Permit w
CITY F TIGARD MECHANICAL PERMIT
„y� , DEVELOPMENT SERVICES PERMIT #: MEC2000 -00466
„I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/4/00
PARCEL: 1S125DD-08500
SITE ADDRESS: 09720 SW VENTURA CT
SUBDIVISION: WASHINGTON SQUARE ESTATES NO.3 ZONING: R -4.5
BLOCK: LOT: 093 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:
GAS 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Intall gas furnace
Owner: FEES
KERR, BRUCE B Type By Date Amount Receipt
9720 SW VENTURA CT PRMT CTR 12/1/00 $72.50 2720000000
TIGARD, OR 97223 5PCT CTR 12/1/00 $5.80 2720000000
Total $78.30
Phone:
Contractor:
JACOBS HEATING + A/C
4474 SE MILWAUKIE AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Mechanical lnsp
Phone: 503 - 234 -7331 Final Inspection
Reg #: LIC 1441
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: I Permittee Signature: //24 a1
Call (5 3) 639 -4175 by 7:00 P.M. for inspections needed the next business day
4 ft,,.:: t.
!. ` . .,
Permit Application
Date received: Permit no. �4ma cb S 4 i echanical
• •
Al- ` '. : � �! City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OOR972i fr . Date issued: By: I Receipt no.:
E
Phone: (503) 639 -4171 (;E
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: r -1 tr" Building permit no.:
TYPE OF PERMIT
►: & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
❑ New construction 0 Addition/alteration /replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCIIEDULE
Job address: 9 ,z c) S(, V e. 6 ,, _ Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: 1 Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: (Block: 'Subdivision: *See checklist for important application information and
Project name: i3 rt...c..f_ - KP r-- jurisdiction's fee schedule for residential permit fee.
City /countyTk q Alt d f ZIP: Q 1 as 3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and (ration of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCHEDULE
- 3)1/57)4 L L 6'A' FAA t" run. c v 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
space insulated? 0 Yes ❑ No Air rati f xi existing plan C
Is existing system
g P Alteration of existing HVAC system
MECHANICAL. CONTRACTOR Boiler /compressors
State boiler perm it no.:
G • HP Tons BTU /H' - -
, Address; - L/ (_j 4. .5E pit t II c," Jr., _ Fire/smoke dampers/duct smoke detectors
' CUT f i)e -)n + State: CAI ZIP: dna p Heat pump (site plan required) - - -
Phone:;Z 31 4 - 7 3 A J I Fax: » )a -S251%-mail: Install/replace furnace/burner../ BTU /H ' ItJ •/�'
Including ductwork/vent liner ❑ Yes ❑ No / 71(�
CCB no.: f q q 1 Install /replace/relocateheaters- suspended,
City /metro lic. no.: I e1 b S wall, or floor mounted
Name (please print): Sk) rZ LE. CA) Vent for appliance other than furnace
. CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: SH I IQ LE-c -( S •H 011.0 Chillers HP
Com i ressors HP
Address: Environmental exhaust and ventilation:
City: L 5 ¥ `State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust -
_-= - .— - - --_- — --.-1 - -- Hoods; Type U lUres. kitchen/hazmat
hood fire suppression system
Name:' u c p k e y y- Exhaust fan with single duct (bath fans)
Mailing address: 9-7 ( - 1 S I ,) e �} pi. Exhaust system apart from heating or AC
City:"n . . ,R A S tate: 1`l ZIP: q 7,1,2...s Fuel piping and distribution (up to 4 outlets)
Type: _
Phone: 4, . •5 i O 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: • • " - 1 Fax: - - -- - I E- mail:- - - - - - -- - Woodstove/pelletstove .
Other: .. - , .
Applicants signature: -. ' " ' ' .. - I - Date: - - -- - - -"- - - - - Other: -
Name (print): -
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $ -07 . S — CD
P lan review (at %
Credit card number: / / expires if a permit is not obtained ( %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ ...5
Name of cardholder as shown on credit card accepted as complete. TOTAL $ 3 ` J
Cardholder signature Amount 440 -4617 (6/00/COM)
8300(1
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEES DI ILE:
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 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 fumace 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 Boller Certification required for units >200k BTU.
"Residential A/C requires site plan showing placement of unit.
is \fists \forms\mech- fees.doc 10/11/00
•
' '''CITY OF TIGARD BUILDING INSPECTION DIVISION -�
24 -Hour Inspection Line: 639 -4175
-s - • 9-4171 MST
BUP
Date Requested ��I 7 :1= � M BLD
Location ?72.0 • w ve" Suite c A 'u a -G 4 e./
Contact Person gra K- Ph 417/ -- / Z f Z . P M
Contractor Ph /// SWR
BUILDING Tenant/Owner ( / a /I,6o / n / ELC
Retaining Wall +, Gr+ J / ELR
Footing Access:
Foundation •
Ftg Drain / /it ` O
Crawl Drain Inspection Notes: 5�
Slab
Poost st & Beam 45 r LT.
Ext Sheath /Shear L 1M . 45 4'
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
Post & Beam I
Rough In
Gas Line y ^ �
S u • .e Dampers
,
'ART FAIL
CTRICAL •
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 for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk -
Other Date 1 R. o I n spector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspectio record from the job site.