Permit CITY TIGARD MECHANICAL PERMIT
1 I DEVELOPMENT SERVICES PERMIT #: MEC2001 -00159
— ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/14/01
PARCEL: 2S1 02 BA -00800
SITE ADDRESS: 12155 SW GRANT AVE A 6
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND ZONING: I -P
BLOCK: LOT: 059 JURISDICTION: TIG
CLASS OF WORK: REP FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: 1 VENT FANS: 2
OCCUPANCY GRP: F2 VENTS W/O APPL: VENT SYSTEMS: 1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
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:
> 10000 cfm: GAS OUTLETS:
Remarks: Fire restoration. Suite A- installation of (1) unit heater, suspended, (1) bath fan, and (1) dryer vent. Suite
B- install B vent and environmental vent only.
Owner: FEES
SEE -ZER PROPERTIES Type By Date Amount Receipt
26785 SW NEILL RD PRMT CTR 5/14/01 $72.50 2720010000
NEWBERG, OR 97132 5PCT CTR 5/14/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
ROBBEN + SONS HEATING
2214 SE 8TH AVE
PORTLAND, OR 97214 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 233 -5841 Final Inspection
Reg #: LIC 1884
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 - 1.80 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -00 -0010 througr{ e i R 952 - 001 -0080.
You may obtain copies oft e e rules or direct questions to OUNC •\ c. ng ' r - % : •
, issue i y ` / Permittee Signat
Call (51 • 639 - 4175 by 7:00 P.M. for inspections needed the next business day
24/7„.„t� ,..a t;✓' C C — _,,i..s.e..r.) #� 6 tip_ , , oc2! —000 0 7
f Mechanical Permit Application
Date received: 5 11111111M1)111111
P i a/ Permit no.: rif.C A h .a. .,.A I City Of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Recei
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 n Commercial/industrial ❑ Multi - family Cl Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: J /6" S kr r Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: ,f- I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name: cS��Z,E jl jurisdiction's fee schedule for residential permit fee.
City /county: pri. , Mat, I ZIP: %' 7 ,,z 3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on / premises: XrftrIll, 2G AND COMMERICAL/INDUSTRIAL EQUIPMENT SCHEDULE
/ ?;0�a +�/L --- G r 5 ♦ ' )3 - ... '__ It • Fee(ea.) Total
Est. date of completion/inspection: ter- /6 of Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air
Is existing space heated or conditioned? 0 Yes ❑ No Air conditioning unit CFM nditioning (site plan required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
. MECHANICAL CONTRACTOR Boiler /compressors
Business name: /h p iyZ vt. yT n Ce • State boile permit no.:
i f HP Tons BTU/H
Address: X / <SF 8712 Fire/smoke dampers/duct smoke detectors
City: pi,„zL .. I State: tS I ZIP: 77'2 iii Heat pump (site plan required)
Phone: X33 —SBif/ IFax:,,L,3 - mail : Install/replace furnace/burner BTU /H
Including ductwork/vent liner CI Yes ❑ No
CCB no.: /5 e InstalUreplace /relocate heaters — suspended,
City /metro lic. no.: "Q 9,(37 wall, or floor mounted I
Name (please print): Vent for appliance other than furnace f
CONTACT PERSON Refrigeration: --
Absorption units BTU /H
Name: Chillers HP
Address:
1),L)../ HP
/, ,,�,� Environmental exhaust and ventilation:
City: '� I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
Ow,VNER Hoods, Type I/ II/res. kitchen/hazmat
hood fire suppression system
Name: , ry - y,,t.01 �(" Exhaust fan with single duct (bath fans)
Mailing address: _ / _ Exhaust system apart from heating or AC
City: 6 a` 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/pellet stove
Applicant's signatur I Date:
/4 / Other:
y Other:
Name (print): r f ',G r / -2 .
'Not all jurisdictions accept credit cards, please call jurisdiction for more information Permit fee $ /
❑ 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. /
TOTAL $ / °C t 6
Cardholder signature Amount , 440-4617 (6/00 /COM)
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 $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
$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 alhthatapply ; s BOilef r: Heat_ Air , ,
$1.20 for each. additional $100.00 or or it
Fem7 s 1'1, see Y. ,or Pump , Cond
fraction thereof. f_99.0.010,..00.9.*:, , _ :Comp *.; ', , ` *
s ,„.w ." - .
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
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
mil. BTU 19) Commercial or industrial type incinerator
Air ha
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: ':0` °' , $
g wood stoves, 656 8% State Surcharge
Commercial or industrial incinerator .) 4,590 e3 °; ` , . "' :
Other unit, including , ° >�
af3 °; $
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 A/C requires site plan showing placement of unit.
is \dsts \forms \mech - fees.doc 10/11/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspec ± Line: 639 -4175 Business Line: 639 -4171 N"
i
/' BUP
Date Requested ^ 6 - Z7 AM PM BLD
Location / 2// 5 C S �✓ l9 f" CAP Suite MEC / 6 /- 7
Contact Person Ph 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 (1/1 // a Al fi
Framing
Insulation
Drywall Nailing
Firewall (Ail) D 0/ G''� /
Fire Sprinkler .•(( jJ
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
Post & Beam (, /..
Rough In /b4 -
f
Gas Line 4,1,1?
Smo am ers
I �.
SS FAIL
EL TR,
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
Othe oach /Sidewalk
Date (0791/6( n Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.