Permit CITY TIGARD MECHANICAL PERMIT
YI t , DEVELOPMENT SERVICES PERMIT #: MEC2001 -00115
^ III 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/9/01
PARCEL: 1 S135CC -00100
SITE ADDRESS: 10200 SW TIGARD ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: 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:
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: AIR HANDLING UNITS
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
GAS OUTLETS: 1
> 10000 cfm:
Remarks: Line for future stove /fireplace
Owner: FEES
ROGER DAY Type By Date Amount Receipt
10200 SW TIGARD PRMT CTR 4/9/01 $72.50 2720010000
TIGARD, OR 97223 5PCT CTR 4/9/01 $5.80 2720010000
Total $78.30
Phone: 503 - 670 -1704
Contractor:
D + R HEATING + AIR COND
PO BOX 1292
27251 S DAVE RD REQUIRED INSPECTIONS
CANBY, OR 97013 Final Inspection
Phone:
Reg #: LIC 84489
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 rules or direct questions to OUNC by calling (503)246 -9189.
Issue By: Permittee Signature: 1 - ■∎�
Call (5 ) 639 -4175 by 7:00 P.M. for inspections needed the -xt business day
Y ..,
.. . A
.Mechanical Permit Application
Date received: I -9 --0 ( Permit no.: a-pd //
AA - ' , I City of Ti Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 Date issued: By: Receipt no.:
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
$ I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement •
0 New construction Ii Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /0,200 9 ‘,.c..-- 77 e Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: f 4uite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ •
Lot: (Block: ISubdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: 7 r ;y4, f ,1 I ZIP: 97223 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and - location of work o remises: T, 7/ 965 AND COMMMERICAL/INDUSTRIAL EQUI PM ENT SCHEDULE
/ y s� P or 5,4',"e ,r eig:/p Fee(ea.) Total
Est. 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
Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECI IAN ICAL CONTRACTOR Boiler /compressors
Business name: p �- State boiler permit no.:
HP Tons BTU /H
Address: Fire/smoke dampers/duct smoke detectors
. City: I State: I ZIP: Heat pump (site plan required)
Phone: I Fax: I E -mail: InstalUreplacefurnace/burner BTU /H
CCB no.:
Including ductwork/vent liner 0 Yes 0 No
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: Chillers HP
Address: Comyressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
DATER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: A - ,04 Exhaust fan with single duct (bath fans)
Mailing add ss: J r a 00 5' , 7 , . Exhaust system apart from heating or AC
r Fuel piping and distribution (up to 4 outlets)
City: 7— tk o.Z.f I te:Oki ZIP2a.,..2._3 Type: LPG NG Oil
Phone: Xi - d Fax: E -mail: Fuel piping each additional over 4 outlets
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: E - mail: Woodstove/pelletstove
Other:
Applicant's signature: 922'/ Other:
Name (print): 2 r— 0 �J�
Not all junsdtctions accept credit cards, please call jurisdict o %for more infonnation Permit fee $ ' ,� ( J
❑ visa ❑ MasterCard Notice: This permit application Minimum fee $
e xpires if a permit is not obtained
Credit card number: / / Plan review (at %) $
Expires within 180 days after it has been
Name of cardholder as shown on credit card accepted as complete. State surcharge (8 %) .... $ 5, 0
$ TOTAL $ — 7Q,
Cardholder signature Amount 440-4617 (6/00/COM)
MECHANICAL PERMIT FEES r..
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
$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's `Air;- `;r ;s ; ;��r fti *Ai4O
$1.20 for each additional $100.00 or For items' 7 =11, see -' w
fraction thereof footnotes‘below: * ""r,
'Come
7) <3HP;absorb unit
ASSUMED VALUATIONS PER APPLIANCE: 8) 3-1 BTU 14.00
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
Vent not included in applicance 445 10.00
permit 13) Air handling unit 10,000 CFM+
17.20
Repair units 805 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 10.00
to 100k BTU
3-15 hp; absorb. unit, 1,700 15) Vent fan connected to a single duct
101k to 500k BTU 6.80
15-30 hp; absorb. unit, 501k to 1 2,310 16) Ventilation system not included in
mil. BTU appliance permit 10.00
30-50 hp; absorb. unit, 3,400 17) Hood served by mechanical exhaust
1 -1.75 mil. BTU 10.00
>50 hp; absorb. unit, 5,725 18) Domestic incinerators
17.40
mil. BTU 19) Commercial or industrial l type incinerator
Air handling 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
Hood served by mechanical exhaust 656 22 ) More than 4 -per outlet (each)
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 s ,
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 BUII DING INSPECTION DIVISION
24 -Hour Inspection Line: 63 175 Business Line: 639-4 offer
! Z��j
Date Requested . / b -_3 AM PM
BLD
Location / D Z 0 0 r , Sfi uite D •:/.'. 0 o ---
Contact Person - AP r Ph -47 a-3S9 P 0 I 60 q-
Contractor (6 t h _ SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing cess.
Foundation FPS
Ftg Drain SGN
Crawl Drain I . - ction Notes.
Slab 6 e2, .Q.A SIT
Post & Beam
Ext Sheath /Shear k _ /� ■ _' !'
Int Sheath /Shear
Framing ,r
Insulation /( 0 1 , 1 _ _ r -- I �
Drywall Nailing � 0 L zoo 1 - 00 4 0 bislA 1. «Sy1 t a -ts S i#
Firewall I 1 I I
Fi Sprinkler IL _/_-_41E__ -
Fire Alarm \ \\
Susp'd Ceiling �----- v
Roof •
Misc:
Final
PASS PART FAIL
CUMB
& Beam)
Under Slab
1
Water Service �
Sanitary Sewer //�
Rain Drains �� • - 1 - • 0 \ \ _u — C a• \,if1/4A.,/
Fin • \
Post & Beam i �� ”` 1 7,
Rough In 7'Q S - 4 1106
Smoke Dampers
Final
'0 PART FAI AO Om ., f ., mss- / ■ / • ' �y> s 0
ELECTRICAL -
Service A/ . / �� I f , I - — 0 / —/ - fl • a 17 OQ l i r
Rough In
UG /Slab 0) G� ' 6 �Cl f■ta- CA , • Low Voltage /�
Fire Alarm • g -() / — QV /)-3 (/r7S +')e F/ �/G
Final Z... /& � J -€ btit / t ,S ° (/� i /
PASS PART FAIL / / --�� d- //-�� •
SITE EGG vd / . OQ / F (- ` ri- <. -1'sp - 7��7�0 0 —
Backfill/Grading •
,
Sanitary Sewer y�- �c�,�l 3 ct� f ea,,, 42_P .
Storm Drain [ ] 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 q
Approach /Sidewalk Date l 31 b1 Inspector Ext3 i J
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.