Permit r
CITY OF TIGARD MECHANICAL PERMIT
1 DEVELOPMENT SERVICES PERMIT #: MEC2001 -00071
-- 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/26/01
PARCEL: 2S115AD -02300
SITE ADDRESS: 10534 SW TUALATIN DR
SUBDIVISION: DOVER LANDING ZONING: R -4.5
BLOCK: LOT: 004 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:
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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Replace existing gas log unit with new gas insert.
Owner: FEES
CLINTON, JOHN W + JENELLE G Type By Date Amount Receipt
10534 SW TUALATIN DR PRMT CTR 2/26/01 $72.50 2720010000
TIGARD, OR 97224 5PCT CTR 2/26/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
HOT SPOT FIREPLACE + PATIO
11525 SW CANYON RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 503 - 626 -9138 Final Inspection
Reg #: LIC 00071782
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 y •
co ' the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throug OA; y52-001- 080.
You ay obtain pies of these rules or direct questions to OUNC by . '� (50• , •1 •'.
1
Iss a By: / ; 1- , ;i /J Permittee Signature: ,a 1111
Call ( ' 3) 639 -4175 by 7:00 P.M. for inspections needey a next business day
Mechanical Permit Application
Date received: a Aef) Of Pen nit no.: N ..;QO %DOD 7/
. 4':.�i City of Tigard Project/appl.no.: Expire date:
City of Tigard Address 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERM11'
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction a' Addition/alteratio repla ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /0534. S 7;7,44.; 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: IBlock: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county:(, 4, I ZIP: 9 70 Z,y I & 2 FAMILY DWELLING PERMIT FIX SCHEDULE
Description and local n of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCHEDULE
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 ?AYes ❑ No Air handling unit CFM
space insulated? Yes ❑ No Air conditioning rati of xi existing plan HVAC Is existing system
g P � Alteration of existing HVAC system
NI ECI IAN I CAL CONTRACTOR Boiler /compressors
Business name: *Of 5, ' j ,�� State boiler permit no.:
HP Tons BTU /H
Address: //5 ZS ,Son Cw,n Fire/smoke dampers/duct smoke detectors
City: /3e°o.r■P2,�o •... State:0Z I ZIP: 9 760 S' Heat pump (site plan required)
Phone: Co Za -'9 Z I Fax: 626 9/451E-mail: Install/replacefurnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: 54C 76 Install/replace/relocateheaters- suspended,
City/metro lic. no.: 1.57s wall, or floor mounted
Name (please print): 7 i ; is _ . Ca�S ./e. 2).--. Vent for a liance other than furnace
CONTACT PERSON efngera• on:
Absorption units BTU/H
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: J ooL., C,/...-4 Exhaust fan with single duct (bath fans)
address: - Exhaust system a . art from heating or AC
Mailing /US.? It 3 .✓ /� w� c
State ZIP: Fue p p .: an ..1 but on up to 4 out ets
City: // ,4 /LLB I rJR 9 7Zt? 5t Type: LPG NG Oil
Phone: c''4 - 3/ f Fax: E -mail: Fuel i ing each additional over 4 outlets
p p g (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace -
City: State' I ZIP: Insert -type y am° o�t
Phone: / / • - .•ail: Woodstove/pellef ve
Other: _
Applicant's signature �!filr�L1 Date: ".„ Otter
Name (print): / : - r ,•• /,,,� �f _
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ /�
❑ Visa O MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Plan (at %
Credit card number an rev ( %) $
Expires within 180 days after it has been State surcharge (8%) .... $ `5 • � °
Name of cardholder as shown on credit card accepted as complete TOTAL $ 7%'50
$
- Cardholder signature Amount 440-4617 (6100/COM)
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
$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 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 g) 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) 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 NC requires site plan showing placement of unit.
I:\dsts \fomts\mech- fees.doc 10/11/00
Chininey Inspection By:
Custot,�er G /..- • ��
9 5 �i1 �v (/fA R�
Address t JOHN LAMBERT
City f3q( StateZip 503- 292 -2267
Date -1 '
Date � a " I - fime CCB NO, 0121197
Last Swept Type of Fireplace . ,
House Age Woodstove Insert Comments:
Chimney Cap no no Freestanding
No. of Flues I I ,
Flue Size(s)—
Number of cords burned per season .
•
Type of wood used ❑ soft ❑ hard ❑ wet ❑ dry
How did you hear about us?
• e.
SAFETY NOTE: The tnap•ctron Form Is the result of • general visual Inspection. N Ia only
H a INSPECTION Intended as a record of this mammon, and is not a statement of fke wo dwisua
w a or eatery cenihcaton No warranty of safety or function is to be
knpMed. Untie • m y < Crown condnna Of d run
ioeterart and use are beyond ow control.
To" m z FIREPLACE
1 1. Hearth 1 Mil
2. Firebox/Grate Chimney M
flue CUSTOMER VERIFICATION
3. Glazed Creosote I have read this form and now understand which areas of
� tls
4 . Damper woodburning system appear to be satisfactory and which
areas not satisfactory. I hldi
5. Smoke Chamber MI M are ry have also made a visual Ins f '
l• I MI tion of the area and I acknowledge the satisfactory comple-
6. Spark Screen/Doors i• tion of the work described.
7. Tools Smok
chamber - im
CHIMNEY O ma Signed Date
8. Brickwork Smoke IN MI
9. Glazed Creosote shelf �`
10. Flue Tiles Damper ntel C in NEXT SWEEPING RECOMMENDED
11. Animals in Flue ��� I - Date
Throat r our NE
12. Crown/Wash �— •
13. Chimney Cover /Cap Facing ...g. = Fireplaces and /or chimneys should be inspected yearly for
14. Height —r any structural faults, and all wood burning stove flues should
Lintel _ — ow fp. be swept at le; st once a ye; .
WOOD STOVE Nom
15. Stove Pipe Condition Firebox OEM
/ � i , /
•
and Screws Sweep asop s • •nature
16. Stove Condition AIM we IN RECEIPT
and Gaskets BtI
�� PRICE
17. Installation and Heanh Measurements OTHER FIRE SAFETY ow ft = e • �- `e • r Cam- `� MOM
18. Fire Extinguisher tti,
19. Smoke Detectors Foundation MI •
20. Fire Escape Plan MillIM11.11 pc) c.g ci l
Danger Signs
SUBTOTAL
• Has had chimney fire yes no
• 3rd Degree glazed Creosote yes O DATE COMPLETED _ TOTAL S0 o+
• Is chimney a potential fire hazard yes o e 1990 August West Systems, Inc THANK 'vat P
I /63
CITY OF TIGARD BUILDING INSPECTION DIVISION t i
4 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
MST
BUP
Date Requested 3-/5 AM PM BLD
Location /1)5 ,34 $ w 7 6t/a /l D 1 Suite MEC 2 !)U o 7/
Contact Person Ph 4(i 3/ PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
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
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
ECHANIC 1t hI M
Post & Beam 9G.)
Rough In r-? f 44,
Gas Line
Smoke Dampers
Final
PASS 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 inspecti• Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: _ ea I [ ] Unable to inspect - no access
ADA
Otheoach /Sidewalk Date Inspector I Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection ecord from the job site.
Io•o3
— OF TIGARD BUILDING INSPECTION DIVISION - '
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
.--- BUP
Date Requested 5--/ 5 AM PM BLD
Location / S` ' la tcp 6 y 1 ,D)^. Suite MEC O / ca 7(
Contact Person Ph as-ii 3/ Y f / PLM
Contractor Ph 5Z3 SO q 7 w SWR
BUILDING Tenant/Owner '�/ -n 71/4 - C411 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
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
(MECHANICAL)
Rost & Beam
Rough In .6 ,,,ep/ 4u _
Gas Line
S ke Dampers
PASS PART FAIL
TRICAL
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. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call or 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.
• 4
BUP - Building Permit ELC - Electrical Permit
4 Inspection Description Date Passed By J Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing 4 Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry /Reinforcement
Framing
MFG - Structure set -up MEC - Mechanical Permit
Insulation
Drywall nailing 4 Inspection Description Date Passed By
Post/beam mechanical
Suspended ceiling Gas line
Engineered soils Mechanical rough -in
Welding Lab Final Fire damper
Concrete Lab Final Duct work
Bolting Lab Final Smoke detector
Fireproofing Lab Final Mechanical final 3 I 1 0 � J'e6
Structural observation
Final inspection
PLM - Plumbing Permit
4 Inspection Description Date Passed By
BUP — Fire Protection System Permit Plumbing underslab
Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm final Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final
Sprinkler supply lines
Sprinkler underfloor /slab
Catch basin /Manhole SWR - Sewer Permit
Engineered soils J Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR, MEC, SIT PERMITS
e -
L
•, P ' .
C ITY OF TIGARD MECHANICAL PERMIT
A 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
- '��a �, DEVELOPMENT SERVICES PERMIT #: MEC2001 -00071
,..44.-. I
DATE ISSUED: 2/26/01
- �
PARCEL: 2S115AD -02300
SITE ADDRESS: 10534 SW TUALATIN DR
SUBDIVISION: DOVER LANDING ZONING: R -4.5
BLOCK: LOT: 004 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:
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 OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace existing gas log unit with new gas insert.
Owner: FEES
CLINTON, JOHN W + JENELLE G Type By Date Amount Receipt
10534 SW TUALATIN DR PRMT CTR 2/26/01 $72.50 2720010000
TIGARD, OR 97224 5PCT CTR 2/26/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
HOT SPOT FIREPLACE + PATIO
11525 SW CANYON RD
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 503 - 626 -9138 Final Inspection
Reg #: LIC 00071782
Q
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 O
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended O
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted the Oregon
Utility,NOtification Center. Those rules are set forth in OAR 952 - 001 -0010 throug O • ' ' 52- 001 -e 080. O
You ay obtain copies of ese rules or direct questions to OUNC by . 'no (50. 4 • - .
Iss e B gli/ ,_ , Perm ittee Si nature: Y _ / . ii . /� 9 / ...
ice-
— Call ( i ) 639 -4175 by 7:00 P.M. for inspections neede,' a next business day