Permit CITY OF TIGARD
MECHANICAL PERMIT
� : :r DEVELOPMENT SERVICES PERMIT #: MEC2001 -00271
'' �. — • 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/27/01
PARCEL: 1 S126DC -06700
SITE ADDRESS: 09283 SW LOCUST ST
SUBDIVISION: MLP96 -0014 PP1997 -124 ZONING: R -12 .
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: OTR 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: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of a/c unit.
Owner: FEES
LEON CAPSOUTO Type By Date Amount Receipt
9283 SW LOCUST PRMT CTR 7/27/01 $72.50 2720010000
TIGARD, OR 97223 5PCT CTR 7/27/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
SPECIALTY HEATING & COOLING
9528 SW TIGARD ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Cooling Unt Insp
Phone: 620 -5643 Final Inspection
Reg #: LIC 66578
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility No ' ' to n Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You y obtainls pies of these rules or direct questions to OUNC by calling (503)246 -9189.
Issue Permittee Signature: )TEGU....k.WC2..)
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
1.
Mechanical Permit Application
il 3, I Daterived: 7 A? p/ Permit no.: Ii-.e�
7
" 1 City of Tigard Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT '
4 - 1 & 2 family dwelling or accessory 0 Commercial/industrial Cl Multi- family 0 Tenant improvement
0 New construction 3 Addition/alteration/replacement 0 Other.
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
. Job address: Q., 7-3 St LOG(,`$ 7- 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: 7 -- (k),A-S M ZIP: of ? __-J I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: fjrt.4* A-1(_-- AND COMMERICAL /INDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
_ Est. date of completion/inspection: 7/3 3/ jeD / Description Qty. Res. only Res. only
Tenant improvement or change of use: 13VAC:
Is existing space heated or conditioned? Yes 0 N o Air handling unit CFM
Air conditioning (site plan required) / •
Is existing space insulated. ,Yes 0 o • Alteration of existing HVAC system
1%'I EC11ANICAL CONTRACTOR Boiler /compressors
State boiler permit no.:
Business namek_ 4-L-7 . P iP Q et * • ./ 11G HP Tons BTU/H
Address: 45 '5CCU a i s' l / / Fire/smoke dampers/duct smoke detectors
City: 78'Cvl d I State: 0 4 ZIP: q Tat 9.3 Heat pump (site plan required)
Phone• Fax59� 07/
�. 2 5 kill gi E -mail: Instal /replace furnace/burner BTU /H
CCB no.: 4,4.5 7 Including ductwork/vent liner 0 Yes Cl No
I 9$62 Instal l/replace/relocate heaters - suspended,
City/metro lic. no.: / q wall, or floor mounted
Name (please print): • , r/rA -h • tif el5 Vent for appliance other than furnace
CONTACT PERSON Refrigeration: __
//''� ,, Absorption units BTU/H
Name: J -04 Lee /Y �C, hid '7 e A. Chillers HP
Address: cj5 3- $' Sf-C / / R� S T Environmental exhaust and ventilation:
City: Tye/A I Sta e:O2 I ZIP: q 7d.a --3 Appliance vent .
—
Phone6v3 6.20 -56 'Fax:59g0 E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: of .,ep n Q Exhaust fan with single duct (bath fans)
Mailing a' dress: S(,v OC,((,� E xhaust system apart from h ea ti ng or AC
� Q2 Er Fuel piping and distribution (up to 4 outlets)
City: --r d State: O : 9 'loZa 3
Type: LPG NG Oil
Phone: -- /70 Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required) •
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert -type
Phone: Fax: I E -mail: Woodstove/pellet stove
�^ ^nA / 0 [ 1 other Other:
Applicant's signature "7 � ate: 7 O .
Name (print): �.�'i& I / Y /1- 7 e/ 6 -
Not all jurisdictions accept credit cards, please can jurisdiction for more information Permit fee $ �� J
Notice: This permit application
0 Visa 0 MasterCard Minimum fee $ .
expires if a permit is not obtained P lan review
Credit card number / / (at %) $ _
Expires within 180 days after it has been S &.° Name of cardholder as shown on credit card p accepted as complete. State surcharge (8 %) $
$ TOTAL $ 7 5, c)
Cardholder signature Amount 440-4617 (6I00 /COM)
•
. - . -1'. I I.
- Commercial Schedule
1 &2 Family Dwelling Schedule
ASSUMED VALUATIONS PER APPLIANCE
Description
Furnace to 100.000 BTU Table IA Mechanical Code Oty Price Total
•
1)
including ducts & vents 955 • Furnace t
including ducts avents U
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 r
including vent 955 or floor mounted heater 14.00
•
suspended heater, wall heater s) Vent not included in appliance permit 6.80'
•
or floor mounted heater 955 6) Repair units 12.15
Check all that apply: 'Boiler Heat Air.
Vent not included in appliance permit 445 For Items 7 -10, see or Pump Cond ' Oty 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 100k to 500k 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 -- 1000
13) Air handling unit 10,000 CFM«
1 -1.75 mil. BTU 3400 ' 17.20
> 50 hp; absorb.unit 10.00
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
Non-portable evaporate coller 656 10.00
Non -
p p 18) Domestic inc
vent fan connected to a single duct 446 17.40
19) Commercial or industrial type incinerator
Vent sysL not included in appliance permit 656 69.95
Hood served by mechanical exhaust 656 20) Other units including wood stoves 1000
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 mu EINE
Each additional outlet • • 63 PLAN REVIEW 25% OF SUBTOTAL ':
_
r;.: -.
Required for ALL commercial permits only _ _. _
TOTAL _
Other Inspections and Fees:
1. Inspections outside or normal business hours (minimum charge-two hours)
$72.50 per hour •
2. Inspections for which no fee is speafically indicated (minimum charge -half hour)
$72.50 per tour
Total Valuation Fee 3. Additional plan review required by changes, additions or revisions to plans (minimum
dune hour) $72.50 per hour
• 'State Contractor Roder Certification requ
$1.00 to $5,000.00 'Minimum $72.50 - Residential MC 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
V
1 ,/1
F r:7
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested af AM PM BLD
Location 9 Z R3 '- Suite MEC a 1
Contact Person Ph la 2- Sao 4 /3 PLM
Contractor Ph SWR
BUILDING Tenant/Owner 7766, 1 ELC
Retaining Wall ELR
Footing CC2SS: � � � �
Foundation dation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath/Shear Q th /Shear (� 30 - /0 ; 30
Int Sheath /Shear
Framing -Ave //G .v 4 - .' ! 2,
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
r dierCHANICAL)
Post & Beam
Rough In
Gas Line
Sm. - Dampers
49 PART FAIL
E CTRICAL
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 g _ (/,_ 0
Other Date Inspect Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.