Permit :F
CITY TIGARD MECHANICAL PERMIT
aln DEVELOPMENT SERVICES PERMIT #: MEC2003 - 00202
-- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/30/03
PARCEL: 2S103AA
SITE ADDRESS: 10865 SW WALNUT ST
SUBDIVISION: ZONING: R - 4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: El VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
ELE 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: 7 OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Upgrades to exhaust fans (restrooms) connect/install existing cooling tower, minor controls upgrades. Valuation:
$5,397.00
Owner: FEES
SCHOOL DISTRICT NO 23 J Description Date Amount
13137 SW PACIFIC HWY
TIGARD, OR 97223 [MECH] Permit Fee 6/30/03 $78.58
[MECPLN] Plan Rev 6/30/03 $19.65
[TAX] 8% StateTax 6/30/03 $6.29
Phone: Total $104.52
Contractor:
PORTLAND MECHANICAL CONTRACTOR
6521 SE CROSSWHITE WAY
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Cooling Unt Insp
Reg #: LIC 151807 Duct Inspection
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
- I
Issue y: • . ,11 ,_ ! , /6 , LLs! I ' Permittee Signature: 4 -...e. _ _ _ _____,
- Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next b siness day
/0865 .s60 um-Les/07
Mechanical ?'ermit Application FOR OFFICE USE ONLY. ,. (� Received Mechanical
o'r " Ji _. " f • Date/By: y: ' a� 6 Permit No.: dzeloa3 -eieO`
G 2
a� 6 . - �� . . L V ' �J Planning Approval Building
City Ol Tigard Date/By Permit No.
13125 SW Hall Blvd. , .'e i ".i Plan Review Other
Tigard, Oregon 97223 Date/By: s/' %03 613 Permit No.:
Phone: 503- 639 -4171 Ftalcl 1503k54.$C1A60 ) Post - Review Land Use
/crier °A Date/By: Case No.: I
Internet: www.ci.tigard.UE.)i�.!)itC DIVE %I∎ -% `^ .j 91 1 ' I Contact tuns. ® SeePage2for
24 -hour Inspection Request: 503 - 639 -4175 Name/Method. --7 Supplemental Information. V
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
I, Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all t
CATEGORY OF CONSTRUCTION mechanical materials equipment, labor, overhead and profit.
LI 1 & 2- Family dwelling si Commercial/Industrial Value: $ 5 7, 00 See Page 2 for Fee Schedule ,,
❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) l Total _`
❑ Master Builder ❑ Other: Heating/Cooling
`
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00 I
Job site address: `O b (05 IS ) [.)e Uf ,-voAvao Gas heat pump 14.00 . ,
Suite #: I Bldg. /Apt. #: Duct work 14.00 1
Project Name: (WpW1. e, M', p•`� / 12tri°Gra Hydronic hot water system 14.00 L
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
k
141143 T W . 1 1Lf.J T• Unit heaters (fuel, not electric)
U2b' f ist i{ L' -r t-1/44-114) (in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00 C /)
Subdivision: Lot #: Repair units 12.15 ��
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00 I
DESCRIPTION OF WORK Gas fireplace 10.00
OleGYZA1E5 t k*1Anr - riNiO> (tItSTYLO ) _Flue vent (water heater /gas fireplace) 10.00
GAWU / /J(► 1►c1 -•1 Tt J Log lighter (gas) 10.00
Wood/Pellet stove 10.00
tAltub It C,IMIVUL.S 0146 N Wood fireplace /insert 10.00
Chimney/liner /flue /vent 10.00
❑ PROPERTY OWNER I ❑ TENANT Other: 10.00
Name: Tice 1UM.CCT1..1 scivout. `:'r Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: 6`t t D 5l., S Aet-I lOYM2l► ':7r Clothes dryer exhaust 10.00
City /State /Zip:1t( Pal* Mt • 1"7s775 Single duct exhaust
Phone:S63- 131- 41864 Fax: 431 - 404.1 (bathrooms, toilet compartments,
❑ APPLICANT ❑ CONTACT PERSON utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Other: 10.00
Address: Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax: Furnace, etc. **
Gas heat pump
E -mail. WalUsuspended/unit heater **
NTRACTOR Water heater **
Business Name: �4/.4die.4c -, Fireplace **
Address: SZ i47,/.2 Range **
BBQ **
City/State/Zip/ Clothes dryer (gas) **
Phone: -7L/e 2 Fax Other: **
CCB Lic. #: ,57fG7--- Total:
Authorized Mechanical Permit Fees*
L�,- - rm. � Subtotal: $ �
Signature ^ Date: Z D�✓ 7 Minimum Permit Fee $72.50 $
rer% M44)4 1 L.14+1 recr Plan Review Fee (25% of Permit Fee) $ j T ___ .
(Please print name) State Surcharge (8% of Permit Fee) $ ( a- f
TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information ar
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to $5,000.00 Miriimum fee $72.50
$5,001.00 to $10,000.00 $72.50 for the first $5,000 00 and $1 52 •
fbr -ech additional $100.00 or fraction
thereof, to and including $10,000 00
$10,001.00 to $25,000 00 $148.50 for the first $10,000.00 and
$1.54 for each additional $100 00 or
fraction thereof, to and including
$25,000 00.
$25,001 00 to $50,000.00 $379.50 for the first $25,000 00 and
$1 45 for each additional $100.00 or
fraction thereof, to and including
$50,000 00.
$50,001.00 and up $742.00 for the first $50,000 00 and
$1.20 for each additional $100 00 or
fraction thereof.
Assumed Valuations Per Appliance:
Value Total
Descnption Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance ermit 445
Repair u.uts 805
< 3 hp; absorb. it, 955
to 100k BTU
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU
15 -30 hp; absorb. unit, 501k to i mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725
•
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
No,s- portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets - 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION:
i. \Dsts\Permit Forms \MecPermitAppPg2 doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 • - MST
BUP
Received Date Requested AM PM BUP
Location r S Suite MEC 3 -06 a�
Contact Person Ph ( 77( ) 2 ( 7- 3- "(3( 3( PLM •
Contractor _ Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing , ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab. Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation -
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling •
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
_ Under Slab
Rough -In
— Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
�. i :,T FAIL
744 ;i 1 ;
Rough -In
Gas Line
Smoke Dampers
SS ` PART FAIL
RICAL
Service
Rough -In
UG /Slab •
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line / — � •
ADA 8/�g4 3 Ins ector — " - Ext
Approach/Sidewalk Date p
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL