Permit ■
,CITY OF TIGARD
A t • MECHANICAL PERMIT
*fk , DEVELOPMENT SERVICES PERMIT #: MEC2001 -00307
i 4j. ' i' ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 08/24/2001
PARCEL: 2S103BD -00200
SITE ADDRESS: 11710 SW WALNUT ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: 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:
WOD 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: 1 <= 10000 cfm: OTHER UNITS:.
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of WOOD BURNING HVAC system.
Owner: FEES
CAPPOEN, RAYMOND J Type By Date Amount Receipt
SUZANNE PRMT CTR 08/24/20( $72.50 2720010000
11710 SW WALNUT ST 5PCT CTR 08/24/20( $5.80 2720010000
TIGARD, OR 97223
Total $78.30
Phone:
Contractor:
ANCTIL SHEET METAL CO.
4320 N WILLIAMS AVE
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Mechanical lnsp
Phone: 503 - 281 -0752 Heating Unt Insp
Reg #: LIC 8897 Duct Inspection
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 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 -918..
Issue By: Aille, . _!` .A,_ _ /4, Permittee Signature: j7)'2 i !/1
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Datereceived.�r�� Permit no.: i/i - � u,�•, G.,, City of T •
Z;'Y_i��! Tigard RECEIVED Project/appl. no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 AUG 2 0 2061 Case file no.: Payment type:
• Land use approval: COMMUNITY 1JFVFI (Wrw; ... 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 I NFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: f "I ( 5 0 kiALNu1 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: 'Block: P jiSubdivision: `See checklist for important appiication information and
Project name: Rl 2 0 9 4 3 jurisdiction's fcc schedule for residential permit fee.
City /county: - I- 14ArLp I ZIP: 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:
HVAC:
Is existing space heated or conditioned? 0 Yes ❑ No Air handling unit CFM
space insulated? 0 Yes 0 No Ali rati conditioning existing HVAC Is existing Csyste
g P Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: A ly GT 1.1-- 14 g AT 1144 4 G941) t- I P44 State boiler permit no.:
HP Tons BTU /H
Address: y 3 Z O 1J , WILLIAM S Ma. . Fire/smoke dampers/duct smoke detectors '
City: QD t2-v 4, iv0 I State: pp_ I ZIP: el-/....2„.1 -I Heat pump (site plan required)
Phone: - 2g I - 6-16 - Fax: Zgt -S�ZzI E -mail: Install/replace furnace/burner IZO j'BTU/H •
CCB no.: 8 8 411 Including ductwork/vent liner III Yes O No I
Install/replace/relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: 1S 0 rj ►A LA O V N 4 S M A Chillers HP
Address: Li •5 Z D 4 , VI LLI ANA S E nvironm rs HP
Environmental exhaust and ventilation:
City: 120, ►ZT u p a ., 4 I State: p vk I ZIP: a 1 Z 1.'1 Appliance vent
Phone: 28t - o - 15z Fax:282 -Shzt E -mail: Dryer exhaust
OwT`ER � ' ,. • . Hoods, Type I/ II/res. kitchen /nazmat
" hood fire suppression system
Name: C A, Po INE Exhaust fan with single duct (bath fans)
Mailing address: I V to S to WAt.IJ vT Exhaust system apart from heating or AC
City: ¶ 14ArZ O I State: pa I ZIP: q 7 ve 3 Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
rocess piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert-type
Phone: I Fax: I E -mail: Woodstove/pelletstove
Other: _
Applicant's signature: ��yyy Date: Other: WOOD ISO 00144 FLOWAGE
Name (print): 140gsp.k k b ct A
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa ❑ 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 $ - ZS 3 d
$ Cardholder signature Amount 440 -4617 (6/00/COM)
MECHANICAL PERMIT FEES s,
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 QV (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
including ducts & vents 14 00
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
fraction , 0ereof, to and including
$10,000.00. -` including ducts & vents - I 17.40 I i , 46
$10
$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 .
I • •- ' - l fraction thcrocf. • . , fnotnntes below. ; Comp* - _. . .'"' _.
7) <3HP;absorb unit
to 100K BTU 14
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 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) O ther units including wood stoves
Non - portable evaporate cooler 656 I 10.00 I,D, p8
Vent fan- rnnnected to a•sinole d uct 446 _ _ ____ _ 21 ��....,..,.. to four c ut!etc
....., piping ono
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 $12
•
Other unit, including wood stoves, 656 • ' 8% State Surcharge - $
inserts, etc. S $o
Gas diping 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: ` ' , $ 3c.
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'perhour
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.
" A/C requires site plan showing placement of unit.
is \dsts \forms\mech- fees.doc 10/11/00
CITY OF TIGARD BUILDING INSPECTION DIVISION , •
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested f- I AM PM BLD
Location 1) 7/Q $-'' w <4 ' s7 Suite MEC ...9p41 �GU 30 7
Contact Person Ph 21/ G7 f v 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 / • ,U int 5rA Lc - • _ • C
Insulation
Drywall Nailing 2ti 7 .(J//Gl (.iUSTIOro /41 tZ dP y
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
CH AL
ost & Beam
Rough In
Gas Line •
Smoke Dampers
Fi -
PART FAIL
LECTRICAL
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 Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. -
•