Permit S a
'•h CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2002 -00215
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/23/02
PARCEL: 2 S 104AA -02700
SITE ADDRESS: 12255 SW 126TH AVE
SUBDIVISION: BELLWOOD ZONING: R -4.5
BLOCK: LOT: 039 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: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Remarks: Install exterior A/C unit. Cannot be placed in the required set backs.
Owner: FEES
WEISS, STEVEN R + REBECCA M Type By Date Amount Receipt
12255 SW 126TH AVE PRMT CTR 5/23/02 $72.50 272002000C
TIGARD, OR 97223 5PCT CTR 5/23/02 $5.80 272002000C
Total $78.30
Phone:
Contractor:
COLUMBIA HEATING + COOLING INC
8900 SW BURNHAM
TIGARD, OR 97223 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 624 -2704 Cooling Unt Insp
Reg #: LIC 76359 Final Inspection
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 questions to OUNC by calling
19t-Q1 R
Issue By: 1 Permittee Signature: , �jZj
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day Ct
• • ' Mechanical Permit Application
Date received: Date received: 5 y Permit 3Jk7 ..009l 5
"'` " ' '1 _„ City g
Ci of Tigard .: Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By 9, QQ Receipt no.:
Phone: (503) 639 -4171 V
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
• 1 & 2 family dwelling or accessory 0 Commercial/ind :.1 LI Multi- family LI Tenant improvement
U New construction gadditi . r . teration/ r 1lacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /aa -- 5 ,) / ,.,2 6 4-1_ , 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: "779 , , j I ZIP: 97 z ;7 3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
- dt/ '9/ _.. Fee(ea.) Total
Est. date of completion/inspection: . 1 j3D /O 1 . Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
space heated or conditioned? 0 Yes LI No Air handling unit CFM
Is existing p Air conditioning (site plan required)
Is existing space insulated? 0 Yes LI No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
State boiler permit no.:
Business name: �U ,,../6,,,„ --7 ./.7.4, co HP Tons BTU /H
Address: G'O x (-9, p 3 g 7 Fire /smoke dampers /duct smoke detectors
City: 77' Cry State: q- 2 , 2 _s ZIP: q _Heat pump (site plan required)
Phone: 6. 9 a7 D y � I Fax:9( 42 7a E -mail: Install/replacefurnacelburner BTU /H
Including ductwork/vent liner ❑ Yes LI No
CCB no.: 76 3 5 J Install/replace/relocate heaters - suspended,
City /metro lic. no.: /v 7.,. wall, or floor mounted
Name (please print): ,F77 c ' { �� / c Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: /*A./ Q '-/b/ Chillers HP
Address: / Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: 0 2 ; 0 Fax: E -mail: Dryer exhaust
OWNER Hoods, Type 1/11/res. kitchen/hazmat
hood fire suppression system
Name: 6 G/Ly- 1-.4 .le i S Exhaust fan with single duct (bath fans)
Mailing address: /- • ic' Exhaust system apart from heating or AC
. , -
City: -- 7 - 7 - ,, -- 7 - 7 - ,, / State:c ZIP: 17 2, 3 Fuel pipmg and distnbut on G Oil
to 4 outlets)
Type: LPG NG
Phone: 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: !Fax: 1 E -mail: Woodstovelpellet stove
Other:
Applicant's signature: ,„e . . 1 0, e I Date: 2z-fl Other.
Name (print): /e /5
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa 13 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 4.40-4617 (6/00/COM)
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
$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 Pump Cond
Comp fraction thereof. footnotes below. p *•
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 10,000 CFM 10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 955 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 applicance 445 10.00
permit 18) Domestic incinerators
Repair units 805 17.40
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 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 induded in 656
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1,170 1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator $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 Boller Certification required for units >200k BTU.
TOTAL COMMERCIAL a ` ' "' $ ** Residential NC requires site plan showing placement of unit.
VALUATION: at i li g..es
All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms\mech - fees.doc 12/26/01
(4 IA-IJ %611 A" %ri Cad i - 0,4 / .'S S w 10 6,64- ,
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11 35
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CITY OF TIGARD 24 -Hour - -
BUILDING % - , Inspection Line: (503) 639 -4175
4.--
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
G� BUP
Received Date Requested L��' ' AM / 3 2M BUP
Location / 2 - 7%4 4 5 Zu (2-& 7 Suite / /, mod-' S
Contact Person /9Gitvt Ph ( ) & 7 V PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner Te ' 7 9 ' ? V ELC / . "'`R
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection No T
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear 'I 4)k9 o D= �� 3
C
Framing _J V I �CJ� , �d Q J
Insulation
Drywall Nailing
Firewall , ° C._�-. ,C. -!)" .Q� ----- al
Fire Sprinkler
Fire Alarm - I D / 3 L1
Susp'd Ceiling
Roof
Other: �
Final ` J TS C--erv‘ {-
PASS PART FAIL
PLUMBING 2A
Post & Beam
Under Slab n �_ , n /�
Rough-In Se V 1 OLX r wV . CA-to... 0Z1 --Z t--/- 6 --- 7 ----. s --- Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS T FAIL
.9
i AJ t
Post & Beam
Rough -In ` �I C
Gas Line V" ll
S oke Dampers
in
A 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 Approach/Sidewalk Date I ' e I nspec t or L v v Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL