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15870 SW OAK MEADOW LN
CITY
OF
T I GA R® MECHANICAL PERMIT
DEVELOPMENT SERViCES PERMIT#: MEC2003-00609
13125 SW Hail Blvd.,Tigard, OR 97223 (503)639-4171 DATE ISSUED: 10/16/03
PARCEL: 2S111 DC-11800
SITE ADDRESS: 15870 SW OAK MEADOW LN
SUBDIVISION: SLIMMERFIF.LD NO.11 ZONING: R-7
BLOCK: LOT:614 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE; SF UNIT HEATERS: VENT FANS:
OCCUPANCtf GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: _ BOILERS/COMPRESSORS _ HOODS:
_ FUEL TYPES _ 0 - 3 HP: DOMES. INCIN:
LPGJ s 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 '1ANDLING UNITS CLO PRYERS:
OTHER UNITS:
FURN >=100K BTU: <= 1 0000 cfm: —�!
> GAS OUTLETS:
10000 cfm:
Remarks: Replace gas furnace.
Owner: _ FEES _
WAI.1 ER MILLIMAN Description Date Amount
15870 SW OAK MEADOW LN IMECH]Permit Fee 10/16/03 $72.50
TIGARD, OR 97224 [TAX]S%StateTax 10/16/03 $5.80
Phone: 503-620-2061 Total _$78.30
Contractor:
PIONEER GAS FUR114ACE
3615 NE BROADWAY
PORTLAND,OR 97232 REQUIRED INSPECTIONS
Phone: 503-249-5000 Mechanical Insp
Final Inspection
Reg#: LIC :6102
d
AZ
H
e7
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 dans 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 m,.xe than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregun Utility Notification Center. Those rules are set forth in OAR 952-001-00
t
issued By: — — Permitted Signature:_.^^1 f�i"/�l✓C'�`i'�"7��/
Call(503)639-4175 by 7:00 P.M. `or inspections needed the next business day
Mechanical Permit Application
`I —�--
Date feceived/G /a /A?_ Permit no /,� 3"X( /J
City of Tiga� CEI Y ED t'mjecUappl.no.:�f-= Expire date
Ciryof'Tigard Address: 13125 SW lilall vd,Tigard,OR 97223
Datc issued. B k reip�no.:
Phone: (503) 639-41'11 fi
Fax: (503) 598-1960 OCT 16 2003 Case 'e no.: Payment type:
Land use approval: 611 Y Uf IW►K!1 Bailding permit no.:
;Jo�b
do: ,amily dwelling o;accessory v Commercial/industrial U Multi-family U Tenant improvermcnt
ew construction U A<Idi;ion/alteration/replacernent U Other:
_ '� Indicate equipment quantities in boxes below.Indicate.thr.,dollar
ddress: / ✓
Suite no.: _J_^ value of all mechanical materials,equipment.labor,overt.ead,
Tax map/lax lot/Account no:
profit.Value Sr
Lot: rt Block: Subdivision: •Sec checklist for important application information and
Project name: f 'tr+-xan jurisdiction's fee schedule for residential permit fee.
City/county: u- ZIP: z
Description and 19ey n of work on premises:
r-(A#-f1Q a Fee(eit.) T1
Est. to of compledon/inspection: � Ine Qt • Rd•°°F Resod
Tenant improvement or change of use: Air han�d�lin,��unit
Is existing space heated or conditioned?U Yes U No r co0ion ng(site plan requ r ! _
Is existing space insulated?U Yes U No Alteration ofexisting {VACsystem -
ot er compressor,
Business name: State boiler permit no.:
B
t�X\�� � �_—_ HP Tons_ BTWII
Address: CLC rirelsmokers1duct a�nol,e eta ectors
City: t _ State: Zara C 7 2.3 eal pump(i tc p llp uircd)
phone ax: -0-:0 ) nsta re—iD eplacei rnac urn-r
Including ductwork/vert;mer U Yes O No Aj
CCB no.: /O !_ _. Tnsta rep ncTrJrr .eaters-suspe:n e ,
Cil /metrolie.no.: 131,&o wall,or floor mounted
Name(please,print): ens or ap Innce of er 1 an ornate
mm c Brat n:
Absorptionunils _. BTU/I1
Chillers_�_i____�_v_._ HP
Name: -Ile
Address: _*^ ��� l:ompre m;s HY
C-)-'1_ ,e'r�'ron�nren't`aTeA ul!toss n :ens ton:
City: State: ZIP: Appliance vrnt
P+one: Fax: E-mail: Drye_r_e_x gust
I foods,Type d I Wes.k i toten at-7 t�mnt
hood fire suppression+system
Name; ery.-moi �• Exhaust fan with single duct(bath fans)
x aunts stem a art rom teat n or
Mailing address: q m
p p nit a %t ■ up to 4 out e'a
IL City: , State: v ZIP: T __LPO No Oil
Phone: C Pax: F mtul: ue in eat additional over outlets
�- Precen piping(schematic required)
Number of outlets
Named Other aslanceor e"llpmeM., _
Address: Decorative fireplace
m City: I State: 17-IP: — nsert-t e _
(� Phone: Ila E- ail: Woodstovetpellel stove
Applicant's signature: Dcte:
Name(print)-.__ '
r
Nal all Juri+dictimcr
+arpl crettit cattle,plena call juri+rlictian f(w more Ittfottnatlna. Permit fee.....................$
Notice:This permit application Minimum fee................$ -7 •StZ_
U visa U expires if a permit is not obtained
da card mtml» _ ___ +� within 190 days atler it has been Plan review(at
P 96) $
Crmte• �---
as complete. TO surcharge(89I+).... ^ .
Nam:of a+nal,ke+
rir rAmvn one it tr�e accepted� P TOTAL. $
Cardholtkr+i�ttaturc �� �a' 4401617(6WK OM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FA Y t3%VELLING FEE SCHEDULE:
- PADS Total
t)esc.'ip
tlon:n: �y (Ea) Amt
?'�TAL VALUATION: PERMIT FEE: Table 1A M enicsl Grde _._-_----
1.00 to$5000_�._00 Minimum its 72.50 ____ 1 j F-uma o 100,00(3 STU 14.00
$5,001.00 to 510,000.00 $72.50 for the first 55,000.00 and Includi dues 8 vents
$1.b2 for Bach additional 5100.00 or 2) FUm 100,000 BTU+ 17.40
fraction thereof,to and Including Ind in duras f1 Fan's `
;I) FI Furnace 14.00
10,001.00 to$25,000.00 $148.50 for the first 510,000.00 and In uding vent ___ -•--- --
61.54 for each additional$100.00 or 47 uspended heater,wall heater 14.00
fraction thereof,to and including floor mounted heater _ --
$25000-00. - 5 Vent not Included In appliance permit 680
$25,001.00 to$50.000.00 3 .k f each additional$100-00 or ----r t66 0"'t -
8) Repa;r units 12.1s
fraction thereof.to and Including
$50 000.00. Boller Heat Air
$742.00 for the tical$50,0W.06nd Check all ih�t apply: or Pump Co,xt
$50,051.00 aand up $1.20 for each,Jditional$100.00 or For Items 7-11,ase rip •.
fraction thereof. footnotes*below.
7)<3HP;absorb unit 14 00
Minimum Permit Fee$72.50 SUBTOTAL: s to 1MK BTU--
8)3-15 HP;absorb X5.80
8%State Surcharge $ unit look to 500k BTU � -
9)15-30 HP;absorb 35.00
`4 Plar Ravlow Fee(of subtotal) $ unfit.5-1 mil BTU
Requlnd fog 't L commercial rmits ON 10)30-50 HP;absorb 52.20
TOTAL COMM-RWL PERMIT FEE: $ unit 1-1.75 mit BTU --
11)>50HP;absorb 87.20
_- -- unit>1.75 mil BTU
12)Air handling Unit to 10,000 CFM to.%
A.r_aSUMED VALUATIONS PER APPLIANCE: 3 /ur handling unit 10,000 CFPt'
Value Total 17.20
p Ea Amount
Desr� Imo' 955 14)Non-p atZle evaporate cooler
Fumar»to 100,000 BTU,Induding 10.00
ducts 8,v ints 1,170 15)Vent fen connecle a single duct 8
Fumarw> i00,000 BTU Including
ducts&ver is 9516)Ventilation system not Inclu n
or fuma
Flo ,viincludin vent 95 - 1010
Suspended healer,wall heater or a (lance
floor mouMo d heater - 17)Hood seryby ed by mechanical exhaust 1000
4 '
Vent not Ind led In appliance 18)Domestic incinerate � 7.40
Mill5
Repair units -
<.3 hpRBbtso'.b.unit, 55 19)Commercial or industrial type incinerator 69.95
to 100k BT'J`_ 1 700
3-15 hp;at�sorb.unit, 20)Other units,including wood stoves 1000
101k to arnl,BTU 310 21 Gas piping one to tour otdiets
15-30 hp,absorb.unit,501k to 1 5.40
mil.BTI 3,400 22)More than per outlet(each) 100
30.5o;absorb.unit,
0`
1-1,75 mil,P.TU 725 5. :
4. >50 hp;absorb.unit, Mlnilnum Permit Fee s72.b't SUBTOTwa
>1,75 mil.BTU 856 614 Stats Surcharge
AIr handlingunit to 10 000 dm 1 170
N Air handli�unil>1U,000 cfm IDENTIAL PERM-
Non.�ortable evaporate cooler 858 - TOTAL RES (I FEE: :
446
Vent fan loon en�ed to a single duct 858
-_-�
Vent system not Included in
/ m a Ilonce rmit 656 other Inenecflone na d Fe l
(a Hood serveddrrrschanlcal exhaust 1 Inspectlene outside o normal business hours(minimum charge-two hours)
J pomestic Incinerator 170 f62 5o Per hour.
Commercial or incinerator
Industrial Incinerator 4 590 2 Inspectbns for which n i toe is specifically indicated (minlmum chprge-half hour)
656 $82 50 per tour
Other unit,Including wood stoves, 3 Additional plan review req.iced by changes,additions a revisions to plena(minimu
inserts etc. 300 charga one-half hour)$62.10 per hour
Gas n 1-4lwtlots
E�h liddifional outlet -- "Stale Cont-actor seller Cer Ifieatlon required fo+units>20ek
"Residentlal AIC requires s to plan showing pls<;ement of unit.
TOTAL COMMS I(R AL _ $ All New Commercial Bulldh:gs require 2 sets of plans.
VAI,.UATION:
I:kfstsVorms\mech-fees.doc 02/11/02
CITY OF TIGARD 24-Hour
BUILDING go Inspection Line: (503)639-4175 ."
II.QPEGTIUN DIVISION Business Line: (50316394171 A"T
_ SUP
Received _ Date Requested _�� "" U AM PM_ _ 13UP
Location --- ,-� �a i —Suite _ MEC _-UO
Contact Person _ _ Ph( ) _ IILM
Contractor Ph(--) SWR
BUILDING Tenant/Cr (,L') _ EL4
Footing ELC
Foundation AiX`e8t3
r;,,r; .in ELR
,raw( -)rain ---- ---_
;;lab Inspection Notes: SIT
Post&Bearn
Sr;ear Anchors — _ _----
Fvt Sheatt✓Shear
Int Slisath/Shear --`-
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler -- _
Fire Alarm
Susp'd Ceiling — — —
Root
Other: ____ ------- -
Final
PASS PART FAIL —
PLUMBING _
Pest&Beam "—
Under Slab
Rough-In
Water Service ----
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain ----- -— -- - /
Shower Pan
Other: _ - - ------ - '
Firs!
PASS PART FAIL ----^ - -----
MECHANICAL
as Line
f3. Smoke Dampers — - ---- --
na
N SS PART FAIL — -- - ---- ----
ELECTRICAL
Service
m Rough-In _ _ —
UQ/Slah
Low Voltage
Fire Alarm
Final Reinspection fee of$_— pection. I'�at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL � P� -- ---nequlre:;before next Ins
SITE Please call for reinspection RE:_____- _ — _ Unable to inspect-no access
Fire Supply line
ADA I Dslb1---L(_ Z 0
Approach/Sidewalk `-
Other:_
Final T- DO NOT REMOVE this Inspection irecolyd ftem the Jt"b eke.
PASS PART FAIL