Permit w
CITY OF TIGARD MECHANICAL PERMIT
i4' DEVELOPMENT SERVICES PERMIT #: MEC2004 -00279
+ - - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/14/2004
71
PARCEL: 1 S 133RD -13800
SITE ADDRESS: 12687 SW SORREL DOCK CT
SUBDIVISION: SUMMER LAKE ZONING: R -7
BLOCK: LOT: 019 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:
ELE 3 - 15 HP: COMM. 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:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: AC install.
Owner: FEES
BAITINGER, GEORGE F + LOIS M Description Date Amount
12687 SW SORREL DOCK CT [MECH] Permit Fee 5/14/200' $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 5/14/200' $5.80
Phone: 503 - 524 - 8587 Total $78.30
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS
Phone: 503 Cooling Unt Insp
Final Inspection
Reg #: LIC 447
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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
Issued By: P ermittee Signature: )- 90
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application • FOR OFFICE USE ONLY
Received Mechanical it No. // I y�
Date/By: O) Perm �a (- a7.)7 7
RECEIVED PlanningA.prov. Building
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. MAY ; ' 20i4 Plan Review Other
Tigard, Oregon 97223 DateBy: Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -196j , i , �. Post Review Land Use
`"''' �„' o; -ms - 4 '� �1" Date/By: Case No.:
Internet: www.ci.tigard.or.us a a �_ `
j I G Contact See Page 2 for
24 - hour Inspection Request: 503 - 63' • Name/Method: ® Supplemental Information.
- ■ TYPEOF WORK. . . . . !: COMMERCIAL FEE* SCHEDULE - USE CHECKLIST.;• : 'z.,'_ •
❑ New construction ❑ Demolition Mechanical permit fees* are based on •the total value of the work
g Addition/alteratio placem , ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
`` °` - `�; % ;`' CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
K1 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family ' :` EQUIPMENT /SYSTEMS FEE*;SCHEDULE: i
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Coolin
•: >::'JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 1 14.00 (t{
Job site address: 12( j SoRPve1 _ « Gas heat pump 14.00
Suite #: j Bldg./Apt.#: Duct work 14.00
Project Name: Bgrr/taGr 1131q 9,..%
Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site:
(for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
I clot-n/1/2c J t D*- 5 Z, Flue/vent (for any of above) 10.00
Subdivision: 1 Lot #: Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
_ DESCRIPTION OF WORK - . Gas fireplace 10.00
i\ /c__ .K.r....c . - Flue vent (water heater /gas fireplace) 10.00
!' ' eN OQ.'3 ►Z,[, C.11iAxxxtc. "� Log lighter (gas) 10.00
1 Wood/Pellet stove 10.00
..C,. '.)c» / re, CCP.3W t ►SSve O� Wood fireplace/insert 10.00
3 v.) e_ tip- (05*t00 - Ptergg . 2gc-oct3 • Chimney/liner /flue /vent 10.00
0 PROPERTY.OWNER I ❑ TENANT . Other: 10.00
Name: Environmental Exhaust & Ventilation
Loo 'e (_ A' r.0 z12-„ Range hood/other kitchen equipment 10.00
Address: 12.40S1 - Go_ IOC. Clothes dryer exhaust 10.00
City /State /Z3 i `rt GKQ. Q l2. Z_3 Single duct exhaust
Phone: �- "L� 1 Fax: (bathrooms, toilet compartments,
4 ®APPLICANT . - . [CONTACT PERSON " utility rooms) 6.80
Name: C ._ DA.1i. w '` t4 e_kT Attic/crawl space fans 10.00
Address:
SC Other: 10.00
Fuel Piping ,
City /State /Zip: G * *($5.40 for first 4, $1.00 each additional)
Phone: E Furnace, etc. *1
� z I Fax Gas heat pump **
E -mail: Wall/suspended/unit heater **
- - CONTRACTOR. Water heater **
Business Name: VA Fireplace e **
Address: 15 'iSO S� t�IAZ Pr..) Range **
BBQ • **
City /State /Zip: � Q1015 Clothes dryer (gas) **
Phone: k A -!f a 4 I F 445r 1511 Other: **
CCB Lic. #: Total: •
Authorized �� • Mechanical Permit Fees* '
,� + S ubtotal: $ i - i
Signature: �_/ '� i • - Oil!. / 0 "r 2�n
'Mr Minimum Permit Fee $72.50 $
� d..1 DIMS Plan Review Fee (25% of Permit Fee) $
(Please print name) 3et. '„ State Surcharge (8% of Permit Fee) $ o'. w''
r TOTAL PERMIT FEE $ lb 1•
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
•
Commercial Fee Schedule:
•
•
Total Valuation: Permit Fee:
$1.00 to $5,000.00 Minimum fee $72.50
•
•
$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.
$50,001.00 and up $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof.
Assumed. Valuations Per Appliance: -
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace> 100,000 BTU including ducts 1,170 •
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445 . • . ,
Repair units 805
< 3 hp; absorb. unit, 955
to 100k BTU
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU
15 -30 hp; absorb. unit, 501k to 1 mil. 2,310
•
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656
•
Vent fan connected to a single duct 446
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator _ 1,170
_ Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL . . $
VALUATION:
• ,
•
i:lDsts\Permit Forrns MecPermitAppPg2.doc 01/03
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mte, . HEATING AND . • -
, ' . '. . . Ea q . 9 T GlG • AIR CONDITIONING
GAS, OIL and ELECTRIC FURNACES • AGREEMENT
SERVICE • REPAIRS •.AIR CONDITIONING
15550 S.E. PIAllA AVE. CLACKAMAS, OREGON 97015 OR (503) 656-1184 WA (360) 256 -1184
FAX (503) 656 -7511 Builders Board #447 WA - Contractors Reg. #BELLHI •
QUOTE NO. DATE: CAS - °S - 03
BUYER'S NAME: L.o =S ` G - "' . *L F T.- 1It�-X- DAY PHONE
BUYER'S ADDRESS: 12.0 -ir • f.% = • CT . NIGHT PHO • 2 -- PP
' TIC -,A►b We' - 9 . COc 5 1
--ICIP AM� T '� • . '
- __ _ _JOB _PHONE _ _ __ _
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CITY OF TIGARD.
24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Reque ted 5-2D-0 AM PM BUP
Location l 2(� S ? h - d i lr> C Suite MEC ; — on Z 7�
Contact Person Ph ( ) PLM
Contractor Ph ( ) , C7-1'7SWR
BUILDING
Ten. Owner '_ ! , ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int
Fram9
hn ath/Shear at
Insulation (!).-/
Drywall Nailing
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
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
Gas Line
. Dampers C
o p"
PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next insp tion. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA S =- 2-
Approach/Sidewalk D Inspector • Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL