Permit • CITY OF TIGARD MECHANICAL PERMIT
2 ^P
,, MI DEVELOPMENT SERVICES PERMIT #: MEC2000 -00463
,I 13 125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/29/2000
W
PARCEL: 2S111 CA -08200
SITE ADDRESS: 09935 SW KABLE ST
SUBDIVISION: GULF SIDE ESTATES NO. 2 ZONING: R -7
BLOCK: LOT: 026 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:
LPG . 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of gas furnace and gas piping.
Owner: FEES
RHODES, TODD E + LISA M Type By Date Amount Receipt
9935 SW KABLE ST PRMT CTR 11/29/20C $72.50 2720000000
TIGARD, OR 97223 5PCT CTR 11/29/200 $5.80 2720000000
Total $78.30
Phone:
Contractor:
JACOBS HEATING +A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503 - 234 -7331 Mechanical Insp
Reg #: LIC 1441 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 es of these rules or direct questions to OUNC by calling (503)246 -9189.
Issue By: /� ,' • / Permittee Signature: DAl i°G /e/9-T7cr7V
'Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
...
Date received: / / / ?glife) Permit no.: ---e z yea
• --- City of Tigard RECEIVE® Project/appl.no.: Expire date:
o Ti and Addre 13125 SW H Blvd Ti OR 97223
City f Date issued: • By: 4 "' Receipt no.:
c`
Phone: (503) 639 -4.171 .
Fax: (503) 598 -1960 " ' �" ���� Case file no.: Payment type:
rr
Land use approval: cg milliTY Dnici o I BEN Bu perm no::
` ' • ',. • . - - TYPE OF PERMIT ' . .
'71 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family • ❑ Tenant improvement
. ❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION • COMMERCIAL VALUATION SCHEDULE
Job address: ep9 3 S sw /< 6/e .3 f- . 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: (Block: Subdivision: *See checklist for important application information and
Project name: "To cst IR f'1- 01�E jurisdiction's fee schedule for residential permit fee.
City /county: 'f l 6p•1th ZIP: of a 2 1 8 2 F N LY DWILLING T FEESC DUL •' ''
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPNIENTSCHEDULE
fiNST d..tm 5'AS RLoe niece e. 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? 0 Yes ❑ No Air handling unit CFM
space insulated? 0 Yes ❑ No Air conditioning (site plan required)
Is existing P Alteration of existing HVAC system
. .. . MECHANICAL CONTRACTOR .. Boiler /compressors
Business name: COS H fe 't t„.1 C State boiler permit no.:
HP Tons BTU /H
Address: •t / t-/7 tf SE W a t ,' ui t' Fire/ smokedampers /ductsmokedetectors
City: Pt.+y=' to • - I State: o►2..I ZIP' 9 7.1.p ‘i _ Heat pump (site plan. required)
Phone: , -1 _ s, 3 0 I Fax:/ 3.9A T' -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No Ka)
CCB no.: ) al f • ! %M ID,1/ AC112L4` 0 !.Cb Install /replace /relocate heaters — suspended,
City /metro lic. no.: kV te S wall, or floor mounted •
Name (please print): Ej' ff lill,. i4 S H{q, V-^°' Vent for appliance other than furnace ..
CONTACT PERSON Refrigeration:
Absorption units BTU /H
Name: 3 H IL u 61-111 Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: e) f fk't° late: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
• OWNER , - Hoods, Type 11 II/res. kitchen/hazmat
hood fire suppression system
Name: TOCIC1 Ar Exhaust fan with single duct (bath fans) '
Mailing address: 1935 5 tA ,3 kec t, le (Si" ., Exhaust system apart from heating or AC
City: g„ Wei I State: !l /2. .I ZIP: 4'7„,a.../ Fuel piping and distribution (up to 4 outlets)
Type: LPG CPC NG Oil $ 0 1
Phone: 6g ' - g,4 a0 Fax: E -mail: Fuel piping each addit onal over 4 outlets
- ENGINEER Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace _
City: I State: ZIP: Insert — type
Phone: I Fax: I E -mail: Woodstove/pellet stove
Other:
Applicant's signature: i?a ..t. OkJ Date: Other: `
. Name (print):. ` .: :. , ~. ; .
. ' Not all jurisdictions accept credit cards; please call jurisdiction for. more information) - Permit fee $
CI Visa ❑MasterCard I Not Th perm app Minimum fee $ w7 • `
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ 5• S 0
Name of cardholder as shown on credit card accepted as complete. TOTAL $ 7 9, 3 /D
Cardholder signature Amount 440-4617 (6/o0/COM)
■
MECHANICAL PERMIT FEES . ,
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING F 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 @heck.:all!that apply;:, ;,Boilers `Heat • a' .
$1.20 for each additional $100.00 or 4 ,4For For items 7 =11, see, or Pump - i Cona .' , t
fraction thereof. footnotes below:. ,,,; Comp.. . , ' ?''`' .
7) <3HP;absorb unit
1 . 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 ; a; -�
Other unit, including wood stoves, 656 8% State Surcharge ' c' ', ', F $
inserts, etc. :° ,, 'r-a''
Gas piping 1-4 outlets 360 - 25% Plan Review Fee (of subtotal) ?r ! °''': :ft $
Each additional outlet 63 Required for ALL commercial permits only .:- ° - - .,, " °i
TOTAL COMMERCIAL $ . TOTAL RESIDENTIAL PERMIT FEE: t sa ` . ,,,, $
VALUATION: , ,R ' '
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 .
c
CITY OF TIGARD BUILDING INSPECTION DIVISION .
'���� . -„„„s/3 24 -Hour Inspection Line: 639 -4175 • Business Line: 639 -4171 °'
Date Requested / ■.- 7 - 4 AM !/ PM BLD - Ira,
Location C f ,s 5 w /C4640 5 ` Suite
Contact Person Ph 533 - X 8 4 ( -3z 34 PLM
Contractor Ph SWR
BUILDING: • . y • -_. Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler ea-s6- l A (...:._
Fire Alarm
Susp'd Ceiling i
Roof
Misc:
Final
PASS PART - FAIL
PLUMBING ty i-':f' .:Y
. .Post & Beam
Under Slab • -
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final -
4- -C:t4R FAIL
C- N i c o l l _ t``- : .
& Beam -
ost -
Rough In
Gas Line
S • ke Dampers
, PART FAIL
•
T, a r..•RICAL g sp.: , ... s`
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 /2 - 2 - OG Inspector / Pi Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.