Permit CITY TIGARD MECHANICAL PERMIT
I& DEVELOPMENT SERVICES PERMIT #: MEC2001 -00104
r � J I I 1 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/3/01
PARCEL: 2S112CA -06600
SITE ADDRESS: 15230 SW THURSTON LN
SUBDIVISION: ASHFORD OAKS ZONING: R -7
BLOCK: LOT: 020 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: SR3.3 VENTS WIO 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: < =10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Furnace replacement in garage.
Owner: FEES
THOMSON, ROBERT A + EVELYN L T Type By Date Amount Receipt
PO BOX 231225 PRMT CTR 4/3/01 $72.50 2720010000
TIGARD, OR 97281 5PCT CTR 4/3/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
BELL HEATING
(GREG MILLETT)
15550 SE PIAZZA AVE REQUIRED INSPECTIONS
CLACKAMAS, OR 97015 Heating Unt Insp
Phone: 656 -1184 Final Inspection
Reg #: LIC 447
PLM 3 -286PB
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 o these rules or direct questions to OUNC by calling (503)246 -9189.
Issue By: ( :, �. t ✓��,,� Permittee Signature: '<cfl/\ � Q
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
c\k k
t` . , Mechanical Permit Application
RECEI Date received:)_ Q/ Permit no.:MLL- / -OO /0'
City of Tigard Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR, 9 2 , Date issued: By: Receiptno.:
Phone: (503) 639 -4171 /'{ F' 2 200 i
Fax: (503) 598 -1960 Case file no.: Payment type:
COMMUNITY DEVELOi 'Mtt , 'Building permit no.:
Land use approval:
TYPE OF PERMIT
'% : 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
0 New construction ❑ Addition/alteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 1 5 6 S AA./ " A.A- S-}-010. 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: I ZIP: - 1` - 8 2 FA IILI' rtraYt P 7ilV�I C E E
Description and location of work on premises: Fur s a.« AND COMMERICALJINDUSTRIAL EQUIPMENTSCHEDULE
f ! ........ - _ Fee(ea.) Total
Est. date of completion/inspection: 4 Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned ?Yes ❑ No Air handling unit CFM
Air conditioning (site plan required)
Is existing space insulatedPaYes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
State boiler permit no.:
Business name: -
mammalian= HP Tons BTU /H
Address: S _ ' — r�� Fire /smoke dampers/duct smoke detectors
City: k-., (� WWI ZIP: *'26 — Heat pump (site plan required)
Phone: ,. - //� Email:
Install/replace furnace/burner /_S BTU /H �.
Including ductwork/vent liner 0 Yes ❑ No , 1 °
CCB no.: L#1 7 Install/replace/relocate heaters — suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU /H
Name:1Z(1 \3Q Y -i- ' I Chillers HP
Address: k5 .3O S . Uti V\ u r—S-±0 )1 Compressors HP
Environmental exhaust and ventilation:
City:` cL &c. State: a Q I ZIP: 9 7, sz e/ Appliance vent
Phone: 6P8 t s—) Fax: E -mail: Dryer exhaust
OWNER Hoods, Type I/ IUres. kitchen/hazmat
hood fire suppression system
Name: 2 C) I j ' ( .i- t ,r5 < p .\-- Exhaust fan with single duct (bath fans)
Mailing address: ' S- Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City: I State: I ZIP: Type: LPG NG Oil
Phone: 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���� y b_ Date: " 3 /' Other:
Name (print):
Permit fee $ —V
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
0 Visa ❑MasterCard Mi n i mum fee $ � 7,2
expires if a permit is not obtained
Credit card number: ' / / ex p p Plan review (at %) $ �----
Expires within 180 days after it has been State surcharge (8 %) $ 5 i S 0 /
Name of cardholder as shown on credit card accepted as complete.
. $ �-7 TOTAL $ / p ,. 1U v
Cardholder signature Amount 440-4617 (6/00/COM)
MECHANICAL PERMIT FEES • y
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price Total
Table 1A Mechanical Code Qty (Ea) Amt
$1.00 to $5,000.00 Minimum fee $72.50 1) Furnace to 100,000 BTU
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and including ducts & vents 14.00
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
fraction thereof, to and including
$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
$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
1 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 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) than 4 -por outlet (each)
Hood served by mechanical exhaust 656 Moro Moro 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 NC requires site plan showing placement of unit.
is \dsts \forms\mech- fees.doc 10/11/00
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
MST
BUP
Date Requested 171— AM PM BLD
Location / )� ) 0, $w 1 u Suite • MEC 2'/_O i(
Contact Person Ph '/ 7) PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall - ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
- PASS PART FAIL
•
PLUMBING •
. Post & Beam S`
Under Slab
Top Out
Water Service ��
• Sanitary Sewer
Rain Drains
Final
PASS PART FAIL J
Post & Beam
Rough In T"uv // p+ -
Gas Line
Smoke Dampers
PAS PART FAIL '
ELECTRICAL
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. ay 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 r cord from the job site.