Permit (2) 3 707 s- � •' � L6. Af. ,�, !�
f CITY OF TIGARD MECHANICAL PERMIT
4 °vl DEVELOPMENT SERVICES PERMIT #: MEC2002 -00414
A I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 D ATE ISSUED: 9/18/02
PARCEL: 2 S 103 D D -00400
SITE ADDRESS:--1-3711ff SW PACIFIC HWY 100
SUBDIVISION: 13/ . -1 ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: A3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
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:
> 10000 cfm:
Remarks: Relocate 3 diffusers and new t -stat. Project value: $1,200.
Owner: FEES
WILSON'S TIGARD RETAIL CENTER Type By Date Amount Receipt
BY BOMCC ESCROW ADMINISTRATION PRMT CTR 9/18/02 $72.50 2720020000
TX1 -2495 5PCT CTR 9/18/02 $5.80 2720020000
DALLAS, TX 75201
Phone: Total $78.30
Contractor:
OREGON HEATING + NC INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED INSPECTIONS
Mechanical lnsp
Phone: 538 -2953 Final Inspection
Reg #: LIC 125815
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 No 'flcation Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952 -0 1 -0080. You may obtain copies of these rules or direct questions to OUNC by calling
(nR 94 R -Q1 RQ
Iss e By , 1 1! ' cii.) ; ', Permittee Signature: , .Q ( '(�—
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Date received: ? I . Permit no.: iff y _‚�I4
.A.::.,.,:-Iii'' ! City of Tigard Project/appl. no.: Ex ire Address: date:
City of Tigard Add 13125 SW Hall Blvd, Tigard OR 97223 Date issued: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory a-Commercial/industrial ❑ Multi- family • ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: J.' '1 r}') 5L..) Q � i , Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite s.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: , profit. Value $ (p-of:D C .
Lot: (Block: I Subdivision: *See checklist for important application information and
Project name: .... 13(1 • r= G'S' jurisdiction's fee schedule for residential permit fee.
City /county: / ! q ZIP: en ,-3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
D; sc 'ption . ; lockion of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCIIEDULE
_, I .., 4 Fee(ea.) Total
Est. date of completion/inspe• on: c Description Qty. Res. only Res.only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? Pi Yes ❑ No Air condi conditioning unit CFM
ioning (site plan required)
Is existing space insulated? r• Yes ❑ No Alteration of existing HVAC system /
MECIIANICAL CONTRACTOR Boiler /compressors
,� //�� /,�, ,, State boiler permit no.:
Business name:
V '2C 6 • - ,) HP Tons BTU /H
Address: -e,[) • ak 3 q7 Fire/smoke dampers/duct smoke detectors
City: p A f I State:, ,. I ZIP: apj j/ s — Heat pump (site plan required)
Phone: — ,49,5-3 Fax: I E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: / ;r7_( Instal I/replace/relocate heaters-suspended,
City /metro lic. no.: ( ff�� wall, or floor mounted
Name (please print): ► Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
/ Absorption units BTU/H
�
Name: ,r,r/ 1- Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: , await , / _ Fax: E -mail: Dryer exhaust
OWNER Hoods, Type If II/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: I I State: ZIP: Fuel Type: piping and distribution PG NO to 4 o (up utlets )
Phone: Fax: E - mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace •
City: I State: I ZIP: Insert - type
Phone: 'Fax E - mail: Woodstove/pellet stove
O
Applicant' signature: . . ,, i� v- s ate." ,t■ps Other.
Name (print): 7, , ,s.,f r _
O
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7 . S
Notice: This permit application Minimum fee $
❑ Visa ❑ MasterCard
expires if a permit is not obtained P lan review i %
Credit card number: / / (at %) $ •
Expires within 180 days after it has been State surcharge (8 %) .... $ .S► go
Name of cardholder as shown on credit card accepted as complete.
. $ TOTAL $ -2g, O
Cardholder signature Amount 440 -4617 (6/0o/COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) 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 14.00
$1.54 for each additional $100.00 or including vent
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 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 Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Cond
fraction thereof. footnotes below. Comp ••
Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU 14.00
8% State Surcharge $ 8) 3-15 HP; absorb
unit 100k to 500k BTU 25.60
25% Plan Review Fee (of subtotal 9) 15-30 HP; absorb
$
Required for ALL commercial permits only unit .5 1 mil BTU 35.00
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20
unit 1 -1.75 mil BTU
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 CFM+
Description: Qty (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 fan connected to a single duct
ducts & vents 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
Floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in appliance 445 10.00
permit - 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
101 k 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 Minimum Permit Fee $72.50 SUBTOTAL: $
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge $
Air handling unit >10,000 cfm 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 served by mechanical exhaust 656 Other Inspections and Fees:
1,170 1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator 1
$62.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
Other unit, including wood stoves, 656 $62.50 per hour
inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge -one -half hour) $62.50 per hour
Each additional outlet 6 * State Contractor Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL $ "'Residential A/C requires site plan showing placement of unit.
VALUATION: All New Commercial Buildings require 2 sets of plans.
- is \dsts\forms\mech - fees.doc 02/11/02 •