Permit R CITY OF TIGARD MECHANICAL PERMIT
y �n DEVELOPMENT SERVICES PERMIT #: MEC2001 -00021
`'� DATE ISSUED: 1/19/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S102CA -00914
SITE ADDRESS: 13495 SW VILLAGE GLENN DR
SUBDIVISION: VILLAGE GLENN ZONING: R -4.5
BLOCK: LOT: 014 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: 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Change out to gas furnace and associated gas piping.
Owner: FEES
MEEKS, GARY E MARJORIE A Type By Date Amount Receipt
13495 SW VILLAGE GLEN DR PRMT CTR 1/19/01 $72.50 2720010000
TIGARD, OR 97223 5PCT CTR 1/19/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
WATTS HEATING & COOLING INC
18108 SE RIVER RD
MILWAUKIE, OR 97267 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503 - 653 -0514 Heating Unt Insp
Reg #: LIC 134602 Final Inspection
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 i i i.n Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
Yo may obtain c..ies of t r les or direct questions to OUNC by c ling /43)246 -9189.
Iss By: _ / , I i Permittee Signature:x
Call (5 1 ) 639 -4175 by 7:00 P.M. for inspections needed the next business day
gc Zo II - O , - 1
Mechanical Permit Application
Date received: - Permit no.:
-14 • .. J . City of Tigard
- � __.. `J b Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 9722
Phone: (503) 639 -4171 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 ' Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 41 # s' $ to (/'/ j A 6 6 pp. Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: 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: jurisdiction's fee schedule for residential permit fee.
City/county: c A R. • ZIP: 4 ZZ 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
Fee (ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res.only
Tenant improvement or change of use: Ii Air a m ■ --
handling unit CFM
Is existing space heated or conditioned? ❑Yes ❑ No Air conditioning (site plan required) _
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system =
M1 CIIANICAL CONTRACTOR Boiler /compressors
Business name: l�S o € • --/ t3 b 4 - • AO ■ / State boiler permit no.: ,■■
HP Tons BTU/H
Address: g Len / IV Ion ' TD Fire/smoke dampers/duct smoke detec tors -
` State: Q ZIP: 9 7 d 1p 7 Heat pump (site plan required) —
Phone: I . , - Ass . Fax: E - mail: Install/replace furnace/burner BTU /H MI
1 j 0 7"� Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: Install/replace/relocate heaters - suspended, ■ --
City/metro lic. no.: wall, or floor mounted
4 1 Name (please print): Vent for a' s liance other than furnace MN
CONTACT PERSON efnge on: ■ --
Absorption units BTU/H
Name: Chillers HP - _—
Address: Co ,lessors HP =
a plromnv e ust an ven • non: ■
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
- Name: j A Q '/ E.q..-K'S Exhaust fan with single duct (bath fans) - __
Mailing address: • 1 q9S ' 1 (4.r - ., - Exhaust system a. art from heating or AC IM
City: C F}-e._ State: De ZIP: 7 ? 5 Fuel pip .: an distnb on (up to 4 ou eta -
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel . i . ing each additional over 4 outlets M
• ENGINEER Process pip . : (schematic required) MI11.111.1111111■M
Name: Number of outlets -
Other appliance or equipment: ■ --
Address: Decorative fireplace
City: State: ZIP: Insert -type —
Phone: I7 E -mail: Woodstove/pelletsrove =
Other:
Applicant's signature: Aril, • Date: fW0 / ()th
/ X Name (print): .• = =
Permit fee $
Not all jurisdictioas accept credit raids, please call jurisdiction for more information. Notice: This permit application 7a ,
❑ Visa 1:1 MasterCard Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ 5 i 8d
Name of cardholder as shown on credit card accepted as complete. TOTAI. $ 7 • Jv
Cardholder signature Amount
440-4617 (600/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
ASSUMED VALUATIONS PER APPLIANCE: to look BTU 14.00
Value Total 8) 3 -15 HP; absorb
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
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 10.00
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725 18) Domestic incinerators 17.40
mil. BTU 19) Commercial or industrial 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 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.
iAdsts\forms\mech- fees.doc 10/11/00
3. - 1
`CITY OF TIGARD BUILDING INSPECTION DIVISION -
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP
Date Requested / - Z AM PM BLD
Location / 3'/ -r - ' U// 5 7 !'Y Suite MEC 2A/1 a Z
Contact Person Goa 44s Ph 7 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 / C 'i%, - re - sr Gt4y,v /.7
Insulation
Drywall Nailing 4-1 ' 8 6
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
MECHANIC
- e am
Rouah In
tGas Line?
Smoke Dampers
•
Final - •
--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. 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 `
Date �r 7 O/ I
• Other Ext
Final
PASS PART FAIL ' DO NOT REMOVE this inspection record from the job site.-