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9200 SW EDGE-WOOD STREET
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
BLIP `
Received Date Requested � AM-_--_- - - - PM _ BLIP
Location _ D U / IJ O GYM od I Suite MEC
Contact Person _ _- �A -,,�,�. Ph(041 ) _")23 �/�� PLM
Contractor ---_- U , Ph( ) SWR WILDING---- Tenant/Owner _-- _-^---_— -_ ---- ELC
Footing
Foundation ELC -
Ftg Drain �C8S8:� n —
Y
G4��.�-(r.. - ELR ----- - --- ---
Crawl Drain �� ' •tJ �.--'
Slab Inspection Notes: SIT
Post& Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear - -- - -
Framing
Insulation
Drywo II Nailing
Firewall
Fire Sprinkler --- - - ------ __---_
--------------------------
Fire Alarm
Susp'd Ceiling -- _----------------- --
Root - ----
Other:_ -- - --- ---
Final
PASS PART_ FAIL - --'-' -
PLUMBING -
- - - - - --
Post 8 Beam
Under Slab --_ -
Rough-In -
Water Service
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:
Final
PAS -41 FAIL — --- - --- __---- -- --- ---__._-..--
CHANIC
n
Rough•Ir: ---- ---- - ----�z-- —
C,4s LirtB -- ---- - _.-..--- --
Smoke Dampers ------_ - --_- --- ------ --- --
Final
'PA'?S]' PART FAIL -.._----- -- ------------- - ----_----
hICAL
Service -� -
Rough-In
UG/Slab - _`_ -- -- ---- --------
Low Voltage _-
Fire Alarm _�- ----- ------ --- - -- -------
Final Reinspection tee of$_-_-__ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART_ FAIL
SITE - F] Please call for reinspection r] Unable to inspect-no access
Fire Supply Line --
ADA
Date b Int<Irector
Apt roach/Sidewalk __ Ext
Other-
Final
therFinal IDO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL
CITYOF T I GA R D MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00256
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 5/19/03
PARCEL: 2S 102DG-01 700
SITE ADDRESS: 09200 SW EDGEWOOD ST
SUBDIVISION: EDGEWOOD ZONING: R-4.5
BLOCK: LOT: 014 JURISDICTION: TIG
CLASS OF WOP.K: OTR FLOOR 1"I JRN: EVAP COOLERS,
TYPE OF USE: SF UNIT HEATER: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: 1
STORIES: BOILERS/COMPRESSORS _ HOODS:
FUELTYPES 0 - 3 HP: DOMES. INCIN:
LPG ~^ 3 • 15 HP: COMML. INCIN:
MAX INPUT. BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS'?: 30 - 50 HP:
OD
GAS PRESSURE: 50 + HP: CLO DRYERS.
FURN < 100K BTU: 1 AIR HANDLING UNITS C
OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: --
> 10000 cfm: GAS OUTLETS:
Remarks: Furnace conversion to gas,venting for alet heater,gas piping for furnace and water heater.
Owner: FEES
GEORGE T ENY Description Date Amounty
9200 SW EDGEWOOD ST
TIGARD, OR 97223 I Mh(.'II J Permit !:cc 5/19/03 $72.50
ITAXJ R'/,Stalc'faN 5/19/03 $5.80
Phone: Total $78.30
Contractor:
FORECAST HEATING&AC
17135 NE GLISAN ST.
PORTLAND,OR 97230 REQUIRED INSPECT IONS
Phone: 503-253-7020 Gas Line Insp
Mechanical Insp
Reg#: LIC 152194 Heating Unt Insp
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State or 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 AR 952-001-00
Issued By: v_ , ��' Permittee Signat.ne:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
Mech,nnical Permit Application '
r J o
Received Mechanical ,.
Date/13y: Permit No..
CII Of j'I al(0 Planning Approval Building
City g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 pate/B : Permit No.
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review Land Use
Internet: www.ci.tigard.or.us Date/By: Case No.:
contactSce Page 2 for
24-hour inspection Request: 503-639-4175 Name/Method: '� Su IcmentaI Information.
TYPE OF WORK COMMERCIAL FEE*SCHEDULE-USE CHECKLIST
E---New construction I I Demolition Mechanical permit fees*are based on the total value of the work
Addition/alteration/re lacement Other; performed. Indicate the value(rcanded to the nearest dollar)of all
CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead and profit.
l &_2-family dwelling— Commercial/Industrial value: SSee Page 2 for Fee Schedule
_Accesqory Buil dIn g Multi-Family RESIDENTIAL E)UIP_MENT/SYSTEMS FEE*S_CIIEDULE
- -----�--- --
Description t I Fre eat Total
Master Builder Other: fleating/Coolin
JOB SITE INFORMATION and LOCATION Furnace-add-on air conditionin ** 14.00
Job site address: ZOO ,Vj a "(X"A Gas heat pump 14.00
Suite#: _ B1 ./A to Uuct work 14.00
Project Name: t 1 14dronic hot waters stem 14.00
--- Residential boiler
Cross street/Directions to job site: (for radiator or hydronic s stem 14.00
Unit heaters(fuel,not electric)
in wall,in-duct,suspended,etc.) 14.00
Flue/vent for any of above 10.00
Subdivision: Lot#: Repair units 4 12.15
Other Fuel At► Ilances
Tax map/parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
1 `Q ctie a' titRC2_LCLtoo-/talc Q . Flue vent(water heater/ as fireplace) 10.00
.Z W �t�J *L-9- Wood/Pellet
lighter as 10.00
-- Wood/Pellet stove _ 10.00
Wood fire lacehnsert 10.00
Chimney/finer/flue/vent _ _ 10.00
PR7PERTV OWNER TENANT Other: _ 10.00 _
Name: Environmental Exhaust&Ventilation
— -- ------- Range hood/other kitchen equipment 10.00
Address: -- --
-- --- Clothes dryer exhaust 10.00
City/State/Zip: — _ _ Single duct exhaust
Phone: Fax: (bathrooms,toilet compartments,
0,A"W MT CONTACT PERSON utility rooms) 6.80
Name: U Attic/crawls ace fans 10.00
Address: — — Other: 10.00
Fuel Piping
City/State/Zip: •*(S5.40 for first 4,$1.00 each additional
Phone: 503-`1`13 SI S D Fax: --- Furnace,etc. �` 1— •*
Gas heat Iump _ *•
E-mail: _ _ Wall/suspended/unit heater •' _
_ CONTRACTOR Water heater _ ••
Business Name: tf` CASE {��}�rV C C Fireplace _ ••
Address: 1'i i5 Nr—: (?, A& Ran e —
..
BB •ii
City/State/Zip: ja Q Z_ 97z 3 0 Clothes d er(gas) _ *•
Phone:5o3- -?oto Fax: 5o3-252Other:_ _•!—
CCB Lic. #: 1521 t — . _ Total:
Authorized Mechanical Permit Pees*
Signalurr: Subtotal: S
Minimum Permit Fee$72.50S
.N _ Pian Review Fee(25°%of Permit Fee) S
ZJZ
(Please print name) _ State Surcharge(8•o of Permit Fee) S
TOTAL,PERMIT FEE $ R
Notice: This permit application expires If a permit I+not obtained within *Fee methodology set by Tri-County Building Industry Ser-Oce Board.
180 days after It has been accepted as complete. -Site plan required for extet;or A/C units.
i\DstsV'errnit Fomu\MccPcrmitApp.dtK 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule_:_
Total Valuation: Permit Fee: —�
$1.00 to$5,000.00 Minimum fee$72.50
$5,001.00 to 510,000.00 $72.50 for the first$5,000.00 and S1.52
for each additional$100.00 or fraction
thereof,f, and including 510000.00.
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 thereof,to and including
$25,000.00. _
$25,00100 to$50,000.00 $379.50 for the first S25,000.00 and
$1.45 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
770-010()
and up $742.00 for the first$50,000.00 and
51.20 for each additional$1 WAX)or
fraction thereof.
Assumed Valuations Per A1 nee:
Value Total
Description: Qty _jEa Amount
Furnace to 100,000 BTU,including 955
ducts&vents _
Furnace>100,000 BTU including ducts 1,170
&vents
Floor fumace including vent 955
Suspended heater,wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
<3 hp;ibsorb.unit, 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>IOOOOcfm 1,170
Nun- orable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
�rermit
hood served by mechanical exhaust 656
Dome ii.,incinerator 11170
Commercial or industrial incinerator 4,590 _
Other unit,including wood sto%cs, 656
inserts,etc. _
Oas pipinpl-4 outlets 360
Each additional outlet 63
TOTAL COMMEIICIAL $
VALUATION:
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