12687 SW 138TH PLACE 12687 eW 138"' AVE
CITYOF TIGARD - MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00513
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 8/21/03
SITE ADDRESS: 12687 SW 138TH AVE PARCEL: 2 S 104 B D-06300
SUBDIVISION: ROSE MEADOWS ZONING: R-7
-� BLOCK: LOT: 022 JURISCICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLER''.:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: -- BOILERS/COMPRESSORS _ HOODS:
FULL TYPES _ _ 0 3 HP: 1 DOMES. INCIN:
LLE — 3 - 15 HP: COMML. INCIN:
MAX INPLIT: BTU 15 - 30 HP:
FIRE DAMPERS?: 30 - 50 HP: REPAIR UNITS-
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS.
FURN >=100K BTU: <= 10000 cfm: — — OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of exterior AC unit.
Owner: ----_— --- — _. ----FEES - -- -
MENSAH, TETE' Description `Date Amount
12687 SW 138TH
TIGARD, Ort 97223 [MECH]Permit Fee 8/21/u131 $72.50
TAX) 8%StateTax 8/2.1/03 $5.80
Phone: Total $78.30
Contractor:
SYSTEM AIRE INC
14444 SW FERN ST
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone: 503-524-5927 Cooling Unt Insp
Rey #: LIC 38062 Final Inspection
This permit is issued subject tc the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. 111 worts will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of is.•uanrp, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules cidoptc( in the Oregon Utility Notification Center. Those rules are set forth i, OAR 952-001-00
Issued B / -C/[)/
Y� 1'-���'����[�J Perrnittee Signature:
Call (503) 639--1175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application Receive.
Uate/B �/ ` PermitNa.f/;tJ�` `��7/✓
City of Tigal•d I M LCL Planning ppr vat Building
.
Date/By: Permit No.:
13125 SW Hall BlvdPlan Review Othcr
Tigard,Oregon 97223 A,� ryryn(�n(�
Date/By:: Permit No.:
Phone: 503-639-4171 Fax:U-481143 Post-Review Case Use
`' Date/By: Case No.:
Internet: www.ci.tigard.or.us Contact Jyris.: See Page 2 for
24-hour Inspection Request: OaNd90-41��pG Name/Method: / 5u Icmcnlal Information._
BUILDING DIVISION —
TYPE OF WORK_ COMMERCIAL FEE*SCHEDULE.-USE CIIECKLIST
❑ New construction_ ❑ I)cttx�lihcm Mechanical permit fees'arc based on the total value of the work
Addition/alteration/replacement _ElOthee: performed. Indicate the value(rounded to the nearest dollar)of all
CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead and profit.
_1 vSec Page 2 for Fee Schedule
&2-Family dwellingCommercial/Industrial
Value: s �„ d4
Accessory Buildin Multi-Family RESIDENTIAL ESUIPMENT/SYSTE]K. '-EE*SCHEDULE
Description 4v Fec ea. Total
Master Builder Other: Heatin Coolia
JOB SITE INFORMATION and LOCATION Furnace-add-on air conditioning" 14.00 ,
Job site address: 12, SW L $ Gas heat pump 14.00
Suite#: Bld ./Apt.#: _ Duct work 14.00
Project Name: Fly-ironic hot water system 14.00
Residential boiler
Cross street/Directions to job site: for radiator or hydronic system 14.00
re-rN ' 3 ye Unit heaters(fuel,not electric)
rV in wall,in-duct,suspended,etc. 14.00
Flue/-lent(for any of above) 10A0
Subdivision: T Lot#: Repair units _ 12.15
--. --- _ Other Fuel A_ Ilancea
Tax ma / areal #; _ Water heater _ _ 10.00 _
DESCRIPTION OF WOR Gas fireplace _ _ 10.00
- �� _Flue vent water heater/ as fireplace) 10,00 _
- Log lighter as 10.00
--- - - - —----- ---- Wood/Pellet stove_ 10.00
Wood fire lace/insert _ 10.00
Chimney/liner/flue/vent
PROPERTY OWNER TENA; i Other: I J 10.00
Environmental Exhaust dr Ventilation
Range hood/nther kitchen equipment 10.00
Address: J' _ _ _ Clothes dryer exhaust 10.00
C�Ity/State/7.1�_ _-_ __ _ Single duct exhaust
Phone: _ Fax: (bathrooms,toilet compartments,
APPLICANT CONTACT PERSON utility rooms) 6.80
_Name: - Q-111 - J" L� Attic/crawl space fans _ _ 10.00
Address: t r c J V Other: — 10.00
_ _[14 1�. s rn �i Fuel Piping
City/S! 0i d, qX 97ZZ3' ••(55.40 for first 4,$1.00 each additional
Phone:r , ;� � Fax: j 590 Furnace,etc. _ ••
Gas heat um _ ••
E-maiL,jJ- a - e 01n' E' Wall/suspended/unit heater — ••
CONTRACTOR Water heater •'
Business Name: _5?L164,ei1f W11 tc 11C Fireplace _ •• _
Address: /I,,, f .-.t✓ - Range
R-' Z 2
BBQ
sd ert a5 •Y --�
Phone: �;2 �" -7 ]_Fax: Other:
CCB L.ic. #: C� Z __-- _ Total _
Authorized 00 -- ' Mechanical Perntlt Fees*
Subtotal: $
Signature: _ .� _' rf�_�ate:_g !-03 _
' '� � Minimum Permit Fee 572.50 S ca ro
�f� �j�� —Plan Review Fee(25%of Permit Fec) S
(Please print name) ✓ State Surcharge 8410 of Permit Fee) S 5r0
_ TOTAL PERMIT FEE S
Nonce: 1 his permit application e%plre%Ira perntlt 1%not ohtalurd Nilhln "Fee methodology set by Tri-County Building Industry Service Board.
180 days after it ha%liven accepted a%complete. "Site plan required for exterior A/C units.
i:\Dsts\Permrt I-orns\MccPcinntApp doc 01103
Mechanical Permit Application - Cite of'Figard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to$5,000.00 _Minimum fee$72.50
$5,00LOU to$10,000.00 $72.50 for the first$5,000.00 and$1.52
for each additional$100.00 or fraction
thereof,to and includin $10 000.00.
$10,001.00 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
$25,000.000
$25,101.00 to$50,000.00 $379.50 for the first$25,000.00 and
$1.45 for each additional$100.00 or
fraction thereof,to and including
$50,000.00.
$50,001.00 and up $742.00 for the first$50,000.00 and
$1.20 for each additional$100.00 or
fraction thereof'.
Assumed Valuations Per A-pQI nce:
Value Total
Nscri tion: Qly (") Amount
Furnace to 100,0(10 BTU,including 955
ducts&vents _
Furnace>100,000 BTU including ducts 1,170
&vents
Floor furnace includin vent 955
Suspended heater,wall heater or floor 955
mounted heater _
Vent not included in appliance permit _ 445
Repair units _ 805
<3 hp;absorb.unit, 955
to 100k BTU _
3.15 hp;absorb.unit, 1,700
101k to 500k BTU _
15-30 hp;absorb,unit,50 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.BTtJ _
Air handling unit to 10,000 Or 656 1
Air handling unit>I0,110U cfm 1 170
Non-portable evaporate eeoler 656
Vent fan connected to a single duct 446
Vint system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator i 4,590
Other unit,including woaxl stoves, 6511
inserts,etc.
Oas iping1-4 outlets _ _ 360
Foch additional outlet 63
TOTAL COMMERCIAL
VALUATION:
ODsts\Permit Forms\MecPermitAppPg2 doc 01103
i.
38 p
S �
5 �
I
Accessibility:
Barrier Removal Improvement Plan
City of Tigard
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation,alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five per-cent(25%).
VALUATION.: of all renovation, alteration or modification being done
excluding painting,wallpapering. (1) $ 25
multiply: 25% Barrier removal requirement.
BUDGET FOR BARRIER REMOVAL [2] $
In choosing which accessible elements to provide under this section, priority shall be given to those
elements that will provide the greatest access. Elements shall be provided in the following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $ —
(d) At least one accessible restroom for $
each sex or a single unisex restroom:
(e) Accessible telephones: $----
(f) Accessible drinking fountains: and $--
(g) When possible, additional accessible
elements such as storage and alarms: $
70JAL: $hall a ual II a of Value Computation $
i\dsts\romvV►ccc%sibility.doc 06/07/02
CITY OF TIGARD 24-Hein
BUILDING Inspact'on,Line: {503)639-4175
INSPECTION DIVISION Business LinE: (503)639-4171SUP
MST
Received _ Date Requested_ AM__-____— PM __ BU
Location 97 13f�` ____ Su t _ MEC 3
Contact Person _ LTJ-c-Q-P _—_ Ph(--) 7 2-^ PLM -_--
Contractor _—.._ ___-- ___ Ph 0 SWR -
BUILDING_ _ Tenant/Owner _--- ___ ELC
Footing - ELC
Foundation Access: / -
Ftg Drain 1✓ ! ELR __—
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam ----._-..----- -- ---_-_--- —.-.
Shear Anchors - -- --
Ext Sheath/Shear
Int Sheath/Shear
Framing - - - - - -- ----
Insulation
Drywall Nailing ---- ----- -- ------ _� - -----
Firewall
Fire Spr.ikier --- - ------ -- - - --
Fire Ali,m /
Susp'd Ceiling
Root
Other:__....-------- --- - ---- -------
Final _
PASS PART FAIL - - -
PLUMBING
Post 8 Beam ------ --�--_—
Under Slab ------- --- --- - -
Rough-In
Water Seg vico -- -- -- - -- ----
Sanitary Sewer
Rain Drains — - ---- --
Catch Basin/Manhole
Storm Drain - -------- ---
Shower Pan
Other: --- ----- - — -------
Final
P -AFART FAIL-FAE -----.--_--- ------ -- —--
CHANIC -- -- -- -- -- ---- -- -
Post r-.1
Rough-In .C. . ----- --- - --
Gas Line
o Dampers -
Fir
RT FAIL --
•
---
Rough-In \� -- - -- —- - -_-- ------
UG/Slab \\
Low Voltage
------------------------- -----------
Alarm
PART FAIL Reinspection lee of$ ..-_-_-____. required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SS
SITE AI Please call for inspe ion RE: __._ F-1Unable to Inspect-•no access
Fire Supply Lire
ADA '
ApproactJSidewalk Daft Ext
---- IReliecto- i t'r ; ••f _Ett
Other:
Final - DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL