11085 SW 119TH AVENUE w+ �www�r
11085 SW 119"' Avenue
CITY OF TIGARD _ MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2002-00401
DATE ISSUED: 91'101'02
13125 SW Hall Blvd., Tigard, OR 9723 (503) 639-4171 PARCEL: 1S134CA-00508
SITE ADDRESS: 11085 SW 11971-1 AVE
SUBDIVISION: PANORAMA NO2 ZONING: R-4.5
BLOCK: LOT: 019 JURISDICTION_ TIG
CLASS OF WORK: ALT FLOOR FURN: _ EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: P3 VENT S W/O APPL.• VENT SYSTEMS:
STORIES: BOILERSIC_O_MPR_ES_SORS HOODS:
FUEL TYPES 0 3 H?_ DOMES INCIN:
LPG-- 3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMP[-RS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + Kp. CLO DRYERS:
FURN < 100K BTU: I AIR HAND -ING UNITS W OTHER UNITS:
FURN >=100K BTU: <= 10000 crm: GAS OUTLETS:
> 10000 cfm:
Remarks: Gas piping for new gas furnacae and water heater.
Owner: _e FEES
ANTHONY WALKER Type By Date Amount Receipt
1'1085 SW 119TH PRMT CTR 9/10102 $72.50 2720020000
TIGARD, OR 97223 5PCT CTR 9/10/02 $5.80 2720020000
Total $78.30
Phone:503-590-1010 --
Conb•actor:
OWNER
REQUIRED INSPECTIONS
Gas Line Insp
Phone: Mechanical Insp
Reg#:
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 •0010 through OAR
952-001-0080. You may obtain copies of these rules or direct quOstion to 1U7 by.calla
�tin��7e�_U�an
�-11 1 .
Issue By: , Permittee Signature: _
Call (503) 639-4175 by 7:00 P.M. fir inspections needed the ne'R bylsiness day
Mechanical Permit Application
Datereceived: Permit no.: " :L-G U O/
City of Tigard Project/appl.no.: Expire date:
City of Tigard Addrefs: 13125 SW Ifall Blvd,Tigard,OR 97223 pate issued: By: ,x11 Receiptno.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: - Building permit no.:
OF-PERMIT
L1i I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
L'New construction U Addition/alteration/replacement U Other:
JOB SITE t '
Job address: t \��« _ iA` Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: $UIIc no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit.Value$
Lex: Block: S tbdivision: "See checklist for important application information and
Project name: iuri,dictioWs fee schcdule for residential permit Ice.
City/county: I ZIP:
Description and location of work r h premises:
1 (:// F ' lc'/ �C; !� r,'7r/Z f�7f tee(ea.) Ictal
Est.date of completion/inspection: --- t><Kriptittn- �_ (Jt�• Rrn.unlr Htx.00l
Tenant improvement or change of use: Air handling unit CI M..
Is existing space heated or condii w it-I ' J Yrs U No Ircon icon ip nnreyuir:T)__
Is existing space insulated?U Ye,, _J teration of existing HVAC system
NIFUHANIUAL t of er compressors
State boiler permit no.:
Business name: r�'�, { __ HP Tons li7 l�/11
Addtt.ss: _ Fir'smo c dampersIduct smoke detectors
City: State: I ZIP: ca mp(s to plan require )-�
Phone: Fnx: E-mail: nsta pacefurnacc urncr
fiicluding ductwork/veni liner U Yes U No
CCB no.: nslal rep ace/relocate heaters-suspended,
City/mptro lie.no,: _ wall,or fluor mounted
Nam .h. -ase print) Vent r n olance other than furnace
CONTAtt"ll'PERSON e gersl on:
Absorption units_ __ BTU/H
Name: Com
__ Hl' _
— -— Com ressors HI'
Address: nv runmental exhaust and vent at on:
City: State: '1.11': __— Ali iiancevent
Phone: t' 1 ._-- - E-mail: )rycrcx --
oo s, ypr res. tc en76nzmat
No&0hood fie suppression system
Name: t i l H�(t W J_ t (}�,�t Exhaust fan with sin le duct(bath fans)
Mailing address: I (nTw 5 a(%
Exhaust system a art from eatin or C
State: 7.IP: Fuelpiping an at ut on lap to out chs)
City: '.i� 1 -7 •1 Type. __LI'G NG Oil
Phone:'>c i ,j-j— C _ Fax: C-mail: 1 Fuelpipineach o itional over 4 outlets
Process piping(scematic required)
Number of outlets
Nnme-_— _ ter IIx59 app nceorequipmento
Address: Decorative fireplace
City: State: ZIP:
ail: oo stov pe et stove
Phone: lh er. _
Applicant's signature: -q`, 1 \ ate: t j ter:
Not VI jurisdictions accept credit crude,plra�r call iuti-lirtlim liltmote InfarnWlon Permit fee.....................$
Notice:This permit application Minimum fee.. $
U Visa U MasterCard
expires if a permit is not obtained Plan review(al —. %) $
Credit card number: _ ---------- ---- — L— within ISO days after it has been ,¢�
"Mrc" Y State surcharge(896)....$ ��
.rne at c aide s a own on_:twin ear S accepted as complete.
TOTAL ..............•........$
Cardhalder nanatttre ---� 110.1611(6RIDIOW)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 'I & 2 F=AMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: Price Total
$1.00 to$5,000.UO Minimum fee$72.50
- Table 1A Mechanical Code Qty (Es) Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional$100.00 or Including ducts&vents _ 14.00
fraction thereof,to and Including 2) Furnace 100,000 BTU+
$10,000.00. Including ducts&vents - 17.40
$10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace
$1.54 for each additional$100.00 or including 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 Included In appliance permit
$1.45 for each additional$100.00 o• 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 ell that apply: Boller HeatAir
$1.20 for each additional$100.00 or For items 7.11,see or Pump Cond
fraction thereof. fijotnotes below. comp ••
r,t<3HP;absorb unit
Minimum Permit Fee$72.50 SUBTOTAL: t. 100K BTU 14.00 _
8%State Surcharge $ 8)3-15 HP;absorb T
unit 100k to 500k BTU 25.60 _
- 25%Plan Review Fee(of subtotal) $ 9)15-30 HP;absorb
_ Required for ALL commercial permits only _ un It.5-1 mil BTU 35.00
TOTAL COMMERCIAL PERMIT FEE: $ u10)30nit 1-1.75 mmil BTU 52.20
1. absorb
7
11)>50HP,absorb
unit>1.75 mil BTU 87.20
ASSUMED_VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM
Value Tota 10.00
Description: QtyEa Amount 13)Air handling unit 10,000 CFM+ 17.20
Furnace to 100,000 BTU,Including 955 14)Non-portable evaporate cooler
ducts 8 vents 1 10.00 _
Furnace>100,000 BTU including 1,170 15)Vent fan connected to a single duct
ducts R vents
Floor furnace Inr4uding vent 955 6.60
18
Suspended heater,wall heater or 955 )Ventilation system not included In
floor mounted heater appliance permit 10.00
Vent not included In applicance 445 17)Hood served by mechanical exhaust
ermlt - 10.00
Repair units 805 18)Domestic Incinerators
_ 17.40
<3 hp;absorb.unit, 955 19)Commercial or Industrial type Incinerator
to 100k BTU 6995
3.15 hp;absorb.unit, 1,700 20)Other units,Including wood stoves
101k.to 500k BTU
15-30 hp;absorb.unit,501k to 1 2,310 10.00
mil.BTU 21)Gas piping one to four outlets
5.40 _
30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each)
1-1.75 mil.BTU 100
>50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $
>1.75 mil.BTU __ _
Air handling unit to 10,000 efm 658 - 8%State Surcharge a
Air handling unit>10,000 cirri 1,170
Non-portableon evaporate a cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent ten connected to a single duct _ 446 _
Vent system not Included In 656
appliance permit
Hood served by mechanical exhaust 656 - Olher Inspection•and flR:
Domestic Incinerator - j� t Inspections outside of normal business hours(minimum charge-two hours)
$62
Commercial or Industrial Incinerator _ 4,590 2 c i or hour
Inspections for which no lee is specifically Indicated (minimum charge-hall hour)
Other unit,Including wood stoves, 656 $62.50 per hour
Inserts,els. 3 Additional plan review required by changes,additions or revisions 10 plans(minlmun
Gag piping 1-4 outlets360 charge-one-half hour)$62 50 per hour
Each additional outlet i � 63
--- _ -- "Stale Contractor Boller Cerlifb,;ation required for units>200k BTU.
-'--
TOTAL COMMERCIAL -j "Residential AIC requires site plan showing placement of unit.
$
VALUATION: All New Commercial Buildings require 2 sets of plans.
I vistsVomislmech-lees doc 12126/01
CITU' OF-TIGARD ,-Hour
BUILDING inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MS
BUP
Received _ Date Reques :d-_ AM_ pM BUP
Location � ) Sw //� „p - --
Suite_ MEC Zl�`--f,u /r0
Contact Person _ _---- Ph(-.—) -�7f—L /o_/V PLM Zoo L U
Contractor — _ Ph( ) — —_ SWR
BUILDING Tenant/Own(r ELC
Footing ---------_
Foundation ELC
Ftg Drain Access: - ---
Crawl Drain ELR -�
Slab Inspection Notes: SIT
Post&Beam -- - --
Shear Anchors
Ext Sheath/Shear -^- -
Int Sheath/Shear --- ^_
Framing
Insulation
Drywall Nailing -- -- � d— �� - �-- ----_---- -------- ---
Firewall -
Fire Sprinkler -------- --_____--
Fire Alarm -'
Susp'd Ceiling
Roof �—
Final ' y
PASS PART FAIL
-- _ z�4 _
Post
Underr Slab
lab ------------------- t--'T-`-+s-`' _—
Rough-In - - --
Water Service
Sanitary Sewer ---------_--�- - — —'!- -
Rain Drains ------- -----._.._-----__ __--
Catch Basin/Manhole -
Storm Drain
Shower Pan
Other:
nn
-PASS PART F -.-- - __ ---.-___-- -- -- -- _-
Post& Beam_. -- - _---_— - ------ —__— _.--_
Rough-In -_`---
,Gas Line -- ---- - - -
Smoke Dampers -- -._,-- - — -- -�_- - ——-- -
CJPA�SS PART AI -- — ---------__ --_�
ELECTRICAL -�-
Service
Rough.In —
UG/Slab
Lcw Voltage -
Fir-3 Alarm --- _- _--- -
F0A — - � Reins ction tee of$_ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL_
SITE __ I_] Please call for reinspection RE: _. Unable to Inspect-no access
Fire Supply Lina —
ADA (r//
Approach/Sidewalk Date 91 td"/t �- Inspector _-
Other: -
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING inspe-:iun Line: (503)639-4175
INSPECTION DIVISION Business LEne: (503,633-4171 MSl
BJP
C�
Received _ _Date Requested �,d�� A'h1--_.— PM BUP _
Location . �l G' �s �L`t��` ��:quite ----_-- Mt=C
Contact Person -__ .-- Ph(— ___) _ — ___ PLM
Contractor —`__--_—___-_-- _--- Ph ;_— -.--) —__--_ SbVR .
BUILDING TenanUC�M_ __-_- _-- -- --__--_-- FIC -.-- -- -
Footing 5- `JG
F`C
Foundation '-"" -�-�^-----�
Ftg Drain / ? :LR -- -- -
Crawl Drain
Slab Inspection Notes:,, S17 --------------_.-
Post& Beam --__-- -
Shear Anchors ---- ----
Ext Sheath/Shear
Int Sheath/Shear
Framing --- -- -- -- ---- --- -- - _--- -----
Insulation
Drywall Nailing ----- ___- -- -- ------ --- - ------ — -----
Firewall
Fire Sprinkler -
Fire Alarm
Susp'd Ceiling -_A.. . __ _ - --- — -- - - - -- ------- _----- - ---
Roof
Other: -
Final
PASS PART PART FAIL --- --- -- --- - --- ------ - ---------- - -
- - -
LMBI
ostU'76"am -_----
Under Slab - - --- -- -- - - --- - - ----.----_.__._-...
Rough-In
Water Service - _--- _ - ----- - - --- ---- --- -- --
Sanitary Sewer
Hain DrainF ----- --- ------- ---- - ---— ----- ------
Catch Basin/Manhole
Storm Drain _-_--__—
Shower pan
Other:_----- --__
P aS PART FAIL
CH _. L
—W — ----- ---- - — ----__-- --- -- — ----- __
Post&Beam
Roagh•In ---- - ------ --
Gas Line
Smoke Dampers ---- - - --
Fin
AA4S _PART FAIL --- ---- - -- -- _ -- - ---- - -
[ELOCTRICAL
Rough-In
UG/Slab - - -----
Low Voltage -
Fire Alarm
Final n Reinspection tee of$ — required heture next Inspection. Pey at City Hall, 13125 SW!-fall Blvd.
PASS PART FAIL
SITE - __ [� Please call for reinspection RE: _ - -- �I Unable to inspect.-no ar-cess
Fire Supply tine
ADA
Approach/Sidewalk Data Inspector Ext
Other: _
Final DO NOT REMOVE this Inspection record from tire job site.
PASS PART FAIL
�.T
OFTI GA R D PLUh1BING :'ERMIT
I)EVELOrP!'11!'ENTi SERVICES PERMIT#: PLM2002-00360
13125 SW iia:I B!vd., Tigard, OR 97223 (503) G39-41Y1 DATE ISSUED: 9/10/02
SITE ADORES~: 11035 SW 1191- AVE PARCEL: IS134CA-00508
SIJt3DIVISlt-:4. PANORAMA NO.2 'ZONING: R-4.5
,_ BL,-;CN: , — LOT: 019 - ____—yJURISDICTI(3N: TIG
CLASS OF WORK: AL7 GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHiNG MACH: EACKFLOW PREVNTF:S:
OCCUPAN'_;r GRP' R3 FLOOR DRAINS: TRAPS:
SrORtES: WATER HEATERS: CATCH BASINS:
FIXTIJRES LAUNDRY TRAYS: SF 'CAIN URAINS:
SINKS: URINALS: GRE/1,3E TRAPS:
LAVATORIES: OTHER F'IXrURES:
TUB/SHOWERS: SEWER LINE- ti
WATER CLOSETS' 1 WATER LINE:
DISHWASHERS: RP N DRAIN: ft
Remarks: Replacing electric water healer with gas.
Owner: [5PCT
FEEtiANTHONY WALKER ypeBy Date Amount Receipt
11085 SW 119TH RMT CTR 9/10/02 $72.50 27200200000TIGARD, OR 97223 CTR 9/10/02 $5.60 27200200000
Total r 0
578.30
Phone 1: 503-590-1010
Contractor:
OWN-R
REQUIRED INSPECIIONS
Phone 1: Final Inspection --- ----� - —'—
Reg#:
This permit is issued subject to the regulations contained in the Tigard ML:nicipal Cade, Stals of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is riot 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 by the Oregon Utility
Notification Center. Those rules are set forth In OAR 952-0001 .0010 through OAR 852-0001-0080.
You may obtain copies of these rules or direct qu-3stions to OUNC by calling (503) 246-1987,
Issued By: ! Permittee Signature:_ �1 r; 6x)
Call (503) 639-4175 by 7:00 P.M. for an Inspection needed the next busineps Aay
Plumbing Pcrinit Application
-i-- Date received: (I' Vp 7. Permit no.:
ii, City of Tigard Sewer permit no.: Building permit no.:
Addrss: 13125 SW Hall Blvd,Tigard,OR 97223
C7rynfTiFard Pr.•ne: (503) 639-4171 ProjecVappl.no.: Expire(late:
Fant: (503) 598-1960 Date issued: By: I, Receipt no.:
Land use approval: _ - .--_ Case file w, Paymenttype:
TYPE OF PERMIT"
1 &2 fa►a?ly dwelling or accessory U Commercial/industrial J Multi-family U Tenant improvement
U New copstructien J Addition/alteration/replacement IJ Fond wrvice J Other: -_—•__.
1 1 1 t ,
Job nddrcss: '`' Description (.lot. Fee(ea.) Total
-- New l-and 2-family dwellings only:
' Bldg.no.: Suite no.:
Tax map)tax lot/account no.: (includes 100ft.foreach utility connection)
SFIZ(1)bath
Lot: Block: Subdivision: SFR(2)bath —�
I'ro?-,t name: SFR(3)bath
City/county: ZIP: Each additional bath/kitchen
Description and location of work on premises: Siteutilities:
17Z.F,�'7RIC. /</ -- fl[ _ /cJ GyS Catch basin/area drain
Est.date of completion/inspection: Drywells/Ieach line/trench drain
Footing drain(n.a•lin.ft.)
1 Manufactured home utilities
Business name: a�.�IAI/ /� Manholes
Address: A__ _ Rain drain connector
City: _ State: ZIP__ Sanitary sewer(no.lin.ft.) -
Phone: _ Fax: _ E-mail- _ Storm sewer(no.lin.ft.)
CCB no.: 1 Plumb.buy.reg.no: Water service(no.]in.ft.)
City/metro lie.no.: —__---- Fixture or item:
--- Absorption valve
Contractor's representative signature: - -----
-- - - -- Back flow preventer
Print name: Date: Backwater valve
-CONYA17 PERSON 8asi6s/lavatory
Name: Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: - State �71P: _ Ejectors/sum
Phonc: Fax: I nwiL' Ex ansion tank _
ixture/sewer cap
Name(print): —(- Moor drains/floor sinks/hub
Mailing address: a l ti� t, Garbage disposal
—_ Hose hibb _
City: ( State: . ZIP: 'I'1,� 3 Ice maker
Phone:�,p3.�� ;: Fax: E-mail: _ ntercepror/grease trap _
Owner installation/residential maintenance only: The actual instailation Primers) _
will be made by me or the maintenance and repair made by my regular -Roof drain(commercial) _
employee on the p pert n as r O ( ler 447. Sink(s)_basin(s), ays(s)
Owner's si nature:\ '`. w.� Date: - 1c 2 Sump _Tubs/shower/shower pan _
_Name: Urinal
--- ater close:_
Address:_ _ ater heal,
City: State: 7_IP__ Other: ---
Phone:__ Fax: I E-mail: 'rotall
Not as juridictiow ruert credit cards,please can jurisdiction rrn m wr int wmatinn Notice:This permit applicationMinimum fee................$ —2;z . s`
at _ 96
O Visa U MasterCard expires if a permit is not obtained Plan review( ) $
credit card number: s__ _— .___-.LL State surcharge(8%)....S
1;cpirra within 1 R0 days after It has been
�r c Idrr as shown on credit card accepted as complete. TOTAL. ..................... $ �..
S
CordholdeF dRnstute - Amount 110.1616(&WXDM)
PLUMBING PERMIT FEES:
PRICE TUTAL
Now 1 and 2-family dwellings only: T
FIXTURES individuate e QTY ea AMOUNT (includes all plumbing fixtures in PRICE I TOTAL
_ the dwelling and the first100 ft. QTY (ea) AMOUNT
Sink ` 16.60 for each utiles-connection --
--- 16.60
-)- -- - $249.20
Lavatory One 1 bath - _ -- __-
16.60 Two 2 bath
Tub or TublShower Comb. Three 3 bath $359.00
16.60 -_�_.._ - -- -- --
shower Only ---
Water Closet 16.60 SUBTOTAL _
Urinal 16.60 8a/.STATE SURCHARGE -- -
16.60 PLAN REVIEW 25°/a OF SUBTOTAL
Dishwasher - TOTAL
Garbage Disposal 16.60
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE:
3- 16.60
4" 16.60 ---- - - -
Ouantit�b Work Performed
Water Heater O conversion O Tike kind 16.60 Fixture Type: New Moved Replaced Rernovedl
Gas piping requires a separate mechanical Ca ed
enttit. -- 0 _ ---
MFG Home New Water Servic46.4Sink
Service 46.4
-
Lavato
MFG Home New Sen/Storm Sewer 46.40 Tub or Tub/Shower
Hose albs 16.60 Combination
Roof Drains 16.60 Shower Only
16.60 Water Closet
Drinking Fountain Urinal
Other Fixtures(Specify) 16.60 Dishwasher
-------- Garba a Dis osal
Laund Room Tra
_ Washing Machine
Floor Drain/Sink: 2" _-
Sewer-1 at 100' 55.00 3" _
Sewer•each addition46.40 4"
al 100' Water Heater
We ar Service-1st 100' 55.00
Other Fixtures
WOW Service-each additional 200' 46.40 S eel _
Storm&Rain Drain-1at 100' 55.00
Storm&Rain Drain-each additional 100' 46.40
Comm irclal Back Flow Preventlon Device 46.40 -
Residential Backflow Prevention Device' 27.55
Catch Besin 16'60
Inspection of Existing Plumbing or Specially 82.50
Re nested Ina ecU�ns
or/hr _ COMMENTS REGARDING ABOVE: -
Rein Drain,single family dwelling 65.25 -
GreaseTraps
18.80
QUANTITY TOTAL ----
Isometric or riser diagram is required If -
Quantity Totalis >9 -
'SUBTOTAL
TE RG
-
8%STASURCHAE
"PLAN REVIEW 25%OF SUBTOTAL
Required onl II axture t .I,lel Is>9
TOTAL S
"Minimum permit foe is$72 50•a%stale surcharge,except Residential Backflow
Prevention Device,which Is=16 25+a%stale surcharge
"All Now Commercial Buildings require 2 self of plans with isometric or riser
diagram for plsh review.
I.\dsts\form s\plm-fees doc 12/26/01