > 100,000 BTU 2) Furnace 100,000 BTU+ including duds 8 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 1ooK BTU 14.00 • 8) 3 -15 HP; absorb unit to 100k BTU 955 100k to 500k BTU 25.60 absorb.unit 15-30 HP; absorb 3 -15 hp; absorb.0 • unit .5-1 mil BTU 35.00 101k to 500k BTU 1700 10) 30 -50 HP; absorb unit 1 -1.75 mil BTU 52.20 15-30 hp; absorb.unit • 11) >50HP; absorb unit >1.75 mil BTU . a7.zo 501k to 1 mil. BTU 2310 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 > 50 hp; absorb.unit 14) Non poAable evaporate cooler 10.00 > 1.75 mil. BTU 5725 15) Vent fan connected to a single dud 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 to.00 18) Domestic incinerators v ent 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) 1.00 Other unit, including wood stoves, inserts, etc. 656 Minimum Permit Fee $72.50 SUBTOTAL gm l Gas piping 1-4 outlets 360 8% SURCHARGE ' i Each additional outlet - • 63 PLAN REVIEW 25% OF SUBTOTAL =' -- Required for ALL commercial permits only _ �'�' :.- TOTAL MEM Other Inspections and Fees: 1. Inspections outside or nomtal business hours (minimum charge -two hours) $72.50 per hour 2. Inspections for which no lee is specifically indicated (minimum charge -half tour) $72.50 per how Total Valuation Fee 7. Additional plan review required by changes. additions or revisions to plans (minimum charge-one-half hour) 572.50 per hour 'State Contractor Baler Certification required $ 1.00 to $5,000.00 Minimum $72.50 "'Residential Arc requires site plan showing placement of 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 • ....._.___ ..---- . . . ... . :v•Y4 c. g M II 1 s 1 .. . .. . . : . ., . . . . . , . . • . . . . . , . . . • . . . . .. .. _ . . . . _ _ . . . .. . . . . . . .. . . . . . . . . . _ . . _. . . . . _ . . : . . . . _ . . . , . . • \t.) .... .€p . sty , .. • . . . . . . . . . . . . . . . . . . . ._ . . . . . _....,, . , . . ... tt, n. . . . . . ) . . .. \ .,. •,.: . . . . . . . . , .. . -.., • , . . .. . . - . . . ..• •-: : . . . . . . ..- . . . . . .. • ,.. •, . . . . . . ' . •••■■■e", . , • . t r--'. - . . ,...., . .. . •f. -• •-• • • • . .. . . ., . . ... ,,_•.,. .. .•-, .. ....., ,..... .. . . • .. . . . ,. . .. , . . . . . , .. ... .. ._... ,• •• ,.. ., .. ._ . . . ... ...,. _ ,. ... . . , ... _ , ..... 3- (NY CITY 8F TIGARD BUILDING INSPECTION DIVISION MST - • 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested ✓ / U AM PM BLD Location /5"/// Sw 9 3 rse 44_- Suite MEC '00/ U Contact Person Ph 6 Z) - .3" y 3 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 , t�J C/G1/il G4 4-- Insulation Drywall Nailing Firewall Fire Sprinkler 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 AECHA>,l Post & Beam - .. Rough In Gas Line S i ' e Dampers PASS PART FAIL ELECT • 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 Approach /Sidewalk Date :� /6- D / Ins Ext Other Final PASS - PART FAIL DO NOT REMOVE this inspection record from the job site.