Permit CITY TIGARD MECHANICAL PERMIT
. I I DEVELOPMENT SERVICES PERMIT #: MEC2002 - 00487
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/31/02
PARCEL: 2 S 104 D B - 03200
SITE ADDRESS: 13000 SW ROCKINGHAM DR
SUBDIVISION: AMESBURY HEIGHTS ZONING: R - 4.5
BLOCK: LOT: 032 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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:
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: 1
> 10000 cfm:
GAS OUTLETS:
Remarks: Installation of exterior A/C unit. Do not place within the required setback
Owner: FEES
CARTAGENA, LOUIS J + HERTA G Description Date Amount
13000 SW ROCKINGHAM DR
TIGARD, OR 97223 [MECH] Permit Fee 10/31/02 $72.50
[MECH] Permit Fee 10/31/02 $0.00
[TAX] 8% StateTax 10/31/02 $5.80
Phone: 503 -590 -8841 [TAX] 8% StateTax 10/31/02 $0.00
Contractor: Total $78.30
KENTEC HEATING CONTRACTOR
PO BOX 233
WOODBURN, OR 97071 REQUIRED INSPECTIONS
Phone: 503- 982 -6082 Final Inspection
Reg #: 63621
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 f o 4 rules . a. - •ted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -011 -0011 rough : • R
952 - 001 -0100. You may obtain copies of these rules or direct q 4 estions t ��1 0 U ' ./ call .
(5 -6699. i I� - __
, . Issued By: "0 Permittee Signature: m�
Call (503) 639 -4175 by 7:00 P.M. for inspections ne e d the n ext business day
Mechanical Permit Application
Date received: / 0 /3//t) Permit i t t e . . 4 O t j a .-no ' g 7
„Al- ,,: City of Tigar Project/appl. no.: Expire date:
CirygfTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: • By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
r t- ,
,- :TYPE OF P RM1
Itl & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
e '7 �i 4,40B' SITE5INFORMATION ,: .:,., ^ ", „ ' a ` ' `, COMMERCIAL V ALUA TI ON SCHEDULE • "
Job address: 000 Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: S • ite 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: jurisdiction's fee schedule for residential permit fee.
City /county: r _AIM ZIP: ., 's;1 & 2 FAMILY DWELLING 'PERMIT FEE `SCHEDULE1,
* ; t
E COMMERICAIJINDUSTRIAL
Description and .cation of work on premises: AND , QUIPMENTS
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC: ■ --
Is existing space healed or conditioned? ❑ Yes ❑ No Air handling unit CFM
Air conditioning (site plan required) ME
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system _
' ; 7VIECHANICAL` "CONTRACTOR « ti Boiler/compressors bm t I
„ , N . l State boiler permit no.:
Business name
Q ea_ Cv+, rraCfcvr HP Tons BTU /H
Address: ;, rJ [ G L _ Fire /smoke dampers /duct smoke detectors —
! State:Cy I ZIP: . 7c f Heat pump (site plan required) Mil Phone: a A Z Fax: 9 2 -6zs! E -mail: Install/replace furnace/burner BTU /H II
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: • C, 2- Install/replace /relocate heaters– suspended, ■--
City /metro lic. no.: wall, or floor mounted
Name (please print): EF . , - /.. Vent for appliance other than furnace _
• ;'
r 4 . CONTACT PERSON Refrigeration: ■
Absorption units BTU /H
Chillers HP -
Address: •
Compressors HP _
�V� ° �" Environmental exhaust and ventilation: ■
r .N ZIP: Appliance vent
Phone: c • _ ; ? Fax: E -mail: Dryer exhaust ME
• OWNE. , ; ,, , Hoods, Type U IUres. kitchen/hazmat
III
., • ` ' ' hood fire suppression system
• Name: S s fj-1 . Exhaust fan with single duct (bath f ans) -
Mailing address: Exhaust system apart from heating or AC —
City: State: 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) I=
Name: Number of outlets MI
Other listed appliance or equipment: ■ --
Address: Decorative fireplace
City: State: ZIP: Insert – type —
Phone: Fax: E -mail: Woodstove/pelletstove _ —_—
Other: MI
Applicant's signature: Date: Other: IME
Name (print): • E
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ — 7 – ", t/
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
Credit card number: / I expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ U
Name of cardholder as shown on credit card accepted as complete. TOTAL $ t'
Cardholder signature Amount 440 -4617 (6/0o /COM)
MECHANICAL PERMIT FEES A- '•
•
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL¢V,ALUATION OERMIT,FEE?, , -. Desctiptio ,; Pnce Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical'Code .d . _ Qt (E_a) "Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+ .
$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 all :that apply , : Boiler: Heat .Air " ' ° T .
or'i
$1.20 for each additional $100.00 or Ftem`s =11, see" - or; „3 : P ump d.
. Co, ., -
fraction thereof. footnotes' below. ' Corny , ' _
•
Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU 14.00
8% State Surcharge $ 8) 3 -15 HP; absorb 25.60
unit 100k to 500k BTU
25% Plan Review Fee (of subtotal) $ 9) 15-30 HP; absorb 35.00
Required for ALL commercial permits only unit .5 1 mil BTU
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb unit 1 -1.75 mil BTU 52.20
11) >50HP; absorb
unit >1.75 mil BTU 87.20
ASSU.MEDtMALUATIONS PER 'APPLIANC.E : .._';_` : 12) Air handling unit to 10,000 CFM
10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Furnace > 100,000 BTU including 1,170 15) Vent fan connected to asingle duct
ducts & vents 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in appliance 445 10.00
permit 18) Domestic incinerators
Repair units 805 17.40
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101k to 500k BTU 10.00 •
15-30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU 5.40
30 -50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each) • 1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 °ur...
p: Minimum Permit Fee $72.50 SUBTOTAL: , . c
>1.75 mil. BTU i - $
Air handling unit to 10,000 cfm 656 8% State Surcharge ';'< r > > =` #` ` $
Air handling unit >10,000 cfm 1,170 9 hl : µ mew
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: ; v >: ; $
V fan connected to a single duct 446 n., ._- .�5,;
Vent system not included in 656 ° ,r,:C 3
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1: Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator 1,170 $62.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is swcifically indicated (minimum charge - half hour)
Other unit, including wood stoves, 656 $62.50 per hour
inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge -one -half hour) $62.50 per hour
Each additional outlet 63 * State Contractor Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL " * * Residential NC requires site plan showing placement of unit.
.., v' °
VALUATION: ,'. I " >-,,, , $ 9 q
M All New Commercial Buildings require 2 sets of plans.
i:\dsts\forms\mech-fees.doc 02/11/02
- JOB FACT SHEET,`
;. 300 �� D�
NAME / t ,� /rye - JOB ADDRESS
F
5erA Drs— ' ,
EXISTING EQUIPMENT �3o7fo�9go� EXISTING ELECTRICAL
MAKE: f 4ee/4-7 /6 W.° FUEL: BRAND OF PANEL: gO %c /,'/-14-
.
ti d • LOCATION OF PANEL: G'a-
MODEL: �I y la BTU: OC '-cxy
LOCATION: SPARE CIRCUITS: NO se P,r, v,
TYPE OF T STAT ' ELECTRICIAN NEEDED: YES' NO /t /c. ,
II OF STAT WIRE: 0 2 0 3 • '0 4 05 DISTANCE TO FURNACE: FT. s/
BLOWER TYPE: DIRECT BELT • • DISTANCE TO A/C: FT. ,
MOTOR SIZE: 01/6 0 1/4 01/3 • 0 1/2 . :0.3/4. cb,�
MOTOR SPEED: • VOLTAGE: �11� `�
WHAT IS THE CLEARANCE ON EACH SIDE OF THE FURNACE . f ° /iv
RIGHT SIDE: LEFT SIDE: . ;,;� s,
WILL THE FURNACE PASS CODE AS IT IS: YES NO rr
AFTER MODIFICATIONS, WILL IT PASS CODE: YES NO
BRAND OF DOUBLE WALL PIPE:
IF OLD FURNACE HAS A FAN SWITCH, ADVISE CUSTOMER NEW FURNACE DOES NOT COME WITH A FAN
SWITCH AND IT WILL BE AN ADDITIONAL PURCHASE.
,...
DID YOU CHECK SUPPLY AIR: YES '"'""•• NO
REMINDER TO CHECK SUPPLY AIR TO MAKE SURE IT DOES.NO ME . T: CO OFF'THE B, CK THE CEMENT
• FLOOR, MAKE SURE THERE IS ROOM TO INSTALL A COIL 1 .
IF THERE ADEQUATE RETURN AIR: YES NO, • ',
# OF REGISTERS IN HOME: •
ADEQUATE COMBUSTION AIR: . . •
'V
DO YOU NEED: • LOCATION OF O/D UNIT
■ ,
FAN SWITCH ON FURNACE: YES N0 �> r7
-' f p /Int
FAN SWITCH ON STAT: • YES NO .
FAN CENTER: YES NO
CONDENSATE PUMP: NO • /JJ_I
:ONCRETE PAD: 0 NO 6
_INE SET: c -0 , YES NO
'EW FILTER RACK YES NO .
:HIMNEY LINER: YES NO •
p ci da6t Or d /1467'0 :..:
t j / /7/O 2 -
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISt,ON 4 `' Business Line: (503) 639 -4171
BUP
Received `2 Date Requ- ted •" A AM PM BUP �y `'
Location ' J 0 00 I / Suite MEC ¥
Contact Person / Ph ( ) ! it 10 — / 7f PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof f /'�� ' /272.
Other: ;rte
Final
0 (40/ „.
PASS PART •FAIL
PLUMBING
Post & Beam / i
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole -
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL .
MECHANICAL
Post & Beam
Rough -In - c
Gas Line
Smo 'ampers
PART FAIL
0 T RICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Et Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE -0 Please call for rei spection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date _` Inspector ) Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL