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\ CITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2002-00181
13125 SW Hall Blvd., Tigard, OR 9722.3 (503) 639-4171 DATE_ ISSUED: 5/6/02
PARCEL: 1 S 125DD-08600
SITE ADDRESS: 09696 SW VENTURA CT
SUBDIVISION: WASHINGTON SQUARE ESTATES NO.3 ZONING: R-4.5
BLOCK: LOT:094 JURISDICTION: TI-,
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O 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: CLO DRYERS-
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Installation of gas piping for relocation of gas meter.
Owner: r _ _FEES
PIERCE, MARK A Type By Date Amount Receipt
9696 SW VENTURA CT PRMT CTR 5i6/02 $72.50 2720020000
TIGARD, OR 97223 5PCT CTR 5/6/02 $5.80 272002000C
Phone:
Total $78.30-— -- -----
Con`ractor:
PACIFIC GAS WORKS
PO BOX 30646
PORTLAND, OR 97294 REQUIRED INSPECTIONS
Gas Line Insp
Phone:503-317-5573 Final Inspection
Reg #- LIC 136391
Phis permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR
95,t-001-0080. You may ot4tain copies of these rules or direct questions to OUNC by .cliIling
9Ar,-Q1 RQ
Is a By: i Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Percceived• a) G �� Pcrmitno.:It'fC �r.'�/
City of Tigard Project/appl.no.: Expire date:
Addirss: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.. Payment type:
Land use approval: - _ Building permit no..
1
_2<1 &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
_1 Ww t onstru (ion U Addition/alteration/replacement U Other:
1
Joh addre /(4,j�L j/ {J _� Indicate equipment quantities in boxes below. Indicate the Lollar
Bldg no Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit. Value$ ___ —
Tax
Block: Subdivision: - *See checklist for important application information and
Project name: ,jurisdiction's fee schedultr for residential permit fee.
City/county:7,1 ZIP: 22 t Description an ovation of work on premises: _ im
Est.dale ol'contpletion/inspection: Deuriplion QtJ. Res.only Res.only
Tenant improvement or change of use: Air handling unit
Is existing space heated or conditioned'?U Yes U No rr can ruouing(site plan required)
Is existir-space insulated'?U Yes U No teration of existing HNIALU system
o cr compressors
/ `� Ci�5�
State boiler permit no.:
Business namt�: � _ __
HI' 'funs__HTII/H
Address: p_ 'irT e/sma c dampers/duct smo c electors
City: <2A Statc: ZIP: eat pimp(site I an require )
Phone: _ Fax: Email; nsta rep act furnace/burnerffT
Including ductwoik/vcnt liner U Yes U No
CCB no.: nsta rep ac relocate heaters-suspen eta
r:ily/metro tic.no.: wall,or floor mounted
Name(please print): p� & Vent ora ance of tet than furnace
Refrigeration:
Absorption units, __. _ BTU/H
Name: Chillers _ -- HP
Compressors IIP
Address: nv romnenta ex r�u�ienlTlat un:
City: Slate ZIP:- Appliancevent
Phone: Fax: E-mail: Dryerex oust
nods,Type res. tc c azmat
hood fire suppression system —
Name: Exhaust fan with single duct(bath fans)
Mailing address: �-/� C Exhaust system apart rom caun or C _
�.
state; - — ue piping andistribution up to outlets)
TYfNG
G
Oil
Phonc: Fax: I` app ti� vc i in�cac a itiona ovcut c-T is
Kill I rocesspiping(schematic require )
Number of outlets
Nance: _i -- ter listed appliance or Mn pmenf:
Address: Ikcorative fireplace
Cit : tit;tt ZIP: nsert-type
Phone: Pax: E-mail: stove pe et stove
Other:
Applicant's signature: Date:
Name(print):
Not all Jurlsdictinm accept credit ends,pteae call jurisdiction fa mama infonnatim. Permit fee.....................$
Ulriso UMasicrC'nrd Nntice:'11iis permit application Minimum fee................$ _
cxpires if o permit is not obtained Plan review(at __. 9l) $
Credit card number: EXPI within 180 days eller it hes been
ted 0 tete. State surcharge(8%)....$
--Ni—m to ca—rdh—older; s own on c 1I accepted P complete.$ TOTAL .......................$ _._.
Cardholder si#natum Arooanl 4401617 tb0(Y('OMI
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: Price Total
- - - - - Table 1A Mechanical Code Qty (Ea) Amt
$1.00 to$5,000^10 Minimum fee$72.50 1) Furnaw to 100,000 BTU
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and Including ducts&vents 14.00
$1.52 for each additional$100.00 or 2) Furnace 100,000 BTU+
fraction thereof,to and including 17.40
$10,000.00. includingducts&vents
$10,001.00 to$25,000.0(T_ $148.50 for the first$10,000,00 and 3) Floor Furnace
$1.54 for each additional$100.00 or includin vent 14.00
fraction thereof,to and including 4) Suspended heater,wall heater
$25,000.00. _ or floor mounted heater 14.00 _
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not i;tcluded In appliance permit
$1,45 for each additional$100.00 or 6.80 _
fraction thereof,to and Including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Beat Air
$1.20 for each additional$100.00 or For Items 7-11,see Cor omp
pump Con d
fraction thereof. footnotes below.
Minimum Permit Fee$72.50 SUBTOTAL: $ 7)c3HP;absorb unit
to 100K BTU 14.00
-- - - 8)3-15 HP;absorb
Su
8°/.State rcharge $ unit 100k to 500k BTU 25.60 _
2511.Plan Review Fee(of subtotal) $ 9)15-30 HP;absorb 35.00
Required for ALL commercial permits onlyunit.5-1 mil BTU _
TOTAL COMMERCIAL PERMIT FEE: $~ 10130absorb
unit 1-11.7,75 mil BTU 52.20
11)>50HP;absorb
unit>1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM 10.00
Value Total 13)Air handling unit 10,000 CFAs+
Description: Qt Ea Amount _ 17.20
Furnace to 100,000 BTU,including 955 14)Non-portable evaporate cooler
ducts&vents _ 10.00
Furnace>100,000 BTU Including 1,170 15)Vent tan connected to a single duct
dusts&%gnts _ 8.80
Floor furnace including vont 955 16)Ventilation system not Included In
Suspended`!eater,wall heater or 955 appliance permit 10.00
floor mounte d heater 17)Hoed served by mechanical exhaust
Vent not in:luded in appliance 445 _ 10.00
rmit - 18)Domestic Incinerators
Repair units _ 805 _^ 17.40
<3 hp;absorb.unit, 955 19)Commercial or industrial type Incinerator
to 100k BTU 69.95
3-15 hp;absorb.unit, 1,700 20)Other units,including wood stoves
101k to 500k BTU _� 10.00
15-30 hp;absorb.unit,501k to 1 2,310 21)Gas piping one to four outlets
mil.BTU __ __ 5.40
30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each)
1-1.75 mil.BTU _ 1 00
>50 hp;absorb.unit, 5,725 10 nlmum Permit Fee$72.50 SUBTOTAL: $
>1.75 mil.DTU
Air handling unit F01:0,000 cfm 658 8%State Surcharge $
Air handling unit>10,000 ctm 1,170
Non-portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not Included In 656 -
appliance permit
Hood seed by mechanical exhaust 656 _ Other s salons and Pees:
ry
1 Inspections outside of normal business hours(minimum charge-two hours)
Domestic Incinerator 1,170 $ee 50 per hour
Commer,..al or industrial Incinerator 4,590 2 Inspections for which no fee is specifically indicated (minimum charge-half hour)
Other unit,including wood r'. gyres, 656 $e2 50 per hour
Inserts,etc. 3 Additional plan review required by changes,additionE or revisions to plans(mnimum
Ges ip ping 1 4 outlets _ 360 charge-one-half hour)$62 50 per hour
Each additional outlet 63 _ 'State Contractor Boiler Certificatlon required for units>200k BTU.
TOTAL COMMERCIALv $ `Residential A/C requires site plan showing placement of unit.
VALUATION: All New Commercial Buildings require 2 sets of plans.
I:ldsts\forms\mech-fees.doc 02/11/02
CITYO F TIGARD V MECHANICAL. PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003-00428
11125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 7/24/03
SITE ADDRESS: 09696 SW VENTURA CT PARCEL: 1S125DD-08600
SUBDIVISION. WASHINGTON SQUARE ESTATES NO.3
BLOCK: ZONING: R-4.5
LOT: 094 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN:
TYPE OF USE: SF EVAP COOLERS:
UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3
VENTS W/O APPL: VENT' SYSTEMS:
BOILERS/COMPRESSORS
_ FUEL TYPESHOODS:
0 - 3 HP: 1 DOMES. INCIN:
BTU 15 - 30 HF:
MAX INPUT: 3 - 15 HP: COMML. INCIN:
FIRE DAMPERS?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + lip: WOODSTOVES:
FURN < 100K BTU: 1 __ AIR HANDLING UNITS-- CLO DRYERS:
FURN >=100K BTU: ^ r_ 10000 ctm: OTHER UNITS:
> 10000 cf.m: GAS OUTLETS:
Remarks: Install n('unit;uui r•chlacc gaff lin n,u
Owner: ----_
PIERCE, MARK A - FEES
9696 SW VENTURA CT [I ,
escription Date Amount
TIGARD, OR 97223 11 ( IIS I'crn,it Fee 7/24/03 $72.50
1.\ ", stalc'fax 7/24/03 $5.80
Phone: Total $78.30
Contractor:
COLUMBIA HEATING + COOLING INC
P.O. BOX 230397
TIGARD, OR 97223
REQUIRED INSPECTIONS
Phone: 503-624-2704 Heating Unt Insp
Cooling Unt Insp
Reg#: LIC 76359 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00
/ _
Issued By: - �
__�_�,., .� .fL ;� Permittee Signature. ����. � A�
Call (503) 639-4175 by 7:00 P.M. for inspections rrc:eded the next business day
Mechanical Permit Application
r a Date received r Permit no.
CI! "t� 01. Tigard
lgard Project/appl.no. Expire date
CiryojTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503) 639-4171 Date issued: By,j eceipt no
Fax: (503) 598-1960 Case file no.: Payment type
Land use approval: eaildingpormitno.: -
0 1 &2 family dwelling or accessory O Commercial/industnal O Multi-family U Tenant improvement
O New construction U Addition/alteration/replacement U Other:
lo to]j, KM 111111 ItIll WIN I 111MOMMM
Job address: (a fG ► �� Indicate equipment quantities in boxes below Indicate the dollar
Bid&. no.; Suite no.: value of all mechanical materials,equipment, labor,overhead.
Tax map/tax lot/account no.: profit. Value$ _
l,ot: Block: Subdivision: •See checklist for important application information and
Project name: — ju:isdiction's fee schedule for residential permit fee.
City/county: _ Z1P: ---- -
Description and location of work on premises
0,12
:--1 --- Fee(ea.) TOW
Est.date of completiotVinspection: _ _Dt"ArjjHiun Qt • Res.only Res.ord
Tenant improvement or change of use:
Is existing space heated or conditioned?0 Yes U No Air handling unit _CFM
Is existing space insulated?U Yes 'J No Ir conditioning site pan require
A terationo existing H AC system
of er compressors
Business name: State boiler permit no
Ilt��l1_ lel /N�"V��
UHP Tons BTUfH
Address QX Js� 1 '7 it smo a am er uct smoke etectors
CItY: 1_Gga2p Statccat urn atieplan re ulre
Phone.42t/.?7o Fax 9p_oL7 E fttall insta rep ace urnac urne _
CCB no. -- Including ductwork/vent liner O Yes Po�` 'T - -- nsta rep ac re ucate eaters-suspen e ,
City/metro tic. no.: wall,or floor mounted
Nam�(pleaseprnnt 'G L o�s� A en�ntTor appliance of er an urnace
e gent on:
Absorption units_ BTUfH
Name OOAM ICAChillers—•-- HP -
Address: Compressors HP
- -
Environmental exhaust slid vent al on:
City _ _ State: 71P: Appliance vent
Phone: Fax: E-mail: ryerex ausi
Hoods,Type res tc a azmat
hood fire suppression system
Name: Exhaust fan with single duct(bath fans)
Mailing address: rer
City: r State ZIP: CNO Oil
T LPC?ue piping andistribution up to outlets)
Phone; Fax: E-mail Fuelto each additional over 4 out ets
Process piping(schematicrequire ) I
Name: Number of outlets
Other 1 appliance or equipment: I '
Address: Decorative fire lace
City: State: ZIP: risen-t e
Phone: Fax: Email: oo toy a etstove v- —"
ter T '
Applicant's signature. , Date: 7- t, ter:
Name (print): '10rl/ --- -.
Nol all junwLcuons eccep credit cartL•plum cea jurtedic foronu t mom information. Permit fee................... $
O V'ua U MasterCard Notice:This permit application Minimum fee......,.. S
Credit card number expires it a permit is not obtained plan review(at ` 961 $
J`
within 190 days after it hes been P --
tate surcharge (8%) ....$ -_ c
urc of r u owe oa credit a accepted u complete. TOTAL $
drier sip ature —m
M04617(bt>yC'pM
HEATING & COOLING, INC.
8900 S.W. BURNHAM ROAD, SUITE E 1 1 U
TIGARD, OR 97223
(503) 624-2704
FAX (503) 598-0270
AlT
i
ate.-'"-�-r�.�-._-_ �._.. .�•..�
JOB ADURESS7_� .Sza)
SITE PLAN FOR AC OUTDOOR lJN!T LOCATION
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST
BUP
Received c� gDate Reque�sted. -,I- AM _ __ ___ PM ___ BLIP
Location -,.. _ (_-� ( �° V lr� YL,e�,t�t�--� Suite MEC
Contact Person Ph( ) __ PLM
Contractor__ Ph( _) SWR -- _
BUILDING Tenant/Owner _- _ - ELC
Footing ELC
Foundation Access:
Fty Drain ELR
Crawl Drain —
Slab Inspection Notes: _-� SIT
Post& Beam _
Shear Anchors
Ext Shoath/Shear
Int Sheath/Shear
F.n,'
In,
Dr ailing ----- — —
Firewan ("o,
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
'-form Drain - - -- --Shower-Pan
Other:
Final
FAIL
AW-NANICALR*. —_--- - -------
Post&Beam
Rough-In __----_-__-�-- _
Gas Line
Smoke Dampers ------------ —
Fn'ti�1
PASSE PART FAIL -ELECTRICAL
Service — -- — —
Rough-In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of$__ reqs ped before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE —� ❑ Please call for reinspection RE:— u Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Dote� `_ �� Inspector, '�""� "� Ext
Other: �
Final DO NOT REMOVE this Inspection record from the Jdb site.
PASS PART FAIL