Permit i-
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CITY OF TIGARD
l� DEVELOPMENT SERVICES PERMIT #: MEC2001 -00392
� MECHANICAL PERMIT
DATE ISSUED: 11/5/01
- 13125 S H Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134BD-06800
SITE ADDRESS: 11725 SW SPRINGWOOD DR
SUBDIVISION: ENGLEWOOD NO.2 ZONING: R -4.5
BLOCK: LOT: 156 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: 1
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: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Install gas furnace and water heater vent.
Owner: FEES
MCCORMICK, ANTHONY D + Type By Date Amount Receipt
SHERILYN M PRMT CTR 11/5/01 $72.50 2720010000
11725 SW SPRINGWOOD DR 5PCT CTR 11/5/01 $5.80 2720010000
TIGARD, OR 97223
Total $78.30
Phone:
Contractor:
FIRST CALL HEATING & COOLING
1650 NE LOMBARD
PORTLAND, OR 97211 -4798 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 231 -3311 Heating Unt Insp
Reg #: LIC 102030 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 copies of these rul- - or direct questions to OUNC by calling (503)246 -9189.
/
Issue By: • / • �� , Permittee Signature: �2 ;
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
ti .
Mechanical Permit Application
�� Date received: I rj .1 Permit no.:m / -- pp
A City of Ti art.
Am-
•? ty g _,E! d9 _l ING Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hal ' v lgaz O ' ' 3 Date issued: BycZA I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 NOV 0 5 2001 Case file no.: Payment type:
Land use approval: _ Building permit no.: •
Of NR :
TYPE OF PERMIT '
. 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
LI New construction ■ Addition/alteration/replacement 0 Other:
' JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
. Job address: Ili 2_5 c.; t Aj Sp v , n.5 w 0 0 a 0 ✓ 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: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
Citylccunty:T/ CA ✓ 4 [ZIP: 9 7 3 LR- 2. TAMII .Y— i].11;EI.LILVG..P.ERM11LFE,E_ SCI1 Q•UL
Description and loCation of work on premises: //is f - w // AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
ii._5 - i/1 Q C c p� (,c.9r -z..f c A - ea--Le. - • ire n 4 - Fee(ea.) Total
st. 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 0 No Air handling unit CFM •
space insulated? 0 Yes 0 No Air conditioning rata f xiti plan C system
Is existing P Alteration of existing HVAC system
M ECHANICAL CONTRACTOR Boiler /compressors
Business name: HI-64 (':‘,,/ / gral f s 9l � O/, 7 S. State boiler permit no.:
HP Tons BTU/H
Address: j, Sp vC 7 om bct.vt.- Fire/smoke dampers/duct smoke detectors
City: p / / // 'L. I State(94 I ZIP %7Z// Heat pump (site plan required)
Phone: . 2 7- ,_ Fax: 6� /0 E -mail: Install/replacefurnace / burner BTU /H
Including ductwork/vent liner /1'es 0 No ' '( .55 q -S
CCB no.: /0 2030 Install/replace/relocate heaters - suspended,
City /metro lic. no.: L' 06d wall, or floor mounted
Name (please print): (� -La(_ c� , S Vent for appliance other than furnace ' /(} i 4 , y 1
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: Chillers HP
Comyressors HP
Address: Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
•
• OWN Z _ _
`— __ Hoods, Type U II/res. kitchen/hazmat
"" "—" _. -- ' - -' --- — hood tire suppression system
Name: 12 rl /m r 6,r, , r Le" Exhaust fan with single duct (bath fans)
Mailing addres //72.5 S (.Li r , r l 1 t, "70( D-- Exhaust system apart from heating or AC
State: i2 I ZIP: `1'722, Fuel piping and distribution (up to 4 outlets)
City: �/ u Type: LPG NG Oil
Phone: p_ t ., Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: I Fax: I E -mail: Woodstove/pelletstove
Other:
Applicant's signature: u4 ,4p,,,_,, I Date:/ 3 ►- / , Other:
Name (print): l L / A./D A- St fi2_5 .
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ IV_ ✓O
m
0 Visa ❑MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ S .
Name of cardholder as shown on credit card accepted as complete. TOTAL $ '7 g • 3J
$ Cardholder signature Amount 440.4617 (6/00 /COM)
i
. I' ii
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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 including ducts & vents 17.40
$10,000.00. Floor Furnace
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) including vent 14.00
$1.54 for each additional $100.00 or
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
mil. BTU 19) Commercial or industrial type incinerator
Air ha
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
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.
is \dsts \fomis\mech- fees.doc 10/11/00
R
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line ;. 6394171
// BUP
Date Requested ! l AM 1( BLD
Location /77o ce_1 Suite ' L MEC ?' / er0,3 )_
Contact Person ,��Z�a . Ph Li 7 PLM
Contractor Ph SWR
BUILDING Tenant/Owner e ^ // ELC
Retaining Wall �`j� cP 4 4 ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing rdilil �nl Q 72 /�q. 5�— L�Se 2 L`/}�L 7$1.
Insulation 77 /
Drywall Nailing ✓�- 7 ins C7 CO c0/ j
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
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ I 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 . Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.