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10915 SW Fortner Street
— MECHANICAL PERMIT
CITY OF TIGARa
PERMIT #: �1EC200"-00379
DEVELOPMENT SERVICES DATE ISSUED: 10/30101
f, 13125 SW Hall Blvd.,Tigard, OR 97223 1503) 639.4171 PARCEL: 2S103AD-00406
SITE ADDRESS: 10�)IF I�W FONNER ST ZONING: R-4.5
SUBDIVIS'OW LOT: 013 .JURISDICTION: TiG
BLOCK: __ --- --
FFLOOR FURN: EVAP COOLERS:
CLASS OF WORK: OTR UNIT HEATERS: VENT FANS:
TYPE OF USE: SF VENTS VJIO APr'L: VENT SYSTEMS: 1
OCCUPANCY GRP: R3 HOODS:
STORIES: BOILERS/COMPRESSORS DOMES. INCIN:
FUEL TYPES 0 3 HP:
3 15 HP:
LPG COMML. INCIN:
MAX INPUT BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
ESSURE: 50 + HP' CLO DRYERS:
GAS PR
FURN ES RE: AIR HANDLING UNITS-__ OTHER UNI,-S: 1
FURN >=100K BTU: <= 10000 cfm: v N GAS OUTLET S:
> 10000 cfm:
Remarks: Instaliation of gas insert and venting.
rPRMT
Owner: Amount Receipt
ROUTON,CLYDE Ape By DateROUTON, ETTA h1 TRUSTEE CTR 10130101 $66.20 27200100010915 SW FONNER CT CTR 10/30.01 $5.80 2720010000
TIGARD, OR 9727.3 Total $72.00
Phone:
PACIFIC GAS WORKS
PO BOX 30646 REQUIRED INSPECTIONS _
PORTLAND,OR. 97294 -"
Mechanical Insp
Misc. Inspection
Phone:503-317-5573 Final Inspection
Reg #:LIC '136391
Municipal
This permit is issued stabjcrt to the regulations
All work will be done in contained in the ac ordance with appro�ed re.
Specialty Codes and all other applicable
laws.
days of issuance,
if work is
plans. This permit will expire if work is not stareaW irequires
e) o you to follow rules dopted in the Oregordi
for more than 180 days. ATTENTION: Oregonqui e
Utility PJotification Center. Those rues are set forth in OAR 952-001-0010 through OAR
952-001-0080. Yo.a ma
( y ob> n C"r Dies of these rules or direr +iestioito )UNC b 'I'��
tin N1aF-o�aa „ 1. /
{(�� ( Permittee Signature: _ ! - -
Isse By: !� _
��-.._ Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
Mechanical permit Application
' ` -- Datcrec•civcd: /p / Permttno.:f,frjlGd/-�057y
City of Tigard ProjecUappLno.: Expire dale:
01),(!(Tigard Address: 13125 SW Hall Blvd,,Tigard,OR 97223 Date issued: H . Itecei t no:
Phone: ('503) 639-4171 y P
Fax: (503)598-1960 Case file no.: Payment type:
Land use approval- iiuilding permit no.:
All &2 family dwelling or accessory 0 Commercii, industrial U Multi-family U'Tenant improvement
U New construction U Addilien/alteration/rcplaccnicnl U O(her:
INFORMATION
Job uddmas: �y,5 'T /K_ Indicate equipment yuantiues in boxes below. Indicate the dollar
Bldg.no.: _ Suitc no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit. Value$
__ Blo
Lot: ck: Subdivi,.on; *Sec checklist for important application information and
Project name_: jurisdiction's Ice schedule for re;idential permit fee
City/county: Zlf' Z 1
D• �ription ation of work on premises: t t t
Iec("N.) 'Iot:d
I''%1.date of completion/inspection: lk-scri Nion illy. Res.onlv Hes.4111h
'Tenant improvement or change of use: Air handlingunit r'1(\1
Is existing space heated or conditioned?O Yes U No Airconditioning(site planrequile 1) —
I.t Kt,lmf apace insulated?U Yr,, 'J Ni)
t,
Alteration existing system
t of er compressors
'
Business nam � � c Slate Moiler permit no.:
�}!fr-i• r _ HP Tons HTU/H
Address _ d Fir smo campers uct smo a detectors
City: _ St;ttc 7.,IP: 7 �e� eat pump(sac p an require )
Phone:Sa39G9/ x: nsta. rep ace uratic urner -
('('B no.: �jf��f / -- Including ductwork/vent liner U Yes U No
_ ��._ astrt rep ace re ovate eaters-suspeen el..
Cay/metro lie.no.: _ wni+,or floor mounted
'- r ntor a i anc
Ne of er than furnace
atne(please print): _c__ - P
Tic gerat on:
/,htitrrpuonunits__ _ BTU/H
Natnc: Chillers HP
Address: ` i Con, ressors,__
---- - n ronmentr ex ust an vent lat on:
City: t Slate: ZIP: Aepxpt fisa,nceypveen
i
hone: E-mail: Dryer exhaust
res. ire enn
ai
hood fire suppress ionsystem
me: OZ
_ ,ijee P-t _ L-'xhaust fan with single duct(bath fans)
Mailingaddress: -"x au'st system apart from heating or AC
�j Uelpiping an st—ul on(up to ou
City: State- 7.N: t
�•..—='=-- 1'ylx: _ LILPGN(3 Oil
Phont.. —��•� L'-mail Pucl i in vac t n niona over out cls
roeeapiping(sc ematicrequire )
Name: Number of outlets
— ter llqted appliance or equipment: '
Address: I)ecutauve tueplace _
City` State: ZIP: oo _ _
Phone: Fax: I nutil stov pe let stove ^—
��- Other:
Applicant's signature: l>ate: _:17
` ter:
Name (pnnt):._r- -- � -- _
Nnt all Jurisdictions wcept credit cards,please call jurisdiction for nrre information. WoliPermit fee.....................$
J visa U M 7siettard expirre•This permit application
if u permit is not obtained Minimum fee................$
Credit card number . _-f __ �/ / . expPlan review(at , %,) $
.sF plrcs — within 1811 dais after it has been State surcharge(891x)....$ _
Now nt cardholder au iliown on cmdil cart] accepted as complete.
cadholder signature -'_ Amount
110.1617(60K'OM)
MECHANICAL PERMIT FEES - -
COMMERCIAL FEE SCHEDULE:
1 & Z FAMILY DWELLING FEE SCHEC�II!c:
_----
_ Description: sty PTotal
ririce Amt
TOTAL VALUATION: PERMIT FEE: Table 1A Mechanical Code -
$1.00 to$5,000.00 __ Minimum fee$72,50 1) Furnace to 100,000 BTU 14.00
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and includin ducts&vents
$1.52 for each additional 5100.00 or 2) Furnace 100,000 BT 17.40
fraction thereof,to and Including includin ducts&vents
$10,000.00 3) Floor Furnace 14.00
$10,001.00 to$25,000.00 $148.50 for the rust$10,000.00 and including vent -
$1.54 for each aCditional$100.00- 4) Suspended heater,wall heater 14.00
fraction thereof,to and Including or floor mounted heater -
$25,000.00. 5) Vent not Included in appliance permit
325,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 6.80
$1.45 for each additional$100.00 or Repair units
fraction thereof,to and including 6) 12.15
$50,000.00. Boiler Heat Air
550,001.00 and up $742.00 for the first$50,000.00 an,i Check a'I that apply: or Pump Cond
$1.20 for each additional$100.00 or For Items 7-11,see Comp
fraction thereof. footnotes betow.
7)<31-113;absorb unit 14.00
---------- gUt3T0 iAL:
Minimum Permit Fee$72.50 $ to 100K BTU
8)3-15 HP;absorb 25.60
-- 8%State Surcharge $ unit 100k to 500k BTU
9)15-30 HP;absorb 35.00
25% Ion Review Fee(of subtotal) $ unit.5 1 mil BTU _
Required for ALL commerc181 permits only 10)30-50 HP;absorb 52,20
_
TOTAL COMMERCIAL PERMIT FEE: unit
>51.75 it BTb
11) 87.20
unit>1.75 mil BTU
12)Air handling unit to 10,000 CFM 1000
ASSUMED VALUATIONS PER APPLIANCE: _ 13)Air handling unit 10,000 CFM+
- -- Value Total 17.20
rlescri tion: Qt Ea Amount -
Ftime ce to 100,000 BTU,Including 14)Non-portable evaporate cooler 10.00 -
dus&vents 1,170
Furnace ct >100,000 BTU Including 15)Vent fan connected to a single duct 6,80
ducts&vents _ 955
Floor furnace indudin vent 16)Ventilation system not included in 10.00
Suspended heater,wall heater or 955 a fiance ermit
floor mounted heater 17)Hood served by mechanical exhaust 1000
Vent not Included In applicance 445 --m --
18)Doestic InGnerators 17.40
rtnit _
805
Re air units _ _
.r 3 hp;absorb.unit, 955 19)commercial or Industrial type Incinerator 69-95
to 100k BTU 700
3-15 hp;absorb.unit, 20)Other units,including wood stoves 10.00
101k to 500k BTU --2,310
15-30 hp;absorb.unit,501k to 1 2.1)t3as piping one to tour outlets 5.40 _
mil.HT-U 3,400 22)More than 4-per outlet(each)
30-50 hp;absorb.unit, 1.00 -_
1-1.75 mll.BTU 5,725
unit, Minimum Permit Fee 572,50 'SUBTOTAL: $
>50 hp;abaofi,
>1.75 mil.BTU - 856 -��- g•/.State Surcharge
Atr handling unit to 10 000 cfm 1,170 _
Air handl!n9 unit'10.000 cfm 658 s
Non- ortable evaporate cooler 448 TOTAL. RESIDENTIAL PERMIT FEE:
Vent fan connected to a single duct __ 858 ---------�
Vent system not Included In
ap lip ancu permit 656 Other Insoec tom and Fees. business hours(minimum charge-two hours)
Hood Servet;by mechanical exhaust 1 Inspections outside of normal
1j70 70 - $72 50 per hour
Domestic Indnerator
2 inspections for which no fee is pacificallysIndicated (minimum charge-half Koury
_Commerdal or Industrial Incinerator4>6 - --- ---- $72 50 per Hour
Other unit, uired by changes,additions or revisions to plans(minimum
Induding wood stoves, 3 Additional plan review req
Inserts,etc. 360-
_ charge-one-half hour)$72 50 per hour
Gas I In 1.4 outlets 63
Eed1 eddlUonel oUti@t _._ 'Stats Contractor Boller Certification required fog units>200k BTU.
_ --- "Resldeutlal AJC requires site plan showing placement of unit.
TOTAL COMMERCIAL s
_ All Nev; Commercial Buildings require sets of plans.
VALUATION: __ .-
i:\dsts\f,)mtsUnech-fees.doe 08!29/01
t�
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Ir.spuction Line: 639-4175 Business Line: 09-4171 MST — —
BUP
Date Requested //-/(e —AMPM � BLD —---
Location �� 9/S� ��NN � _-- — Suite MECy�-- Cri 375
Contact Person —_ ^ Ph — -- PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall — ELR __ -
Footing Access:
Foundation FPS
Fig Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post&Beam
Ext Sheath/Shear
Int Sheath/She at ---
Framing
Insu!ation
Drywall Nailing --
Firewall --
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: —
Final —�---- -
PASS PART FAIL
PLUMBING ------ _---- -
Post&Bearn — --
Under Slab
Top Out — - -
Water Service
Sanitary Sewer -- — ----
Rain Drains
Final — --- —
P,LSS,_-PART FAIL.
--
Post& Beam -- - --. --- ------.----
Rough In
Gas Line
Ismake hampers
ASS PART_ FAIL
ELECTRICAL -- - -- — —
Seivice
Rough In --
UG/Slab — —
Low Voltage ---
Fire Alarm
Finril -- -__ -- -- —_
PASS PART FAIL
SITE - — ---
Backfill/Grading - — -- -- - -------•
Sanitary Sewer
Storm Drain ( ]Reinspection fee of$_ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ J Plea 4e call for reinspection RE __ — ( ]Unable to inspect- no access
ADA
Approacr,f aldewalk
Othor Date lE �? Inspector--,� ---- - Ext
Final
PASS PART_ FAIL DO NOT REMOVE this inspection record from the job site.