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12300 SW BELL. COURT
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CITY OF
T i GA R D MECHANICAL PERMIT
��V �dP���T SERVICES DATE
MEC2003-00405
13125 SW Hall Blvd., Tig d, OR 97223 (503) 639-4171 DATE ISSUED• 3
2SI0
PARCEL: 2S 104AA-01300
SITE ADDRESS: 12.300 SW BELL CT
SUBDIVISION: BELLWOOD ZONING: R-4.5
BLOCK: LOT: 062 JURISDICTION: T!G
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VE14T FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS _ HOODS:
_ FUFL 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: CLO DRYERS: 1
FURN < 100K BTU: _ AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <= '10000 cfm: GAS OUTLETS: 5
> 10000 cfm:
Remarks: Itcl,lace gas piping to existing furnace and\\atcr heater,add piping&outlets for new gas drver and future range and
Idol.
Owner: _ FEES _
t7ALE J. COOK Description Date Amount --
1200 SW BELL CT [MECH] Pennit Fee 7/17103 $72.50
TIGARD, OR 97223
[TAX)8%,StateTax 7117/03 $5.50
Phone: 03-579-4778 Total $78.30
Contractor:
ROBIN CHURCH
PO BOX 554
ESTACADA, OR 97023 REQUIR71) INSPECTIONS
Phone: 503-630-2430 Gas Line Insp
Final Inspection
Reg#: LIC 84832
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Str 1i 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 sta!,ed within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires-yGuto follow nines adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00
Iss ed ay: ) r' Permittee Signature:
Call (503) 4`0-4175 by 7:00 P.M. for inspections needed the next business day
1
Mechanical Permit Application TReccived Mcchanical, ��o�,
!7/(i Permit No j t[t? �1i` -'
Planning Approval Building
City of Tigard Da—y_— Permit No.: �—
1'-'125 SW Hall Blvd. Plan Review Other
Date/BTigard,Oregon 9722 Post-R Permit ost•Rcview Land Use
Phone: 503.639-4171 Fax: 503-598-1960 -.,�._ Date/B Case No.:
Internet: www.ci.tigard.or.us Contact Juds.: See Page 2 for
24-hour Inspection Request: 503-639-4175 Namc/Method: Su lemental Information.
__ TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST
- New consttut tion Dt�molitiOn _ Mechanical permit '-es'are based on the total value of the work
]_Addition/alteration/replacement �]Other: performed. Indicate the value(rounded to the nearest dollar)of all
1 —
y CATEGORY OF CONSTRUCTION — mechanical materials,equipment,labor,overhead and profit.
Value: S See Page 2 for Fee Schedule
#I &2-FamilydwellingCommercial/Industriallti-FRESIDENTIAL E UtPMENT/SXSTEMS FEE*SCHEDULE
AccessoryBuildin Multi-Family Description I QtyFee ea. Total
Master Builder Other: _ Heatbt Cooun
JOB SITE INFORMATION and LOCATION Furnace-add-on air conditioning" — 14.00
Job site address: S t v Vie_(( ' Gas heat pump _ 14.00
^— � Bld /A t.#: Duct work 14.00
Suite#: g' p Hvdronic hot waters stem 14.00 _
Pro'ect Name: —_ Residential boiler
Cross street/I)irections to job site: _(for radiator or hydronic system) 14.00
Unit heaters(fuel,not electric)
in wall in-duct sus ended,etc. 14.00
Flue/vent for any of above 10.00
--- Rc air units 12.15
Subdivision: Lot#: Other Fuel A Ilances
Tax ma / arcel #: Water heater 10.00
DESCRIPTION QF WORK Cas fireplace _ 10,00
Flue vent(water heater/ as fire lace) 1(1,00
- - - _
Log lighter as 10.00
— -- Wood/PcIlet stove10.00 _
— �— - __- Wood fireplece/insert — 10.00
- Chimne /liner/flue/vent 10.00
ro'OP It'IYnWNrp— '-'T AIVT ^`— Other: 10.00
-� - ----�" `---�— -- Environmental Eithaust do Ventilation
Name: _ � �,k -- — Range hood/other kitchen equipment 10.00
Address: /a 3,0 s,,) y ( r'-T- -- Clothes dryer exhaust 10.00 /e,
City/',,'tate/Zip: G _ QX � -_ Single duct exhaust
Phone7 5`--
Fax: _ (bathrooms,toilet compartments,
P L C iT _ CONTACT h;A§ON utilit rooms 6.80
Attic/crawl s ace fans 10.00
Naive: ---- --- — ----- --- Other: 10.00
Address: _ _._ — Fuel Pl�r►ae_ -
Cit /State/Zl _ **(s5.40 for first 4.$1.00 each addiUonaq
—�----- — .� — Fumace etc. !
Phone' l aX — — Gas itmt pump "
E-mail: —_ __ _Wall/suspended/unit heater
CONTRAS- __ Water heater -•rlti1C�
Fire lace
Business Name: i,.,ru Q£ ..
Ran e
Address: e,? 3Y� BBQ a rtr 9 t. ..
city/state/zip: v Clothes d as
Phone: rax: Other: "
Total:
CCB Lic. #: j 1_ _ _ — Mechanical Permit Fees*
Authorized 3'�' _ _ - Subtotal. S
Signature: .— Dater 3 Minimum Permit Fee$72.50 S�'
Plan Review Fee(25%of Permit Fee S
State Surcharge(8%of Permit Fee) $
(Please print name) TOTAL PERMIT FEE $ °c.
Notice: This permit application expires if a permit Is not obtained within *Fee methodology set by Tri-County Building industry gervice Board.
i80 days after It has been accepted as complete. **Site plan required for exterior A/C units.
i\Dsts\Permit Fonns\MccPcrmitApp.doc 01/til
Mechanical Ilermit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
SI.00 n,$5,00000 Minimum fee$72.50
$5,001.00 to$10,000.00 $72.50 for the first S5,000.00 and 51.52
for each additional 510000 or fraction
thereof,to and including$10,000.00.
510,001.00 to$25,000.00 $148.50 for the first$10,000.00 and
$1.54 for each additional$100.00 or
fraction thcrcof,to and including
_
S25,000.00.
525,001.00 to$50,000.00 $379.50 for the first$25,000.00 and
51.45 for cacti additional$100.00 or
fraction thereof,to and including
S-50-0-0-0,00.
$50,001.00 and up v $742.00 for the first 550,000.00 and
$1.20 for each additional$100.00 or
fraction thereof.
Assumed Valuations Per A Rance:
Value Total
Description: Qty ___LEj& Amount
Furnace to 100,000 BTU,including 955
ducts&vents
Furnace>100,000 BTU including ducts 1,170
&vents
Flow furnace including vent 955
Suspended heater,wall heater or floor 955
mounted heater
Vent not included in appiiance rmit 445
Repair units ---,805
<3 hp;absorb.unit, 955
to 100k BTU —
3-15 hp-absorb.unit, 1,700
101 k to 500k BTU
15-30 hp;absorb.unit,501k to 1 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 handlingun.,to 10.2-00 cftn 656
Air handling unit>10,000 cfm 1,170
Non-vottable evaporate cooler 656 _
Vent fan connected to a single duct 446
Vent system not included in appliance 656
permit_
Hood served b mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit,including wood stoves, 656
inserts,etc.
Oas piping 14 outlaw 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION: ___
is\Dsts\Permit Dorms\MccPermitAppi'a2 doc 01/03
CITY OF TIGARD 24-Hour
BUILJING Inspection e: (503) 639-4175
NIST
INSPECTION DIVISION Business c: (503)639-4171
SUP
Received __— Date Requested-�_ a _ AM _-_- PM __ __ SUP _—
Location MEC 3-0o gos"
Contact Person Ph PLM
Contractor Ph( ) __ SWR
BUILDING _ Tenant'0wn. r J' _.� S� J `� ELC
Footing w �`\1_\ � D ( I=\ �- t;L ELC
Foundation Access: 'Z 1t('L!>L h4 (2 Al I 1 / N�S�( (jd N F",tt
g
Drain
Drain
V v� �1� .} Co (Z (� i � -1 u 1� ��� ELR - --- ---
Slab Inspection Notes: /jSIT
Post&Beam __--C'-�--
Shear Anchors pal
Ext Sheath/Shear
Int Sheath/Shear j✓
Framing -- - - - - - - --
Insulation a �, r v,'V-�-L4
Drywall Nailing _\ - --
Firewall
Fire Sprinkler —
Fire Alarm �s
- �
Susp'd Ceiling
Root
Other: _-
Final
PASS PART FAiL --1�� ---
PLUMBINd - ^_ _
Post&Beam
Under Slab --
Rough-In
Water Service - -- - - - -
Sanitary Sewer
Rain Dra;ns
Catch Basin/Manhole
Storm Drain ---
-
Shower Pan
Other: -- ---- -
Final
PASS_ PART FAIL
MECHANICAL _ _ -
Post& Bean
Rough-In -
r-7�"t-iri�
e Da s --- -- -_
Final
PART AIL _ ----- -
ELEc'rRICAL
Service
Rough�ln �d SLC
UG/Slab f� -- - --
Low Voltage __._----
Fire Alarm
Final F] Reinspection nee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS.PART FAIL_
SITE a Please call for foinspection RE: E] Unable to inspect-no access
Fire Supply Line
ADA -
Approach/Sidewalk Dsts __ �z4_ "_�: .'__ In Of �_ � � Ext
Other: �--
Final DO NOT REMOVE this inspection record Trom the job site.
P
PASS PART FAIL