Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES
PERMIT #: MEC2001 -00043
' II DATE ISSUED: 2/5/01
13125 SW Hall Blvd., Tigard, OR 97223 ( 639 -4171
PARCEL: 2S111 DA -15000
SITE ADDRESS: 08850 SW PIPPEN LN
SUBDIVISION: APPLEWOOD PARK NO. 3 ZONING: R -7
BLOCK: LOT: 143 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: 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 exterior NC unit. Unit cannot be placed within the required setbacks.
Owner: FEES
MATRIX DEVELOPMENT CORP Type By Date Amount Receipt
6900 SW HAINES ST STE 200 PRMT CTR 2/5/01 $72.50 2720010000
TIGARD, OR 97224 5PCT CTR 2/5/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
SUN GLOW INC
2428 SE 105TH AVE
PORTLAND, OR 97216 REQUIRED INSPECTIONS
Mechanical Insp
•
Phone: 253 -7789 Final Inspection
Reg #: LIC 48131
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 - of these rules or direct questions to OUNC by calling "3)246-9189.
Issue By: Permittee Signat re:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Date received:2/ �G% / Permit no.: me -eza4I DOD Y3
; ,, 1 ''Y:1'�� A City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By:Le — I Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF P ' KNIT
O I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction dition/alteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address.g,Q, s -,,u /' grz. n t, / !�"t -'-d Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: JJ�� I Suite no.: value of all mechanical mauls, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ f f to .
Lot: / q z, (Block: I Subdivisions* .4lJ0 "See checklist for important application information and
Project name: exa`, "vre...-/ jurisdiction's fee schedule for residential permit fee.
City /county: I ZIP: q7 7.-Zg.-f I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: (l4& L&'t. AND COMMERICAL /INDUSTRIAL EQUIPMENT SCIIEDULE
Fee(ea.) Total
Est. date of completion /inspection: 2 10Z.VO/ Description Qty. Res. only Res. only
Tenant improvement or change of use: �� HVAC:
space heated or conditioned? 0 Yes Cf 1vo Air handling unit CFM
Is existing P Air conditioning (site plan required) r
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
f lECIIANICAL CONTRACTOR Boiler /compressors
` A / 4 .2. 4 , c� t
/ K State boiler permit no.:
Business name: G; P a„."...42...., j HP Tons BTU /H
Address: 2 G $ /�S ' Fire/smoke dampers/duct smoke detectors
City: I State: I ZIP: " 7"zi,6 Heat pump (site plan required)
Phone: ,O3 -233 17$91 Fax: I E - mail: InstalUreplacefurnace/burner BTU /H
Including ductwork/vent liner 0 Yes 0 No
CCB no.: ?? /3 f Install/replace/relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Vent for appliance other than furnace
Name (p lease print): Refrigeration:
CONTACT PERSON Absorption units BTU /H
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type 1/ 11/res. kitchen/hazmat
hood fire suppression system _
Name: Exhaust fan with single duct (bath fans)
Mailing ad sJ /z ' ) 6 it' Exhaust system apart from heating or AC
City r p,�,�.. FQuK u. I State ZIP: 4-77. Z Fuel piping and d (up to 4 outlets)
Type: LPG NG Oil
Phone — D i Fax: E -mail: Fuel i ing each additional over 4 outlets
recess piping (schematic required)
Name: j :' h ` Number of outlets
-ie �� 9 '�� � Other listed appliance or equipment:
/
Address: o / Decorative fireplace
City: State: I ZIP: Insert - type
Phone: I Fax: I E -mail: Woodstove/pelletstove
Other:
Applicant's signature: "� /1", I Date d z:2/ Other. _
Name (print): ?,p •
t Not all jurisdictions accept � t cards, please call jurisdiction for more information.' Permit fee $ 7 S
0 Visa 0 MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Pl review (at at %
Credit card number: / / %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ 5 PO
Name of cardholder as shown on credit card accepted as complete.
. $ TOTAL $ 7e, 3 O
Cardholder signature Amount . 440-4617 (6A0/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 17.40
$10,000.00. including ducts & vents
$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 or Pump Cond
_ fraction thereof. footnotes below. Comp* "
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 10.00
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 cfrn 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
Other unit, including wood stoves, 656 8% State Surcharge $
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.
iAdsts\formsknech- fees.doc 10/11/00
-PLOT PLAN
LOT *143 4FFLEWOO PARK
R1 251 11 DA
TAX LOT 4 1 000
SSO SW PIPPEN LANE
S.E. 1/4 OF SECTION 11, T.2, R.1W, W.M.
CITY OF TIGARD
WASI- IINGTON COUNTY, OREGON
Xrer D: 1/2R14Custom1/21Blocks 1/2LEDGEND20.dwg
- - -5S SW P I PPEN LANE _ ss - - - -
N
- I
N ` =� - - __5,:, - - I - - \ �-sD
- 1t l e4 - 20'4-- I 20
2
1" = 201 - m11
SIDEWALK I , •1 .".: �.
IZ 8' UTILITY • • ,I6 �•
WATER METER EASEMENT � t' 0
62. N89' "E 2015' _ 201.5
W- - - - - -- WATER LINE -- 202.5' - -- _ S _ - - --
SS - - - - SANITARY SEWER • •- . • So 2018'
SD — - - — STORM DRAIN 5.0
202.0' "
----- ct OF STREET STREET LIGHT 2'2'3 2 02b . " 4.6'1'
I MANHOLE --�
CATCH BASIN - rar 1� _ /4.3 ,
4, 138 SQ. FT. / 0 ., CV
PROPOSED inr- r
STREET TREES �N�►�COURr ��' .4
1.1 O 94' B � / FIN. FLR = 204.3' 0
GARAGE 0 0 Il-
FIRE HYDRANT 0 / ARAGE FLR = 22.2 Q O
20 5.0' . / /// / _ 461' -1
\203.1' ` 202.9'
'` J --- N \
N
V ` S \
PROVIDE EROSION ` �2 -v�l 20
3
CONTROL FENCE
PER COMMUNITY N89'54'25 "E
EROSION PLAN 204.5' 62.00' / 203.5'
LOT LOT /56 Lor
204'