Permit es
CITYOF TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2002 - 00055
I'll DATE ISSUED: 2/11/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 110AA -00300
SITE ADDRESS: 14145 SW 105TH AVE
SUBDIVISION: ZONING: R -
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 11.2 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 4 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Replace 4 gas furnaces with same.
Owner: FEES
BEVERLY ENT TIGARD CARE CTR Type By Date Amount Receipt
BY GEORGE MCELROY +ASSOC INC PRMT CTR 2/11/02 $72.50 2720020000
PO BOX 565048 5PCT CTR 2/11/02 $5.80 2720020000
DALLAS, TX 75356
Total $78.30
Phone:
Contractor:
SPECIALTY HEATING & COOLING
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 620 -5643 Heating Unt Insp
Reg #: LIC 66578 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 may obtain copies of these rules or direct questions to OUNC by calling
rn R . ," ,
Issue By: Imo' ,, Permittee Signature: ;IA A
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
D ate received: �' / / Py Permitno.:/ -O , I)
4" "'' , �l� i" City of Tigard Pro ect/a 1 no.: Expire date:
City of Tigard Address 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By j( Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory JS"Commercial/industrial ❑ Multi - family LI Tenant improvement
❑ New const ruction ' tAddition /alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: (t-f 1 t(5 -SW I DSC ,4 Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical mat rials, e u nt, labor, gerhead,
Tax map /tax lot/account no.: profit. Value $ — • g i '
Lot: (Block: I S / ubdivision: *See checklist for important application information and
Project name: T yard l ee I7.4,1) jurisdiction's fee schedule for residential permit fcc.
City /county:/je (4)/9,6 fl I ZIP: q 1 2..,• - 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Descriptio d location of work on premises: /P•Pp /Ctc e' L{ AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
- -7 Fee(ea.) Total
Est. date of completion/inspection: 4 2 /13 An z Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM •
Is existing space heated or conditioned ?,f Yes ❑ No Air conditioning (site plan required)
Is existing space insulated? Ar Yes LI No Alteration of existing HVAC system
MECIIANICAL CONTRACTOR Boiler /compressors
Business name: lid p et 00 !M l nL.
State boiler permit no.:
b / HP Tons BTU/H
Address: 9'52' Sk) TQ:S+�r Fire/smoke dampers /duct smoke detectors
City: 1; ; cz,✓'e! I State: O/ I ZIP: 9 7 _23 . Heat pump (site plan required) _
Phone: 4 a0 - SG c/ 3 I Fax: S ft- ri E -mail: Install/replace furnace/burner BTU /H 4
Including ductwork/vent liner LI Yes ❑ No
CCB no.: ( 7cf InstalUreplace/relocate heaters suspended,
City /metro lic. no.: / G f4 wall, or floor mounted
Name (please print): go t n . i. j 01,44 zs Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: 1 /.P.e4 1 Sf4/1/.#✓ Chillers HP
Address: ` �A -vx-e GO azavv4i
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U IUres. kitchen/hazmat
hood fire suppression system
Name: - 72 - 614 0 ee AAA • tX/vt t Q/" Exhaust fan with single duct (bath fans)
Mailing address: / q 1 YS s ,) 10327 .4-V Exhaust system apart from heating or AC
City: Via. 4 (State: q(e I Z IP: 9 7 of Fuel piping and distribution (up to 4 outlets)
f Type: LPG NG Oil
PhoneLe 39- // V 4 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: I ZIP: Insert - type
Phone: (Fax: (rE -m
signature: /j'4�� ail: Woodstove/pellet stove
Other:
Applicant's Date: oZ� /// � Other:
Name (print): K - ere ...9.//17.1441
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ - 7--
❑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%
Name of cardholder as shown on credit card accepted as complete. g ( ) "" $
$ TOTAL $ - 7C.3 d
Cardholder signature Amount 440 -4617 (6i00/COM)
MECHANICAL PERMIT FEES Y
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 Qh (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
including ducts & vents 14.00
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
fraction thereof, to and including 17.40
$10,000.00. including ducts & vents
$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
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 9) 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 17.20
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 -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: $
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)
$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 Boiler Certification required for units >200k BTU.
** Residential NC requires site plan showing placement of unit.
is \dsts \forms\mech- fees.doc 10/11/00
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION '" Business Line: (503) 639 -4171 MST
l / �r1 BUP
Received Date Requested `/ S AM PM BUP
Location 1 `/ 1-C /0 4 " Suite MEC 2 (-7o -
Contact Person Ph ( ) (n -o `1 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner (2 22 4.-- ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
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 r'
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PA FAIL
del G
Rough -In
Gas Line
Smoke Dampers -
1'
PASS PART FAIL
• - RICAL
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 D Please call for reinspecti • n RE: 0 Unable to inspect — no access
Fire Supply Line
ADA (-1
— inspector
Date C A `—inspector 721-7N—\-- Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL