Permit i h ; CITY OF TIGARD MECHANICAL PERMIT
IA DEVELOPMENT SERVICES PERMIT #: MEC2001-00347
+L _.� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/4/01
PARCEL: 2S115BC -15700
SITE ADDRESS: 16805 SW 124TH AVE
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
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:
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: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of Heat N' Glo Insert.
Owner: FEES
LORNA JACKSTADT Type By Date Amount Receipt
16805 SW 124TH PRMT BB 10/4/01 $72.50 KING CITY
KING CITY, OR 97224 5PCT BB 10/4/01 $5.80 KING CITY
Phone: 503-684-7027 Total $78.30
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 503 - 656 -1184 Final Inspection
Reg #: LIC 447
PLM 3 -286PB
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
Issue By: cij,, ,(p /,✓�i_, Permittee Signature: G� �� `��
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
10/02/2001 13:13 5036393771 i i CITY OF KING CITY PAGE 02
Permit App cation
Datereceived: I Permit
Mechanical PP (r , {,9
= � ,.� no.:
46 ,I!,: City of Tigard n Projec no.: Expire date:
Address: 13125 SW Hall lvd, Tigat 97223 O11e ' r
City of regard Date issued By) I Receipt no.:
Phone: (503) 639 -4171 0 ? Payment type:
Fax: (503) 598 -1960 \')C) OQM�N3 Case file no.:
Land use approval: _ 01 Payment
B permit no.:
1
'11 O1 P110111
❑ Multi-family ❑ Tenant improvement
1;1 New 2 w c onstrctiou dw or accessory 0 Addition/alteration/replacement Commercial/industrial l0 Other: y
p eonstmn
.101151'11 INI'OIt 1,VI ION ('ONI111 •1111,11. 1'ALI A1'1ON 5( III :9111.1.
Job address: I (pAIJO5 4 6 l (4 R% ,) Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: : , Suite no.: — value of all mechanical materials, equipment, labor, overhead,
g profit. Value $
T , • . lot/account no.: application information and
Lot: Block: Subdivision: See checklist for Important app
Project name: G n — No o jurisdiction's fee schedule for residential permit fee.
City /county: VVIIFKIOSINE 4 1221110EIFVFMINE
• I S 711 11111.V 1)111'.11IN(: PERMIT 111: 5CllIDtJI,R
Descript�ippn and lo ;tio• o wo on •rettli- ' ■ ∎ s tNU('ON18 1 1121(' 1I./ I Nlti` t ltl‘l.1(11;1PN11NIS ( ' 111 I 11U LE
o. V W . • 1 t �o ■. rr� .111 Fee(ea.) Total
�� • a Reason' onl Res. only
Est. date of completion/inspection: (ICY I3VAC:
Tenant improvement or change of use: Air handling unit ., CFM
Is existing space heated or conditioned? U Yes ❑ No • rcon• t oning a to plan required)
Is existing space insulated? 0 Yes ❑ No Alteration of existing RVAC system
M1:('IlANI('AI• CON 1ItA('101t Boiler compressors
�•1 Stine boiler pertntt no.:
i4 1 ` HP 'Eons BTU/H
Address: t r �� G G. Fir smoke dampers/duct smoke .etectors
y ZIP • Heat pum • (site p an • utted)
nstall/rep ace fumao urner B •
Phone: :► L +r lUnlatl. Including ductwork/vent liner O Yee 0 No
3
CCB no.: , . ; L .. ' . .4 Install/tep ac relocate eaters - suspen • - ' .
City /metro lic. no.: wall, or floor mounted
Name (please • rint): _F • �� Vent or a.. Nance other t an furnace
. _spt Oii
('ON 1 A(T I'I• Absorption ita BTU/H
Chillers kIP
Name: L h Co . reason HP HP
Address: S lTit + exhaust a v = .I 1 on:
. G . . . / ' • 1 A. •lianaeve nt
Phone: . 1 I E -mail: Dryer exhaust • oods, ype l/ I res. tell; , azmat
OWN I l( hood fire suppression system
Name: " .I V] Exhaust fan with sin: le duct . thfans
r .
E x lusts : loin a • art one eatm • or A
Mailing address: - ilaTI • t ii�� e t , i r= o a m to • ou ens
Ph • 0 , Fax: E-mail: - ue . i. in , eac ad.ltionai over ' ou eta V
I :N(:IN11It ' . esrp , , g se emancrequir-
Number of outlets — —
Name: Other listed appliance or equipment
_ De L;1, 2%i . -.lace
J�
Address: + w i t y. s/�1.1Ia>h,a.rtlm
���'�` ZIP; ;ELL; pelletatove
Phone: L mail Other.
Applicant's signature: AM., - Date: el er:
Name (print): .�1Ll10 r 1J► •
Permit fee $ �
Nd jurlodt ation , ec ept credit cents, plum jurisdiction for more I eons NOtlee: This perm applicat Minimum fee $ �� D
O. Vies ❑ MasterCard Notice:
/ expires if a permit is not obtained men review (at _ %) $
Cteeft card number
Expires within 180 days after it has been State surcharge (8%) $
erne rare accepted as complete.
S TOTAL $ I
Cardholder signature Amount , 44O - 4611 (6J0o/COM)
10/02/2001 13:13 5036393771 CITY OF KING CITY PAGE 03
w
O
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 $10,000.00 572.50 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 525,000.00 $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 ' 8
fraction thereof, to and including 6) Repair units
$50,000.00. , 12.15
550,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boller Hea Air
$1.20 for each additional $100.00 or For Items 7 -11, see or Pump Cond
Y fraction thereof. footnotes below. Comp* _ "" .
7) <3HP :absorb unit
ASSUMED VALUATIONS PER APPLIANCE: _ to 100K BTU 14.00
8 )
Value Total 3 1 ; r; absorb
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 5
ducts & vents 11) >50HP: absorb
Floor furnace induding 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 appllcance 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 T 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
mil. BTU appliance permit 10.00
30-50 hp; absorb. unit, 3,400 17) Hood served by mechanical exhaust 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 ir handling unit to 10,000 Gfrr) 656 69.95
Air handling unit >10,000 cfrn 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 l 5.40
appliance permit 22) More than 4 -per outlet (each)
Mood served by mechanical exhaust 656 1,00
Domestic incinerator _ 1,170 - Minimum Permit Fee $72.50 SUBTOTAL: ' $
Commercial or Industrial indnerator 4,590
Other unit Including wood stoves, 656 8% State Surcharge $
inserts, etc.
Gas piping 14 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 A/C requires site plan showing placement of unit.
1:\dsts \forms\mech- fees.doc 10/11/00
�� �F . _ _....�..... _ ....._ ----
CITY OF �j� p
BUILDING PERMIT APPLICATION TIGARD DATE , 19 (/ N
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT FOR THE WORK HER N INDICATED
OR AS SHOWN AND APPROVED IN THE ACCOMPANYING PLANS AND SPECIFICATIONS. OWNER PHONE
OWNER 486 •- YIA .Ci(�/`r� O ADDRESS /b d�J6e) /9 ii BUILDER PHONE
ENGINEER
.T.; f LD E R
ARCHITECT DESIGNER
r-�
STRUCTURE r2 NEW O REMODEL ❑ADDITION .REPAIR ❑RENEWAL OFIRE DAMAGE ❑DEMOLITION
RESIDENCE❑ COMM DEDL'CATIONAL DGOV'T D RELIGIOUS DPATIO CAR PORT . ❑GARAGE ❑ STORAGE DSLAB ❑FENCE
BOND uMOVING ECONDITIONALUSE ❑DESIGN REVIEW ❑COUNCtLAPPROVED ❑SIGNS
OCCUPANCY LAND USE ONE BLDG. TYPE FIRE ZONE_ PLAN CHECK BY ���� H
/ °Q12 ` SD-71 /
OCC LOAD FLOOR LOAD HEIGHT NO. STORIES AREA VALUE 775 -
N
I BUILDING DEPARTMENT SET BACKS FRONT REAR LEFT SIDE RIGHT SIDE
!I --
Permit I
Ir THIS PERMIT IS ISSUED SUBJECT TO THE REGULA CONTAINED IN THE BUILDING CODE, ZONING
Plan Check !j REGULATIONS AND ALL APPLICABLE CODES AND ORDINANCES, AND IT IS HEREBY AGREED THAT THE
II WORK WILL BE DONE IN ACCORDANCE WITH THE PLANS AND SPECIFICATIONS AND IN COMPLIANCE WITH
Recording ji ALL APPLICABLE CODES AND ORDINANCES. THE ISSUANCE OF THIS PERMIT DOES NOT WAIVE
l RESTRICTIVE COVENANTS. CONTRACTOR A. A CONTRACTORS TO HAVE CURRENT CITY BUSINESS
;
State � ;—/ LICENSE. SEPARATE PERMITS REQUIRED FOR .vER, PLUMBING AND HEATING.
Total it /• 2-!
L Ely r t APPLICANT uk HGr ;t.
Approved Ii I Receipt No.
ADDRESS PHONE
CJTi OF TIGARD BUILDING INSPECTION DIVISION
24- HoueInspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Rquested / -5-
AM PM BLD
Location Suite A MEC ( Z 1 60 3 4 ( 7
Contact Person Ph D PLM
Contractor Ph SWR
BUILDING Tenant/Owner • �l,G�- �i� _ � �- - �� ELC
Retaining Wall -7D k7 ' 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 PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
�� 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 D ate Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.