Permit ,r
` CITY OF TIGARD MECHANICAL PERMIT
l DEVELOPMENT SERVICES PERMIT #: MEC2003 -00602
- I'll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/16/03
PARCEL: 2S102BA -03400
SITE ADDRESS: 12089 SW 95TH AVE
SUBDIVISION: DUBLIN PARK ZONING: R -25
BLOCK: LOT: 004 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: 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:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS: 1
Remarks: Replace gas furnace.
Owner: FEES
TAN VO Description Date Amount
12089 SW 95TH AVE
TIGARD, OR 97223 [MECH] Permit Fee 10/16/03 $72.50
[TAX] 8% StateTax 10/16/03 $5.80
Phone: 503 443 - 1575 Total $78.30
Contractor:
PIONEER GAS FURNACE
3615 NE BROADWAY
PORTLAND, OR 97232 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Final Inspection
Reg #: LIC 36102
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 -00
Issued By: Permittee Signature: ,n,/ /97y e g7 — TD. , \./
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
- - j echanicalPermit Application
Date received: /d / /y /Q 3 Permit no.lee V103.6060
4,' .`IL' City of Tigard Project/appl. no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223
a�
Phone: (503) 639 -4171 Y I Date issued: Bc "eceipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.: C -
TUT OF PrRM1T `
1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /a0 o 9 5 4 e, , 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: I Subdivision: *See checklist for important application information and
Project name: V O jurisdiction's fee schedule for residential permit fee.
City /county: yj . ert i LIP: 9-- q7.?. -3 1 & 2 FAMILY DWELLING PERMIT FEf, SCHEDULE
Description and 1 n of work on premises: M
AND COMMERICAL/INDUSTRIAL EQUIP
_ ,p rrin � Fee(ea.) Total
Est. d ate of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air
Is existing space heated or conditioned? ❑ Yes ❑ No handling unit CFM
Air conditioning (site plan required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: • i e e r G as Furnace_ State boiler permit no.:
HP Tons BTU /H
Address: 31 15 E.. R u. 3_L Fire/smoke dampers/duct smoke detectors
City: Por-ki ` I Stater) ZI C? 7,2 ? 7 Heat pump (site plan required)
PhoneS(73.2 y ax: 7,2 �yp� 1 Install/replace furnace/burner BTU /H / /` , _
Including ductwork/vent liner ❑ Yes CI No . I / d� / 7 CCB no.: 3t /O2- /) 7 InstalVreplace/relocateheaters- suspended,
City /metro lic. no.: 13 , • wall, or floor mounted
Name (please print): A • a ' • IN/II " Vent for appliance other than furnace
CONTACT PERSON Refngerat on:
Absorption units BTU /H
Name: t (1L-etT Chillers HP
Compressors HP
m t°__ L
Address: 3 06 c t ip . - Environmental exhaust and ventilation:
City: I State: ( ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER . " Hoods, Type 1/ IUres. kitchen/hazmat
hood fire suppression system
Name: --- raiiV 1 ie, Exhaust fan with single duct (bath fans)
Mailing address: 0 0.S , h Exhaust system apart from heating or AC
City: I State:'P: Fuel piping and distribution (up to 4 outlets) ��jj��
Type: LPG ) NG Oil / 5, 9t S.��7v
Phonic _1$7 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: I State: I ZIP: Insert - type
Phone: ax: I. / ail: Woodstove/pellet stove
Other:
Applicant's signature: 4.,ar gam ...i�..iL Date: f i • - Other:
Name (print): / ,
Not all jurisdictions accept credit cards, please call jurisdiction for more information
Permit fee $ .� _2 a 50
CI Visa ❑ MasterCard Notice: This permit application Minimum fee $
Credit card number: ` / expires if a permit is not obtained Plan review (at %) $ -
Expires within 180 days after it has been
State surcharge (8%) .... $ Yei
Name of cardholder as shown on credit card accepted as complete. o
$ TOTAL $ '7g 30
` Cardholder signature Amount , 440-4617 (6100/COM)
P
MECHANICAL PERMIT FEES • _
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT 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) Furnace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 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 Furnace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater 14.00
$25,000.00. or floor mounted heater
$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 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 Comp Pump Cond
fraction thereof. footnotes below.
Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU 14.00
8% State Surcharge $ 8) 3 -15 HP; absorb
unit 100k to 500k BTU 25.60
25% Plan Review Fee (of subtotal) $ 9) 15-30 HP; absorb
unit .5 -1 mil BTU 35.00
Required for ALL commercial permits only 10) 30 -50 HP; absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1 -1.75 mil BTU 52.20
11) >50HP; absorb
unit >1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12) Air handling unit to 10 CFM 10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 9 14) Non- portable evaporate cooler
ducts & vents 10.00
Furnace > 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 appliance 445 10.00
permit
Repair units i 805 18) Domestic incinerators 17.40
<3 100k BTU orb. unit, 955
to 100k BT 19) Commercial or industrial type incinerator
69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101 k to 500k BTU 10.00
15 -30 hp; absorb. unit, 501k 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 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge $
, Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not included in 656
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1 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 fee 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
Gas piping 1 - 4 outlets 360 charge -one -half hour) $62.50 per hour
Each additional outlet 63 `State Contractor Boiler Certification required for units >200k BTU.
* * Residential A/C requires site plan showing placement of unit.
TOTAL COMMERCIAL $
VALUATION: All New Commercial Buildings require 2 sets of plans.
is dsts\forms\mech- fees.doc 02/11/02 -
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ ] l BUP
Received ` /d i"- Z Date Requested 3 ` 1 AM PM BUP
Location /Zc 9 ..44f) Suite (J 3- zt'lT n d Z
Contact Person Ph ( ) PLM
Contractor asmp.e..t Ph ( 5O 244 SWR
BUILDING Tenan / eI _ f /lY ELC Li (VL'
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors /1
Ext Sheath/Shear 503 -- 5 - 1(12 / 5- 5
Int Sheath/Shear
Framing
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
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
P FAIL \3 \ toN�
EC N �"
Pos � C p
am p a' Rough -In ,,t
Gas Line
• . - Dampers
Fi`
"'SS PART FAIL _
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA Awl
Approach/Sidewalk Date 7 /, Ins • • r /i .:/ Ext
Other:
Final DO NOT REMOVE this inspection record from the Jo site.
PASS PART FAIL