Permit W
CITY TIGARD MECHANICAL PERMIT
�I DEVELOPMENT SERVICES PERMIT #: MEC2001-00031
------ ' ' - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/25/01
PARCEL: 2S1 11 CA -07900
SITE ADDRESS: 15280 SW 100TH AVE
SUBDIVISION: GULF SIDE ESTATES NO. 2 ZONING: R -7
BLOCK: LOT: 023 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
GAS 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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Remarks: Back yard gas line installation
Owner: FEES
WARD, ROBERT J Type By Date Amount Receipt
15280 SW 100TH AVE PRMT CTR 1/25/01 $72.50 2720010000
TIGARD, OR 97224 5PCT CTR 1/25/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
SYSTEM AIRE INC
14444 SW FERN ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503 - 524 -5927 Final Inspection
Reg #: LIC 38062
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 questions to OUNC by calling (503)246- 189.
Issue By: F--e.--1 Permittee Signature: /
Call (5 3) 639 -4175 by 7:00 P.M. for inspections needed the next business d y
Mechanical Permit Application
Date received: \ &J b 1 Permit no.: rY1,14.20D / -coc3/
'.�ri , " i 11 City o
'
��. of Tigard
Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171 .
Fax: (503) 598 -1960 Case file no.: Paymenttype:
Land use approval: Building permit no.:
TYPE OF PERMIT
m. 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
• ew construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /s IfQ cel,tJ / bp t f-- _ 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: jurisdiction's fee schedule for residential permit fee.
City /county: v7 (Wd, / Wit I ZIP °7'7 ,/ c?" `' I & 2 FAMILY DWELLING PERMI[ FEE SCHEDULE
Description and location of work on premises: ba at- e"3-;.-.4. AND COMMERICAL /INDUSTRIAL EQUIPMENT SCHEDULE
67 C S (Wt.C. EA 5'1 Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? Yes 0 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: {1�t - / -e.---,------- c HP Tons BTU /H
Address: j 4 N 1Gp■ �' } Fire /smoke dampers/duct smoke detectors
City: - I" G+-v(i I State: CVLI ZIP: e l r d 2. 3 Heat pump (site plan required)
Phone: tz: ' ,e? -'f SN- Install/replace furnace/burner BTU /H
S ) 7 I E-mail: 1 Including ductwork/vent liner O Yes Cl No
CCB no.: 0 ���I �. Install /replace /relocate heaters- suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): /3-eLL /-r- c k_+ Vent for appliance other than furnace
CONTACT PERSON
Refrigeration:
Absorption units BTU /H
Name: i UV 412-D Chillers HP
Address: LSO, q-D ( j 0 t) °'"l"_y{-v,e • Compressors HP
/ Environmental exhaust and ventilation:
City: T v. �j, I State: 61 -1 ZIP: 7 d'� , 1 Appliance vent
hone: 7 »- '1 Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
N ame:. 7 /-�� Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: ZIP: Insert -type
Phone: I Fax: I E -mail: Woodstove/pelletstove
Other:
Applicant's signature: Date: Other:
Name (print): .
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
0 Visa CI 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 %) .... $
Name of cardholder as shown on credit card accepted as complete.
. $ TOTAL $
.
Cardholder signature Amount
440 -4617 (6100 /COM)
•
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price Total
Table 1A Mechanical Code Qty (Ea) Amt
$1.00 to $5,000.00 Minimum fee $72.50 1) Furnace to 100,000 BTU
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and including ducts & vents 14.00
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
fraction thereof, to and including including ducts & vents 17.40
$10,000.00.
$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 ; _ Neat_ Air ,
$1.20 for each additional $100.00 or `For items 7 -11, -see or ,�.Puriip_.. Gored
fraction thereof. ` footn o t e s below. -' ' 'Comp *'=. ' . - ** - .
7) <3HP;absorb unit
- to 100K BTU 14.00 •
ASSUMED VALUATIONS PER APPLIANCE: - 8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount - g) 15 -30 HP; absorb
Furnace to 100,000 BTU, including 955 unit .5 -1 mil BTU 35.00
ducts &vents - 10) 30 -50 HP; absorb
Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & 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 10.00
Vent not included in applicance 445 13) Air handling unit 10,000 CFM+
permit 17
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 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 656 69.95
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: ' ' r' $
Commercial or industrial incinerator _ 4,590
Other unit, including wood stoves, 6 56 8% State Surcharge : . x- : ` , $
inserts, etc. _ "
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) _ $
Each additional outlet 63 Required for ALL commercial permits only „i.: ii
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 Boller Certification required for units nOOk BTU.
'''``Residential A/C requires site plan showing placement of unit.
is \dsts \fornls\mech- fees.doc 10/11/00
CITY OF TIGARD BUILDING INSPECTION DIVISION , ST _
24=Hour(Inspection Line: 639 -4175 Business Line: 639 -4171
Date Requested 1— ZS''- 01 AM 1.0004 BLD
Location 152 I 0 (' —'" Ar‘1' Suite (m 000031
Contact Person Ph PLM
Contractor 4 n e, � 'C�✓� � k r'
2 ` ��� - Ph(`J01) - 51 2.7 SWR
BUILDING J Tenant/Owner r _' ` 3 IJ e-y-A ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Slab
Crawl Drain Inspection Notes: ( � Q�' CJ g � s , Wvc w SGT
> . SIT
Post & Beam ■ ^
Ext Sheath /Shear 1 /1/\ \S 1 A�
Int Sheath /Shear ( i 1
Framing (.D CS 1..,/._.Q 2 � 'Z ( % \ 6'2/ '1 I
Insulation 1 e C 4 I ^ ` `) 0
Drywall Nailing 7 ` 1(�.
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
E CHANK:
Post & Beam
Rou h In
Qs Li e
Dampers
Final `
S ` 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 9 , , Approach /Sidewalk 1/C/0 1 Inspector \( n � Ext /
Other Date
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .
,c '\ •
•
BUP - Building Permit ELC - Electrical Permit
4 Inspection Description Date Passed By 4 Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry /Reinforcement
Framing 0 /— Dd Q
MFG - Structure set -up I - Mechanical Permit
Insulation nspection Description Date Passed By
Drywall nailing Post/beam mechanical
Suspended ceiling Gas line 1 /Z5/o1
Engineered soils Mechanical rough -in
Welding Lab Final Fire damper
Concrete Lab Final Duct work
Bolting Lab Final Smoke detector
Fireproofing Lab Final Mechanical final ,/61
Structural observation
Final inspection
PLM - Plumbing Permit
4 Inspection Description Date Passed By
BUP — Fire Protection System Permit Plumbing underslab
4 Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm final Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
4 Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final
Sprinkler supply lines
Sprinkler underfloor /slab
Catch basin/Manhole SWR - Sewer Permit
Engineered soils 4 Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR, MEC SIT PERMITS
CITY TIGARD MECHANICAL PERMIT
vs"i DEVELOPMENT SERVICES PERMIT #: MEC2001 -00031
.��i 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/25/01
PARCEL: 2S111 CA -07900
SITE ADDRESS: 15280 SW 100TH AVE
SUBDIVISION: GULF SIDE ESTATES NO. 2 ZONING: R -7
BLOCK: LOT: 023 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
GAS 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:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Back yard gas line installation
Owner: FEES
WARD, ROBERT J Type By Date Amount Receipt
15280 SW 100TH AVE PRMT CTR 1/25/01 $72.50 2720010000
TIGARD, OR 97224 5PCT CTR 1/25/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
SYSTEM AIRE INC
14444 SW FERN ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503 - 524 -5927 Final Inspection
Reg #: LIC 38062
f eh
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 questions to OUNC yy calling (503)246-'189.
Issue By: j mil Permittee Signature:
Call (5 3) 639 -4175 by 7:00 P.M. for inspections needed the next business d. y