Permit 4 CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2001 -00201
r 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/7/01
PARCEL: 1S133DD-02600
SITE ADDRESS: 12925 SW VILLAGE PARK LN
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 2 ZONING: R -4.5
BLOCK: LOT: 065 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:
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: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Replace furnace and add exterior A/C unit. NC unit must not be placed within the required setback area
Owner: FEES
COUCH, LERON D AND TAMBERLY AN Type By Date Amount Receipt
BY GREG SNOW PRMT CTR 6/7/01 $72.50 2720010000
12925 SW VILLAGE PARK LN 5PCT CTR 6/7/01 $5.80 2720010000
TIGARD, OR 97223
Total $78.30
Phone:
Contractor:
HARDY PLUMBING + HEATING
14689 NE COUNTRYSIDE
AURORA, OR 97002 REQUIRED INSPECTIONS
Mechanical lnsp
Phone: 222 -9654 Duct Inspection
Reg #: LIC 00060947 Final Inspection
PLM 3 -234PB
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 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:
Call (5 3) 639 -4175 by 7:00 P.M. for inspections needed the next business day
,.
I r
A Mechanical Permit Application
v Date received: , - '� -O Permit no.: u` _Op -00. o
. I ' i
� City of Tigard � :_� ty g Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: M 5 7;2 OD/ -60/ Building permit no.:
TYPE OF PERMIT
g I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: ) gas— �c ),J 1) f (J / �,_...; Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.t value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ •
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: C., /."T2 Pre56 AND COMMERIC.AL/INDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion/inspection: G -. - 7 / Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? Yes 0 No Air handling unit CFM
g p Air conditioning (site plan required) I
Is existing space insulated . ri Yes 0 No Alteration of existing HVAC system
MECI IAN ICAL CONTRACTOR Boiler /compressors
Business name: ! /� / ,) C. z 1 / � ��4 State boiler permit no.:
n 1 ^ q l' , / HP Tons BTU /H
Address: ,....../A- ¶ YLI 1 rJ1 . j2 5 /i0 X Fire/smoke dampers/duct m p ers/duct smoke detectors
City: j9J /A9k,H State6 4 I ZIP:q' '_ Heat pump (site plan required)
Phone: `C) ` aJf4
) -' / I Faxle7g- L),f9QI E -mail: Install/replace furnace/burner IC)6ICBTU /H
v Including ductwork/vent liner LA O No l
CCB no.: (O 0 ` /� Z in Ins tall /replace/relocateheaters - suspended,
City/metro lic. no.: ,yj $ 7 t - f'7 / to wall, or floor mounted •
Name (please print): y /9, r Vent for appliance other than furnace
CONTACT PERSON
Refrigeration:
Absorption units BTU/H
Name: </a M.;' Chillers HP
Address: Com)ressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type 1/ II/res. kitchen/hazmat
hood fire suppression system
Name: (' L)()--- Exhaust fan with single duct (bath fans)
Mailing address: 1 ').� C r) s 2,.. j k ZIP: i LL/ j}(Qn.- L __ Exhaust system a artt�from heating or AC
City: / / / 11-/ 0 I State:19 Fuel piping and distri bution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E - mail: Fuel pinin e ach additional over 4 outlets
Process W ng (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: ax: I E -mail: Woodstove/pelletstove
Other:
Applicant's signature: ) L --, -- - I Date: L - -d I Other:
Name (print): r 1+-P-1? 0 -/
' Not all jurisdictions accept credit cards, please call jurisdiction for more information.' Permit fee $
0 Visa 0 MasterCard Notice: This permit application 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 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount ■ 440 -4617 (WJOO /COM)
c
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price Total
Table 1A Mechanical Code QV (Ea) Amt
$1.00 to $5,000.00 Minimum fee $72.50 1) Fumace to 100,000 BTU
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and including ducts & vents 1 14.00 ' (, �
/� t�
$1.52 for each additional $100.00 or 2) Fumace 100,000 BTU+
fraction thereof, to and including including ducts & vents 17.40
$10,000.00. Floor Fumace
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) including vent 14.00
$1.54 for each additional $100.00 or
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
Fumace > 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
Air handling unit to 10,000 cfm 656 19) Commercial or industrial type incinerator 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: �r1( d/n.4.471) /- [44/74,
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 A/C requires site plan showing placement of unit.
is \dsts \forms\rnech- fees.doc 10/11/00
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1LlLL1l�F �/�
BUP - Building Permit ELC - Electrical Permit
Inspection Description Date Passed By 4 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
� Inspection Description Date Passed By
Drywall nailing
Post/beam mechanical
Suspended ceiling Gas line
Engineered soils _ Mechanical rough -in 01/4/b(
Welding Lab Final Fire damper
Concrete Lab Final Duct work (0 / /I /O/ RO
Bolting Lab Final Smoke detector /_ M
Structural observation Mechanical final (pl�ti(U/ /V'
Fireproofing Lab Final
Final inspection
PLM - Plumbing Permit
BUP — Fire Protection System Permit Inspection Description Date Passed By
Plumbing underslab _
4 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
4 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 4 Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
Inspection Record - BUP, PLM, SWR, ELC, ELR, MEC, SIT Permits
is \fists forms \InspRecordBUP.doc 04 /17/01
C ITY OF TIGARD MECHANICAL PERMIT
A DEVELOPMENT SERVICES PERMIT #: MEC2001 -00201
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/7/01
PARCEL: 1S133DD-02600
SITE ADDRESS: 12925 SW VILLAGE PARK LN
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 2 ZONING: R -4.5
BLOCK: LOT: 065 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:
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: 1 AIR HANDLING UNITS OTHER UNITS: 1
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace furnace and add exterior A/C unit. A/C unit must not be placed within the required setback area
Owner: FEES
COUCH, LERON D AND TAMBERLY AN Type By Date Amount Receipt
BY GREG SNOW PRMT CTR 6/7/01 $72.50 2720010000
12925 SW VILLAGE PARK LN 5PCT CTR 6/7/01 $5.80 2720010000
TIGARD, OR 97223
Total $78.30
Phone:
Contractor:
HARDY PLUMBING + HEATING
14689 NE COUNTRYSIDE
AURORA, OR 97002 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 222 -9654 Duct Inspection
Reg #: LIC 00060947 Final Inspection
PLM 3 -234PB
( 111
p4
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 i
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 hip
calling (503)246r9189.
Signature:
Permittee Si l�
Issue By: � �yl 9
Call (5,63) 639 -4175 by 7:00 P.M. for inspections needed the next business day