Permit CITY TIGARD MECHANICAL PERMIT
,r , l ,\ DEVELOPMENT SERVICES PERMIT #: MEC2001 -00213
.44 -IL DATE ISSUED: 6/14/01
13125 SW Ha Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S104AD -02300
SITE ADDRESS: 12535 SW 128TH AVE
SUBDIVISION: BELLWOOD ZONING: R -4.5
BLOCK: LOT: 050 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:
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 OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace existing gas furnace.
Owner: FEES
FOERSTER, JAMES W AND Type By Date Amount Receipt
JO NELLE PRMT CTR 6/14/01 $72.50 2720010000
12535 SW 128TH 5PCT CTR 6/14/01 $5.80 2720010000
TIGARD, OR 97223
Total $78.30
Phone:
Contractor:
SPECIALTY HEATING & COOLING
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Final Inspection
Phone: 620 -5643
Reg #: LIC 66578
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 -9• :9.
Issue By: ' .j Permittee Si natur . J Q,I�oJ
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Date received: ‘-(4 / / Permit no.: r EC.?.m 1 -(,)
464
1I City of Tigard
. e:_„ t y g Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 9722 I r j Date issued: By: Receipt no.:
Phone: (503) 639 -4171
I
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement 1
❑ New construction r Addition/alteration /replacement O Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /2,5 ,7- 6tk../ j 4" P- V Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: 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: / e5 t- e ,42 jurisdiction's fee schedule for residential permit fee.
City/county 7 ei- Ub}S [4 I ZIP: Cj 7.-Z3 1 & 2 FAMILY DWELLING PERMIT D SCHEDULE
Description and location of work on premises: ' 4 Q 40 i ., AND COMMERICAL/INDUSTRIAL EQUIPN ENTSCIIEDULE
i
/ Fee(ea.) Total
Est. date of completion/ inspection: ,) ` Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? Gres ❑ No Air handling unit CFM
space insulated? Yes ❑ No Air conditioning (site plan required)
Is existing P Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
State boiler permit no.:
Business namei, ,Q(f 4 L- AP y 4 * 41 i Y1 nc HP Tons BTU /H
Address: CI S .SGC.) 7 l) e r / J Fire/smoke dampers/duct smoke detectors
City: TS'ai q° �� y YY State: 0,� I ZIP: q 7,9 v. 3 Heat pump (site plan required)
Phonep3(P0vkc/,�'Faxs c 1 /g-E -mail: Install/replace furnace/burner inced3TU /H 1
CCB no.: �s 7 Including ductwork/vent liner 0 Yes O No
l _ Install/replace/relocate heaters - suspended,
City /metro lie. no.: lb, (-- wall, or floor mounted
Name (please print): s rir A.- 4 y)'14-tom et-5 Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: KA_ ry Lee n c I � Y] '1 O.. Chillers HP
Address: 75a- 8 SCZ "' q $ / '^ Compressors HP
Y T I I C �� Environmental exhaust and ventilation:
City: Sta e:C�e ZI P: Appliance vent
Phone6V 3 (ao - ' Fax: 59rop8' E -mail: Dryer exhaust
OWNER Hoods, Type I/ Illres. kitchen/hazmat
hood fire suppression system
Name: "IQ/WIZ 'O-e 0.6a4.-- Exhaust fan with single duct (bath fans)
Mailing address: / 35 5 sco 4.25 4 '. / / Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City: i `944 d I Staten I ZIP: q 72 9 - 3 Type: LPG NG Oil
Phone:.S/O -3333 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: State: I ZIP: Insert - type
Phone: I Fax: I E -mail: Woodstovelpelletstove
Other:
Applicant's signature: Date: Other.
Name (print): _
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7
O Visa 0 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 $ 3 C -
Cardholder signature Amount 440 -4617 (6100 /COM)
r
Commercial Schedule •
1 &2 Family Dwelling Schedule
ASSUMED VALUATIONS PER APPLIANCE
Description
Furnace to 100,000 BTU Table 1A Mechanical Code Qty Price Total
including ducts & vents 955 1) Furnace to ducts & 0 BTU
g including duds vents 14.00
Furnace > 100,000 BTU 2) Furnace 100.000 BTU+
including ducts & vents 17.40
including ducts & vents 1,170 3) Floor Furnace
including vent 14.00
floor furnace 4) Suspended heater, wall heater
including vent 955 or floor mounted heater ' 14.00
suspended heater, wall heater 5) Vent not included in appliance permit 6.80
or floor mounted heater 955 6) Repair units 12.15
appliance permit 445
Check it all that , see Boiler Heat Air. Vent not included in a
pp p For Hems 7 -10, see or Pump Cond Qty Price Total
Repair units 805 footnotes 1,2 Comp • "
7) <3HP; absorb unit to
< 3 hp; absorb.unit 100K BTU 14.00
8) 3 -15 HP; absorb unit
to 100k BTU 955 sock to Soak BTU 25.60
3 -15 hp; absorb.unit 9) 15 -30 HP; absorb
unit .5 -1 mil BTU 35.00
101k to 500k BTU 1700 10) 30 -50 HP; absorb
unit 1 -1.75 mil BTU 52.20
15-30 hp; absorb.unit 11) >50HP; absorb unit >1.75 mil BTU
87.20
501k to 1 mil. BTU 2310 12) Air handling unit to 10,000 CFM
30 -50 hp; absorb.unit 10.00
13) Air handling unit 10,000 CFM+
1 -1.75 mil. BTU 3400 ' 17.20 -
> 50 hp; absorb.unit 14) Non - portable evaporate cooler 1000
> 1.75 mil. BTU - 5725 15) Vent fan connected to a single dud
6.80
Air handling unit to 10,000 cfm 656 16) Ventilation system not included in
appliance permit 10.00
Air handling unit > 10,000 cfm 1170 17) Hood served by mechanical exhaust
10.00
Non - portable evaporate coller 656 18) Domestic incinerators
vent fan connected to a single duct 446 17.40
19) Commercial or industrial type incinerator
Vent syst. not included in appliance permit 656 69.95
Hood served by mechanical exhaust 656
20) Other units, including wood stoves 10.00
•
Domestic incinerator 1170 21) Gas piping one to tour outlets
5.40
Commercial or industral incinerator 4590 22) More than 4-per outlet (each)
1.00
Other unit, including wood stoves, inserts, etc. 656 Minimum Permit Fee $72.50 SUBTOTAL "
Gas piping 1-4 outlets 360 8% SURCHARGE um Ewa
Each additional outlet - 63 PLAN REVIEW 25% OF SUBTOTAL '_xz_n
Required for ALL commercial permits only _ .
•
TOTAL EOM
Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour
2. Inspections for which no lee is specifically indicated (minimum charge -hair lour)
$72.50 per hour
Total Valuation Fee 7. 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
$ I .00 to $5,000.00 Minimum $72.50 "Residential NC requires site plan showing placement of unit
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
each additional $100.00 or fraction thereof,
to and including $10,000.00
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54
for each additional $100.00 or fraction
thereof, to and including $25,000.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45
for each additional $100.00 or fraction
thereof, to and including $50,000.00
$50,000.00 and up $742.00 for the first $50,000.00 and $1.20
for each additional $100.00 or fraction
thereof
' OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested AM PM BLD
Location / Suite MEC Z- /3
Contact Person Ph ‘4 Ski q 3 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 PART FAIL
<446E-- N1 L
Post & Beam
Rough In
Gas Line
Smoke Dampers
PAS 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 ( 3 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
- -.
-
BU P - 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 4 Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry /Reinforcement
Framing
MFG - Structure set -up MEC - Mechanical Permit
Insulation
Drywall nailing 4 Inspection Description Date Passed By
Post/beam mechanical
Suspended ceiling Gas line
Engineered soils Mechanical rough -in
Welding Lab Final Fire damper
Concrete Lab Final Duct work
Bolting Lab Final Smoke detector
Structural observation Mechanical final - =1:1.1 - z - AF
Fireproofing Lab Final
Final inspection
PL M - 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
is \dsts \forms \InspRecordBUP. doc 04/17/01
r - •
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2001 -00213
A 13 125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
DATE ISSUED: 6/14/01
PARCEL: 2S 104AD -02300
SITE ADDRESS: 12535 SW 128TH AVE
SUBDIVISION: BELLWOOD ZONING: R -4.5
BLOCK: LOT: 050 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:
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 OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace existing gas furnace.
Owner: FEES
FOERSTER, JAMES W AND Type By Date Amount Receipt
JO NELLE PRMT CTR 6/14/01 $72.50 2720010000
12535 SW 128TH 5PCT CTR 6/14/01 $5.80 2720010000
TIGARD, OR 97223
Phone:
Total $78.30
Contractor:
SPECIALTY HEATING & COOLING
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Final Inspection
Phone: 620 -5643
Reg #: LIC 66578
7
n
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by S
calling (503)246 -9- 9 N
Issue By: � - J, ,r e/t Permittee Signatur 1,4
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day 1$