Permit C ITY OF TIGARD MECHANICAL PERMIT
mirk DEVELOPMENT SERVICES PERMIT #: MEC2003 -00254
- c � i 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/16/03
PARCEL: 2S115AA -07900
SITE ADDRESS: 10530 SW TITAN LN
SUBDIVISION: BERKLEY ESTATES ZONING: R -4.5
•
BLOCK: LOT: 011 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:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU .15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Install exterior AC unit. Cannot be placed in the required set backs.
Owner: FEES
HIEB, ALVIN A Description Date Amount
10530 SW TITAN LN
TIGARD, OR 97224 [MECH] Permit Fee 5/16/03 $72.50
[TAX] 8% StateTax 5/16/03 $5.80
Phone: Total $78.30
Contractor:
BEN'S HEATING & AC
PO BOX 80607
PORTLAND, OR 97280 REQUIRED INSPECTIONS
Phone: 503 233 - 1779 Cooling Unt Insp •
Final Inspection
Reg #: LIC 64597
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. T •se rules are set forth in OAR 952 - 001 -00
Issued By: r' 1 Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the n-xt business day
Mechan - -mit A lication FOR OFFICE USE ONLY
AA Received Mechanical
• Date/By 5 - /(o - 0? 8 V Permit No in , a.
City of Tigard Planning Approval Building
Date/By Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By Permit No
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
"a0` °' ( Date/By: Case No.
Internet: www.ci.tigard.or.us Contact Juris : ® See Page 2 for
`^ ■ e'!
24 -hour Inspection Request: 503- 639 -4175 -- Name/Method fi I 41 Supplemental Information.
n,: : ;.": r - : : ` - , , .-4,:: - . TYPEOF'WORK :"f: 2-,:::-:." _- ,_ '-'. • FEE ..SCHEDUt;E`,USECHECKL•IST: :
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
., . mechanical materials, equipment, labor, overhead and profit.
7 ::�_ "CATEGORYOF CONSTRUCTION- ;;: ��.•'.
1 & 2- Family dwelling ❑ Commercial /Industrial Value: $ D See Page 2 for Fee Schedule
[] Accessory Building 111 Multi-Family °'RESIDENTIAI;: EQUIP. MENT /SYSTEMS'FEE* :SCHEDULE `
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling " '
- -:' : :'JOBSITE.LNFORMATION and•LOCATION :` Furnace - add -on air conditioning ** / 14.00
Job site address: I d53 0 SW ri A Gas heat pump 14.00
Suite #: , Bldg. /Apt. #: Duct work 14.00
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
o c a (J by . /04-
Unit heaters (fuel, not electric)
(in wall, in-duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
Other Fuel Appliances ., .
Tax map /parcel #: Water heater 10.00
'1 ".:. _" _, '' -;- =- , ':,DESCRIPTION,ORWORK ` - , . _ Gas fireplace 10.00
a'f ' ,,,/ A-14- Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney /liner /flue /vent 10.00
`' .'PROPERTY.O.WNEW..: = :,-;1'; ® TENANT °' :; ' Other: 10.00
Name: 4t, 14-1`el . - Environmental Exhaust &-Ventilation
Range hood/other kitchen equipment 10.00
Address: /053 0 Syl `N. `�-A✓) Clothes dryer exhaust 10.00
City /State /Zip: �, 1/t' o r 9 as Li Single duct exhaust
Phone: 6 3 9 - q - 7S7 Fax: (bathrooms, toilet compartments,
[0 APPL"ICANT.' = ri4t "?'_ ' • ❑. ONTACT PERSON _ :: ' . utility rooms) 6.80
Name: CAI 6 dim-4-01J Attic /crawl space fans 10.00
Other: 10.00
Address: '' :Fuel Piping - •- ' . _. ;
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
F etc. **
Phone: Fax: **
Gas heat pump
E -mail: Wall /suspended/unit heater **
'.;,' ":,._8 ".,<:f: : ;CONTRACTOR" , ,: :°` • _ ' , Water heater **
Business Name: 3eno I.efrl-crq 1.41 Fireplace **
Address: Pd 130.A c' �aO Range **
City /State /Zip: p j - - \r4N o €, Si aRO _ Clothes dryer (gas) **
Phone: a_33- l 77 9 Fax: 6s 3314,5
3 uS Other: •*
CCB Lic. #: 6 4 5.97 l a -l 3 Total:
Mechanical Permit Fees*
Authorized
Subtotal: $
Signature: Date: - «l0 T7 Minimum Permit Fee $72.50 $
e_ (U r Plan Review Fee (25% of Permit Fee) $
(lease print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
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.
r:\Dsts\Permit FomuVNecPermitApp.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
•
Assu`nied'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 1,
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: '
..
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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 1 /4 6, Date Requested 5 7 - AM PM BUP
Location / t 5 30 5I.!/ T / Suite MEC - a CV
Contact Pers Ph ) 5-7 PLM
` .3ontrar: or o� 9 �S / 77 gl Ph ( ) ' � SWR
BUILDING Tenant/Owner /P ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: pA w g v SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear •
Ina Sheath/Shear �L6�2iC'/LL ,��i L •
Framing AJeeO • �%
Insulation
Drywall Nailing CG 2L'v< T
Fi rewall
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
Post eam
Rough -In
Gas Line
S i oke Dampers
erip
PASS ART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low. Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: E Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date �3 Inspector , Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
�^- BUP
Received Date Requested a 7 AM PM BUP
Location r 5 T -L . I)2_/ Suite
Contact Person Ph ( ) PLM
Contractor Ph ( ) S of - g (a SWR
BUILDING • Tenant/Owner a 3 — d D 93
Footing
Foundation �,�� ELC
Ftg Drain ACCes f�� �\ U / �G �����` � ELR
�
Crawl Drain
Slab Insp ction Notes: / " SIT
Post & Beam ! lam ' .'
Shear Anchors
Ext Sheath/Shear b 1 Rs 7 c.7
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
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
T FAIL
MECHL
Post & Beam
Rough -In
Gas Line
S.mplLe Dampers
Fin
A . —PART FAIL:
Service . 6v
Rough -In d
UG /Slab
Low Voltage
Fire Alarm
in ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line • ? •
ADA /Z/ G ' l Approach/Sidewalk Date Inspector Est
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL