14665 SW 92ND AVENUE-1 i
14665 SW 92"" Avenue
CITYOF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT#: MEC2003-00177
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 4/8/03
PARCEL: 2S 111 AC-02000
SI rE ADDRESS: 14665 SW 92ND AVE
SUBDIVISION: PINEBROOK TERRACE ZONING: R-4.5
BLOCK: LOT: 061 JURISDICTION: TIG
CLASS OF WORK: ALT- FLOOR TURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY" GRP: R3 VENTS W!O APPL: VENT SYSTEM:
STORIES: BOILERS/COMPRESSORS_ HOODS:
_ FUEL TYPES_ _ 0-- 3 HP: DOMES. INCIN:
I_P(DI — T^ 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP:
WOOD
STOVES:
PRESSURE: 50 + HP:
FURN . 100K BTU: AiR HANDLING UNITS CLO DRYERS:
OTHER UNITS: 1
FURN >=100K BTU: <= 10000 cfm: i
GAS OUTLE rS: 1
> 10000 cfm:
Remarks: Install gas piping,outlet and gas fireplace in"r i
Owner. - --- FEES —
STRICKER, DANIEL W+ LESLIE ANN Description Date Amount
14665 SW 92ND AVE
PORTLAND, OR 97224 �;ti1ECIIJ I'crmit Fee 4/8/03 $72.50
[TAX]9%)StatcTax 4/8/03 $5.80
Total $78.30
Phone: 503-639-3290 -- ---
Contractor:
SYSTEM AIRE INC;
14444 SW FERN ST
TIGARD, OR 9722.3 REQUIRED INSPECTIONS
Phone: 503-52.1-5927 Gas Line Insp
Mechanical Insp
Reg#: LIC 38062 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: —J —OfPermittee Signature: -
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
Received Mechanical
_
Date/By: -� {�� Permit No.: #) X17
City of Tigard Planning Approval Building
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Review land Use
Internet: www.ci.tigard.or.us Date/By: Case No.:Contact Juns.: Sce Page 2 for
24-hour Inspection Request: 503-639-4175 Namc/Method: Su Icmental Information.
TYPE OF WORK COMMERCIAL FEE`SCHEDULE-USE CHECKLIST
New Construction Demolition Mechanical permit fees'are based on the total value ofthe work
Addition/alteration/re lacement I LJ Other: performed. Indicate the value(rounded to the nearest dollar)of all
_CATEGORY OF CONSTRUCTION mechanical materials,equipment,labor,overhead and profit.
1 &2- -'amily dwelling Commercial/Industrial Value: s See Page 2 for Fee Schedule
Accessory Building Multi-Tamil i RESIDENTIAL EQUIPMENT/SYSTEMS FEE*SCHEDULE
Description tv Fee ea. 'total
Master Builder Other: �—
Heat m Cool1n
iz
JOB SITE INFORMATION and LOCATION Furnace-add-on air conditioning** 14.00
Job site address: S ",c� Gas heat num 14.00
Suite#: Bld ./A t.#: Duct work 14.00
Project Name: H dronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: for radiator ci h dronic system) 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 12.15
—�-� —
Tax map/parcel #: Other Fuel Appliances
Water heater _ _10.00
DESCRIPTION OF WORK Gas fire lace _ _ 10.00
Flue vent(water healer/•a.i lire lace) 10.00
Log lighter as _ 10.00
— — -- Wood"Pellet stove 10.00
--- - ------ --- Wood fireplace/insert 10.00 _
_ _ Chimnc /liner/flue/vent 10.00
PROPERTY OWNER TENANT Other: 10,00 --
Name: OWN =fr •ef, -0-'L Environmental Exhaust&Ventilation
Address:
— Range hood/other kitchen equipment 10.00
d S w• 1 L t� Clothes dryer exhaust -- 10.00
City/State/Zip: i' ��..t'_ �-
Phone: �7 --3� 6 Fax: — Single ducctt
exhaust ---
(bathrooms,toilet compartments,
_tJA_PPLICAN CONTACT PERSON utility rooms 6.80
Name: (� ��L.• r -r Attic/crawls ace fans 10.00
Address: _ Other: 10.00
Fuel Piping
-City/state/zip: "(S5.40 ror Orsi 4,$1.00 each additional
Phone: Fax: Furnace,etc. --- ••
— -- ----�-- Gas heat um _ ••
E-mail: Gas
heater heater ••
CONTRACTOR Water ter so
Business Name: ,•4-.e Fireplace _— ••
Address: Runge ..
BBQ _ ••
City/State/Zip: f ryv Z 3 Clothes dryer lgasl �►
Phone: 5' Z if S 12 1 Fax: _ Other: ••
CCB Lic. #: -3 8�<)6i _ ---+— Total: _
Authorved Mechanical Permit Fees*
Signature Date: y_ r'-cl 3 Subtotal: $
Minimum Permit Fee$72.50 S _�—
(, Review Fee(25%of Permit Fee) S
(Please prim name) State Surcharge 8946 of Permit Fee) S
__TUTAI.PERMIT FEE C�
Notice: This pertnll application expires If a perndt is not ohillned within •Fee methodology set by Trl-County Building Industry Service Board.
180 days after It lass heen accepted m complete. "Sloe plan required for exterior UC units.
1\Dsts`,Pcrmit PnrmsWeerern,itnpp doc 01 i<?;
_Mechanical Permit Application.-City of Tigard
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total Valuation: Permit Fee:
$1.00 to$5,000. Minimum fee$72.50
$5,001.00 to$10,000.00
for additional$500 00 fraction2
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
$25 000.00.
0.00
$25,001.00 to$50000.00 $1.45 for each additional�$100 00 or
fraction thereof',to and including
$50000.00.
$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 Appliance: value Total
Dcscri tion: t Iia Amount
Furnace to 100,000 BTU,including 955
ducts&veiita 1,170
Furnace B
ace>100,( lU including ducts
&vents — 955
Floor furnace including vent — 955
Suspended hcatei,wall heater or floor
mounted heater 445
Vent not included in a fiance rmit 805
Re air units 955
<3 hp;absorb.unit,
to 100k BTU 1,700
3-15 hp;absorb unit,
101 k to 500k BTU
15-30 hp;absorb.unit.SOIk to I mil. 2,310
BTU 3,400
30-50 hp;absorb.unit,
1-1.75 mil.BTU — 5,725
>50 hp;absorb.unit,
>1.75 mil.BTU
Air handhn unit to 1U U00 cfm 656
Air handling unit>10,000 cfm 1,170
Non-portable eva rate cooler 656 _
Vent fan connected toe sin Ic duct 44b
Vent system not included in appliance 656
rmil
flood served b mechanical exhaust 656
Domestic incinerator 1170
Commercial or industrial incinerator 4 590
Other unit,including wood stoves, 656
inserts,etc, 360 --
Oas 1 in 14 outlets _ 63
F,aeh additional outlet____
TOTAL COMMERCIAL
VALUATION: _ —
i\I)sts\permit Fomu\MecpermitAppl'g2 doc 0l/03
CITY OF TIC ARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST --
INSPECTION DIVISION Business Lune: (503)639-4171
BLIP —
Received Date Requested AM — PM _ BUP
Location L/ P-L — �-LL._��—`Suite-- MEC —
Contact Person —— —�s ' Ph( f� ) 631-32- 24- PLM
Contractor _ ___ _. Ph( _) Od _ SWR __—
BUILDING TenantlOwner _— — ELC —
Footing ELC --
Foundation Access:
Ftg Drain ELR _
Crawl Drain SIT
Slab Inspection Notes:
Post&Beam —_—
Shear Anchors
Ext Sheath/Shear — — ---
Int Sheath/Shear
Framing ------ -_ -----_.— ------------------------
Insulation
Drywall Nailing - -- — --.----- ----- -- -
Firewall
Fire Sprinkler -- - __--
Fire Alarm
Susp'd Ceiling --- _.__ ---------------- ------_--_
Roof
Other: v_ ---
Final
PASS PART FAIL
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 -
- ----��—p-�--
Post& Beam
- --- ----
s
S ke Dampers ----... --- -- __ _- --- ---------------
SS-)PART FAIL -
ECECTRICAL
Service
Rough-In --
Ufi/Bleb ----�----
Low Voltage --- -_— ------- - ----- ---
Fire Alarm -
Final Reinspection fee of$_______--_____required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL_
SITE _ Please call for reinspection RE: Unable to Inspect-no access
Fire Supply Line
ADA —ut
Approach/Sidewalk Date 1=--- - Illtip�tOr
Other: ------._
Final DO NOT REMOVE this Inspection record from the job site.
PASS PAR f FAIL