Permit - L
CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00291
+1- '��L 13125 SW Hall B Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/3/03
PARCEL: 2S101 AD -02400
SITE ADDRESS: 12753 SW 68TH AVE.
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 032 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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: Install new VAV with electric heat; relocate existing diffusers. No plan review required - ducts don't penetrate rated
construction.
Owner: FEES
WESTERN EVANGELICAL SEMINARY Description Date Amount
PO BOX 23939 [MECH] Permit Fee 6/2/03 $100.90
PORTLAND, OR 97281 [TAX] 8% StateTax 6/2/03 $8.07
Total $108.97
Phone:
Contractor:
D L HOWARD CO INC
5340 SW DOVER LN
PORTLAND, OR 97225 REQUIRED INSPECTIONS
Phone: 503 Mechanical Insp
Final Inspection
Reg #: LIC 82769
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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246-669*. i API
Issued By: ( r / / ! Permittee Signature: 69, / / e 1-770
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mc'chanical Permit Application FOR OFFICE USE ONLY
Received ,Q Mec hanical
Date/By p� tQ £8 Permit No.:WI d_ io 3- a/6
City of Tigard RECEIVED Planning Approval
Permit Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review �� Other
Tigard, Oregon 97223 Date/By: 6 - 3 '6j LUJS Permit No.:
Phone: 503- 639 -4171 Fax: 1049a 2)603 /� Post Review Land Use
+� t Date/By: No.:
Internet: www.ci.tigard.or.us , �. _ � � Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 9V�B3'9141� _ Name/Method: T _ Supplemental Information.
BUILDING
TYPE OF'WORK. : • COMMERCIAL FEEiSCHEDULE -'USE CHECKLIST',V
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
Et Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
'''' 'CATEGORY OF CONSTRUCTION _ • mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $a o .0 b See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE!. SCHEDULE
Description 1 Qty 1 Fee(ea.) 1 Total
❑ Master Builder Other: Heating/Cooling
.:'JOB'SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: , L2 7 S 5 (.., Tu. S 1 ---, Gas heat pump 14.00
Suite #: 2...4 /Z• Bldg. /Apt. #: Duct work 14.00
Project Name: c : 3 .nom �b /A, Residential hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Repair units 12.15
Subdivision: _ Lot #: Other Fuel Appliances
Tax map /parcel #: . Water heater 10.00
• DESCRIPTION OF WORK Gas fireplace 10.00
.y am ( k• VA 7 ,A. v OL Flue vent (water heater /gas fireplace) 10.00
/� t` (*Irv-, ,p� Log lighter (gas) 10.00
W /` Wood/Pellet stove 10.00
e›<- f 7 ^ .a 1ifr.u• Wood fireplace/insert 10.00
Chimney/liner /flue /vent 10.00
['PROPERTY OWNER : ['TENANT Other: 10.00
Name: 6�azL, a- Environmental Exhaust &Ventilation
�r Range •hood/other kitchen equipment 10.00
Address: Clothes dryer exhaust 10.00
City /State /Zip: Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
' 0 APPLICANT - 0 CONTACT PERSON.:" . utility rooms) 6.80
Name: P Attic/crawl space fans 10.00
� ✓3M Other: 10.00
Address: S'3 yo. S w 01/4, 1i„^'l 6.4 Fuel Piping
City/State /Zip: f ,- -t-,, ?72- 2 * *($5.40 for first 4, $1.00 each additional)
Phone: 2!1.. —6 7 Of I Fax: 29 3 -0 221 Furnace, etc. **
Gas heat pump **
E -mail: Wall/suspended/unit heater **
CONTRACTOR - Water heater **
Business Name: n, L - How N- (,. Fireplace * *
Address: S Y . Si./ d),&-_1 L-. Range **
City /State /Zip: 4.T-L4.,,d q 7 Clothes dryer (gas) **
Phone: 2. y6 -6 ? 6 u Fax: 24 3 -0 12? Other: **
CCB Lie. #: 2 -765 s/ S/0 y Total:
1 Mechanical Permit Fees*
Authorized
Signature: Date: CO/ o Subtotal: $
[ y � • Minimum Permit Fee $72.50 $
n (% 14/441 Plan Review Fee (25% of Permit Fee) $
`/ (Please print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained withi *Fee methodology set by Tri-County Building Industry Service Board.
180 days after it has been accepted as complete. � * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 0 4)P7o't l
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information '
Commercial Fee Schedule:
Total Valuation:: Permit Fee: ,
$1.00 to $5,000.00 Minimum fee $72.50
$5,001.00 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 including $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.
$25,001.00 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 Appliance:
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including 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, 501k to 1 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. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non- portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION:
is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03