Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2000 -00457
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/11/00
PARCEL: 1 S136DA -00100
SITE ADDRESS: 11308 SW 68TH PKWY
SUBDIVISION: ZONING: MUE
•
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B 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: 3
FURN > =100K BTU: < =10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Changeout grills
Owner: FEES
PROVIDENCE HEALTH SYSTEM Type By Date Amount Receipt
4706 NE GLISAN PRMT CTR 12/11/00 $72.50 2720000000
PORTLAND, OR 97213 PLCK CTR 12/11/00 $18.13 2720000000
5PCT CTR 12/11/00 $5.80 2720000000
Phone: 503-215-6184 Total $96.43
Contractor:
FULLMAN SERVICE CO LLC
5221 SW CORBETT
PORTLAND, OR 97201 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 224 -5221 Final Inspection
Reg #: LIC 122310
ELE 26-821CR
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You may obtain copies of these rules or direct questions to OUN •y , allin 0 6 -9189.
Issue By: Permittee Signature: - /-44//y
Call ( 3) 639 -4175 by 7:00 P.M. for inspections neede • ext business da
/2. - k - o0G t ✓M —' `1'U/a Aqs
: Mechanical Permit Application
Date received: / //a/ Permit no:: /y Zo00 mod ys'?
''yay_ , City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 6 UP62U2v _61 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF P ]tIIiT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi - family 2E1 Tenant improvement
❑ New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION CONP.IERCIAL VALUATION SCHEDULE
Job address: 1(3 U$ 5W , 344 Pk rlcwkty Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $
Lot: (Block: ISubdivision: "See checklist for important application information and
Project name: fro d4v Ct. I S Cowt rnA rt AI a AAVL_ jurisdiction's fee schedule for residential permit fee.
City /county: it c pre\ I ZIP: 1 & 2 FAMILI' DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: 1;4/nit AND COMMERICAL /INDUSTRIAL EQUIPIIENTSCIIEDULE
re vYt oat 4.1 o f Lo(f ivy (A/p Qv I' R-• •wr Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res.only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? es ❑ No
r Air conditioning (site plan required)
Is existing space insulated? Yes ❑ o Alteration of existing HVAC system 7y
Boiler /compressors -
,, to YY n Se rJ i C.0 State boiler permit no.:
Business name:
� k HP Tons BTU/H
Address: 5 2.2.1 SW Go r 14.-ft Fire/smoke dampers/duct smoke detectors
City: 0 - x1 A •Nol S tate: 012 I ZIP: 1'7 2 01 Heat pump (site plan required)
Phone: ZZ.t 52.t 1 I Fax: I E -mail: Install/replacefurnace/burner BTU /H
Including ductwork/vent liner 0 Yes 0 No
CCB no.: 12 23 1 t, Install/replace/relocateheaters— suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): PA v l.v k C S Vent for appliance other than furnace
Refrigeration: __
Absorption units BTU/H
Name: f A v I LA/ ke s Chillers HP
Address: Se G. .60,/ �Com�ressors HP
lEn ronmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U IUres. kitchen/hazmat
,� hood fire suppression system
Name: } vj d(„nL L 1 e `', 5(iiit 10. Exhaust fan with single duct (bath fans)
Mailing address: 4-7 OL, N� G 11 sA Exhaust system apart from heating or AC
City: r A- .. 0t I State:0(Z I ZIP: 112_4 3 Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: 2.1 - 18 Fax: S- Z E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert — type
Phone: I Fax: 1 E -mail: Woodstove/pelletstove
Other:
Applicant's signature: I Date: Other:
Name (print): .
Not all jurisdictions accept credit cards, please cats jurisdiction for more information. Permit fee $ 7!�
❑ Visa Cl MasterCard Notice: This Minimum fee $
s permit application G p I'
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8%) .... $
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $
Cardholder signature Amount 440-4617 (6/00/COM)
MECHANICAL PERMIT FEES -
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: 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) Fumace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Fumace 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 Fumace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and induding 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 Gond
fraction thereof. footnotes below. Comp* • "
7) <3HP;absorb unit
ASSUMED VALUATIONS PER APPLIANCE: to 3- 1K BTU 14.00
8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount 9) 15 -30 HP; absorb
Fumace to 100,000 BTU, including 955 unit .5-1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Fumace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents 11) >50HP: absorb
Floor fumace induding vent 955 unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM
floor mounted heater 10.00
Vent not included in applicance 445 13) Air handling unit 10,000 CFM+
permit 17.20
Repair units 805 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 10.00
to 100k BTU 15) Vent fan connected to a single duct
3 -15 hp; absorb. unit, 1,700 6.80
101k to 500k BTU 16) Ventilation system not included in
15-30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00
mil. BTU 17) Hood served by mechanical exhaust
30 -50 hp; absorb. unit, 3,400 10.00
1 -1.75 mil. BTU 18) Domestic incinerators
>50 hp; absorb. unit, 5,725 17.40
>1.75 mil. BTU 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 656 69.95
Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21) Gas piping one to four outlets
Vent system not included in 656 5.40
appliance permit 22) More than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1.170 Minimum Permit Fee $72.50 SUBTOTAL: $
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656 8% State Surcharge _ $
inserts, etc.
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $
Each additional outlet 63 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
VALUATION: •
Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour.
2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
$72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimum
charge -one -half hour) $72.50 per hour
State Contractor Boiler Certification required for units >200k BTU.
"Residential NC requires site plan showing placement of unit.
i:\dsts \forms\mech- fees.doc 10/11/00