Permit + CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2001 -00402
' FIJI 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/9/01
PARCEL: 2S111 BD -00503
SITE ADDRESS: 14820 SW 98TH AVE
SUBDIVISION: DARMEL ZONING: R -3.5
BLOCK: LOT: 002 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: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replacement of furnace.
Owner: FEES
ETZEL, PATRICIA L Type By Date Amount Receipt
14820 SW 98TH AVE PRMT CTR 11/9/01 $72.50 2720010000
TIGARD, OR 97224 5PCT CTR 11/9/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
COLUMBIA HEATING + COOLING INC
PO BOX 230397
TIGARD, OR 97223 REQUIRED INSPECTIONS
Heating Unt Insp
Phone: 624 -2704 Final Inspection
Reg #: LIC 76359
PLM 34 -175
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 que • C • calling
rnR»aR_Qi R
Issue By: Permittee Signature. AL_ NV &.
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next • siness d
Mechanical•PermitApplica '
,.. iii iii
Date received: I () ) Permit no.#19/ -co j
1 .41 City of Tigard /6/ Projecdappl. no.: Expire date:
CiryojTigard Address: 13125 SW Hall Blvd, Ti gard OR 9 2
Phone: (503) 639 -4171 Date issued: B3 Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
& & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi- family ❑ Tenant improvement
ew construction Addition /alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: It/ S'Z 0 SW gg -. 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: [ Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: 17.1 m. -d I ZIP: q7 ? . t,/ I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and to ation of work on premises: I AND COMMERICAL /IND(USTRIAL EQUIPMF.NTSCIIEDULE
`- Fee(ea.) Total
Est. date of of completion/inspection: ^'r te
Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? U Yes 0 No Air handling unit CFM
Air conditioning (site plan required)
Is existing space insulated? 0 Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
State boiler permit no.:
Business name: (,-, yt b;; afa,),, HP Tons BTU /H
Address: WOO , ,J iavi.ii1'vl -- Fire/smoke dampers/duct smoke detectors
City: -T7 „,,p-r d State: [ ZIP: Heat pum site Ian required)
Phone: 6,4 t.( - 2,70ti [ Fax: [ E -mail: Install/ pla efurn e/burner BTU /H '
CCB no.: (Q 3 s Includin r vent liner O Yes ❑ No
Install/replace/relocate heaters - suspended,
City /metro lic. no.: 0/a 7 a, wall, or floor mounted
Name (please print): A i • ki, / Vent for a . ' liance other than furnace
CONTACT PERSON e I gera ■ on:
Absorption units BTU/H
Name: l A-rj I Ttfako c 9 Chillers HP
Address: J Compressors HP
Environmental exhaust and ventilation:
City: [ State: [ ZIP: Appliance vent
Phone: (r • - D1 Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: g i ~u-f J Exhaust fan with single duct (bath fans)
Mailing address: i i f hi. C� elf'' Exhaust system apart from heating or AC
O Fuel piping and distribution (up to 4 outlets)
City: I i c 4 ed S tate: oft ZIP: x712,5/ T LPG NG Oil
Phone: i l 3„ Y,F Fax: E -mail:
Type.
Fuel i in each additional over 4 outlets
rocess p p g (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: [ State: [ ZIP: Insert - type .
Phone: ax: I E -mail: Woodstove/pelletstove
Applicant's signature: C.,...., \.) Date: Aj 10 0 i Other:
Name (print):
' Not all jurisdictions accept credit cards, please call jurisdiction for more information` Permit fee $ 7 - . , v
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
ex if a permit is not obtained
Credit card number: � / Plan review (at _ %) $
Expires within 180 days after it has been
Name of cardholder as shown on credit card accepted as complete. State surcharge (8 %) .... $ `C - r7
$ TOTAL $ /73.
` Cardholder signature Amount , 440 -4617 (lvW/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) 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
$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) <3HP;absorb unit
ASSUMED VALUATIONS PER APPLIANCE: to 1K BTU 14.00
3-
Value Total 8) 3 -15 HP; absorb
unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount
Fumace to 100,000 BTU, including 955 9) 15 -30 HP; absorb
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 8, vents 11) >50HP: absorb
Floor furnace 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
Vent not included in applicance 445 10.00
permit 13) Air handling unit 10,000 CFM+
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
15-35-3 0 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
1 -1.75 mil. BTU 10.00
>50 hp; absorb. unit, 5,725 18) Domestic incinerators
17.40
Air >1.75
handling BTU 19) C ommercial o r industrial
Air hading unit to 10,000 cfm 656 ) type incinerator
Air handling unit >10,000 cfm 1,170 69.95
Non - portable evaporate cooler 656 20) Other units, including wood stoves
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% State 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)
c / ! $72.50 per hour.
z" > (� 2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
C) $72.50 per hour
D
C U 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 NC requires site plan showing placement of unit.
i:\dstsV. 10/11/00
CITYf` CARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ BUP
Date Ikequested / / z '' AM PM BLD
Location I el g -z 5 g /4 Suite MEC Z'€/- C ( /G L
Contact Person Ph (/ Z y Z 70 c( 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
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 ART FAIL
llEGHANIC
Post & Beam
Rough In
Gas Line
Smoke Dampers
Ski 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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date // Z /-- (/ / Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.