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11650 SW NORTH DAKOTA ST
CITY OF T I GA R D MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2004-00393
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATA ISSUED: 6/22/2004
PARCEL: 1 S 134CA-04100
SITE ADDRESS: 11650 SW NORTH DAKOTA ST
SUBDIVISION: BURLWOOD NO. 2 ZONING: R-4.5
BLOCK: LOT:014 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/G APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
FUEL 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:
FURN < 100K BTU: 1 AIR HANDLING UNITS DRYERS:
FURN >=I OOK BTU: <= 10000 cfm: OTHER UNITS:
> GAS OUTLETS:
10000 cfm:
Remarks: Replace gas furnace.
Owner: _ FEES
OLSEN, ANGELIKA C AND SHAYNE H Description Date Amount
SACE CONSTRUCTION [MF,CH)Permit Fee 6/22/200' $72.50
PO BOX 91427
pORTIAND, OR 97291 [TAX]8%State Surchatl 6/2212001 $5.80
Phone: i;,3-351-9763 Total $78.30
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS,OR 97015 REQUIRED INSPECTIONS
Phone: 503-656-11'44 Heating Unt Insp
Fina' Inspection
Reg#: LIC 447
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L1 This permit is issued subject to thr,regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codec
and all other applicable laws. Ali work will be done in accordance with approved pions. This permit will expire if work is
not started .vithin 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 h OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503) 6-0.699.
Issu By: Permittee Slgnatu
Call(503)'6394175 by 7:00 P.M. for Inspections needed the ne t uslness day
Mechanical.Permit AvAcation Received Mechanical
Date/By: 4/ Permit No.:
CitOf Tigard ^ Planning Approval Building
Y g J Date/By: Permit No.:
13125 SW Hall Blvd. RECEIVED Plan Review Other
Tigard,Oregon 97223 Dat1dB : Permit No.: —
Pbone: 503-639-4171 Fax: 503-598-19p{j 4 Poet-Review Land Use
Internet: www.ci.tigard.or.us Date/By: Cue No.:
24-hour Inspection Re uest:�.S01-639-4115'\R
Contact 0 SK Page 1(W
—
24-hour 9 Name/Method: r Supplements Information,
BUILDING DIVISION -- -
TYPE OF WORK.`: -- �, 1 . C1AIsrFELf'��SCNEDULE-,'U.SID CHECKIoTST444'[�
; t
New construction 10 Demolition Mechanical permit fees*are based on the total value of the work
ddition/alteration/re lacement Other: performed. Indicate the value(rounded to the nearest dollar)of all
"r ?CATEGO��F CONSTRI! TIO ',I I mechanical materials,equipment,labor,overhead and profit.
&2-Familydwelling Commercial/Industrialvalue: S _ See Page 2 for Fee Schedule
Accessory Building Multi-Family '�° IDE : IAL�.F.Ii' `ILNT/SYSTEMS' UtiEr
Description Fee ea.) Total
Master Builder Other: Heattn Cooling _
It • ;INI!ORMATION,and+,LOCATION "s ?+" Furnaceadd-on air con_ditionin•*$ — 14.00
Job site address: /fG p o pump_ L—_ 14.00_
Suite#: Bldg./Apt.#: Duct work _ `14.00
ProjectName: _ �— Hydronic hot waters tem 14.00
Residential boiler
Cross street/Directions to job site:
/ for radiator or hvdrom'c system — 14.00
Al, r�D� Unit heaters(fuel,vot electric)
in wall,in-duct,suspended,etc. 14.00
Flue/vent for any of abovt.) 10.00
Subdivision: Lot# Repair units _ _ 12.15
Other Fuel A 1lcaces
Tax ma /OarCel #: Water heater � — 10,p0
ESI.iArFION OF WORK _ `— — -—
:..`.. _— Gas fireplace 10.00
Flue vent(water heater/ as Circ lace _ �10.00
Loglighter(gas) 10.00 _
Wood/Pellet stove 10.00
— ---- — Wood fire lacc/insert v10.00
Chimney/liner/flue/vent 10.00
0i^ERTY OWNER --P TRNANT • _ "°t Other: 1 10.00
Name: bL.�, n�_qt--� Environmental Exhaust k Venala_tlon
Address: qC CrOA14e+Cfiv� pp /ap �,t! Range hood/other kitchen equipment 10.00
Cit /State!Zl . /)rza /Lt 9 7 A9 Clothes dryer exhaust
Pilon _ I0.00
Single duct exhaust
6 7 FaX: (bathrooms,toilet compartments,
4 l 'DItt tCON�'A•CT P RSON -utility roomsZ6.80
Name: � Attic/crawl space fans A, 10.00
Other: 10.00
Address: !S 5 5 O � ar ems_ _ _ —Fud Piping "y —
City/State/Zip: G1,te_ '"(55.40 for tint 1,51.00 each addltlonal)
IL Furnace,etc. ••
Phone: so3� - I/ Fax: � - 75// Gas heat pump ••
�.. E-mail: J/c..A4- 0 410&— Wall/suspended/unit heater ••CA
_
CONMCTOR , _ Water heater -�•
Business Narr-e: Fireplace •• --
Address: Range
ra S
-City/State/Zip: — Clothes d �!J — _ ••
W Phone:_ Fax: other: •*
CCB Lic. # Total:
Authorized Mechanical Permit Fees•
Signature: _ Date: Subtotal: SMinimum Permit Fee$72.50 S
Plan Review Fee 25%of Permit Fee S
(Please print name) State Surcharge(8%of Permit Fee $ 13.0
TOTAL PERMIT FEE S
Notice: This permit application expires If a permit Is not obtained within "Fee methodology act by Trt-County Building Industry Service Board.
190 days after It has been accepted as complete. "Site plan required for exterior A/C units.
i:tDat\Permit Forms\MecPerrnitApp.doc 01/03
Mechanical PEmit Alicatio4- City of Tigard
Page 2-Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permlt Fee:
51.00 to$5,000.00 Minimum fee$72.50
$5,001.00 to 510,000.00 $72.50 for the first 55,000.00 and$1.52
for each additional$100.00 or fraction
thereof,to and including 510,000.00.
$10,001.00 to 525,000.00 5148.50 for the first 510,000.00 and
51.54 for each additional 5100.00 or
fraction there(,,to and including
_-- 525,000.00.
525,001 00 to$50,000.00 $379.50 for the first 525,000.00 and
$1.45 for cacti additional 5100.00 or
friction thereof,to and including
$50,000;10. _
550,001.00 and u $742.00 for the first 550,000.00 and
51.20 for each additional$100.00 or
fraction thereof.
Aslufti_M_Valustin Per A 110nee:v
Value Total
Description: _ t Ea Amount
Furnace to 100,000 BTU,inclu 'n8 955
ducts&vents
Furnace>100,000 BTI—including cis 1,170
&vents
Floor furnace including vrni 955 _
Suspended heater,wall' or floor 955
mounted heater
Vent not included in appliance permit 445
Re air units 805
c 3 hp;absorb.unit, 955
to 100k BTU __
3-15 hp;absorb.unit, 1,700
101k to 500k BTU
15-30 hp;absorb.unit,Splk to I mil, 10
BTU_
30-50 hp;absorb.unit,
1-1.75 mil.BTU
>50 hp;absorb,unit, 5,725
>1.75 mil.BTU
Air handling unit to 10 656
Air handl ,000 cfm 1 170
Non-portable evaporate cooler _ 656
Vent in connected to a single duct 446
Vent system not included in appliance 656
_permit _
Hood served by mechanical exhaust 636
Domestic incinerator _1 170 \
Commercial or industrial incincratot 4 590 \`
Other unit,including wood stoves, 636
inserts,etc.
Gas piping 14 outlets _ 360 '—
Each additional outlet __ _63
a I TOTAL COMMERCIAL
N VALUATION:
is\Dsts\Permit F0r1n5\MecPerrnitAppPg2.doc 01/03
CITY OF TIGARD 24-Hour
} BUILDING 0 Inspection Line: (503)6394175 0
INSPECTION DIVISION Business Line: (503)639.4171 MST
OUP
Received _— Date Requested�-_�� AM _PM � OUP
/� �-- 1
Location _�/ /d-L=tzl��"".,,
Contact Person ``�� �-� Ph(—) 6e.-'CZ4—:1 PLM
Contractor l�'� _ Ph(--) 6�� SWR
BUILUINQ TenantlOwner - _ ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drair:
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing - --
Firewall
Fire Sprinkler ---- ---
Fire Alarm
Susp'd Ceiling -- - --
Roof
Other:_ - --
Final
PASS PART FAIL7
PLUMBING
Post&Beam
Under Slab _
Rough-In
Water Service
Sanitary Sewer
Rain Drains --- -
Catch Basin/Manhole
Storm Drain —
Shower Pan
Other:
Final
PASS PART_FAIL --
MECHANICAL
Post& Bea
m -- — -- --
Rough-In
Gas Line
Smoke Dampers —
SS PART FAIL
_ E ICAL _
Service
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final F-1 Reinspection fee of$. _required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PAPT FAIL
SITE 0 Please call for reinspection RE:— UnatAe to Insped-no acomm
Fire Supply Line
ADA
Approach/Sidewalk Daft 1 fibs!
Other:
Final DO NOT REMOVE thla Inspetaftn rmmrd frost"m fob ala.
PG^S :`ART FAIL