Permit C ITY OF TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES P PERMIT #: MEC2003 -00380
c� I! I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSD ECEL: : 1513 3
ARL 1 S136DA -00100
SITE ADDRESS: 11308 SW 68TH PKWY 1ST FL
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
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> GAS OUTLETS:
10000 cfm:
Remarks: Extend duct through wall.
Owner: FEES
BENENSON 68TH PARKWAY Description Date Amount
KEY LLC, THE [MECH] Permit Fee 7/11/03 $72.50
BY FIRST AMERICAN TAX VALUATIO
WORCESTER, MA 01615 [MECPLN] Plan Rev 7/11/03 $18.13
[TAX] 8% StateTax 7/11/03 $5.80
Phone: Total $96.43
Contractor:
HUNTER DAVISSON INC
1800 SW PERSHING
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone: 503 Duct Inspection
Fire Damper Insp
Reg #: LIC 01612 Final Inspection
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 t• • •w rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
Issues By: i _,_ ,,1 Permittee Signature:.
Call (50 639 -4175 by 7:00 P.M. for inspections needed the next business day
M: ical Pe 1 141... ;r<a�lon FOR OFFICE USE ONLY
Received Mechanical
�� — Date/By: / 03 Permit No.:i / �,1
- 602063 - eN)32o
CI}� of Ti and Planning Approval Building /�
`J g G" �' �� 2:3 Date/By: Permit NoaC.1 106 3 - 003
13125 SW Hall Blvd. Plan Review Other
_ `
Tigard, Oregon 97223 Y OF Y i 3 A r) Date/By: 7 9 '03 I I Permit No.:
F - ,
Phone: 503-639-4171 Fax? SQ Q /jam �p . j lit'� � t ai , � : � Post - Review Land Use
3- Gool9`
Internet: www.ci.tigard.or.us . • I I' Date/By: Case No.: t L Contact Juris.• A See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 '' - " Name/Method: & Sup Iemental Information.
MMD 0_4).-d-f ( /go 4
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
W ew construction ❑ Demolition Mechanical permit fees* are based on' the total value of the work
ddition/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: $ See Page 2 for Fee Schedule
El Accessory Building ]Multi- Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description 1 Qty 1 Fee(ea.) J Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address://308 Sc..-). •E n .-1 Gas heat pump 14.00
Suite #: Bld /Apt. #: Duct work 14.00
Project Name: Oros/ lm,Nc /�/L'2r4'►r/L Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
U ,And GAP41 Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
#: Other Fuel Appliances
Tax map/parcel
Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
I:•AAt 1D CA - heV2ou5i^ CA.N - Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue /vent 10.00
❑ PROPERTY OWNER 1 ❑ TENANT Other: 10.00
Name: Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address:
Clothes dryer exhaust 10.00
City /State /Zip: Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
❑ APPLICANT _)CONTACT PERSON utility rooms) 6.80
Name : j /I /(� Attic/crawl space fans 10.00
J� t Other: 10.00
Address: W{ ✓) rp.t)/14Y.mVL Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Furnace, etc. **
Phone: Fax: Gas heat pump **
E -mail: Wall/suspended/unit heater •*
CONTRACTOR Water heater **
Business Name: ,4 Fireplace **
,�
Address:It/](� � S{Y�i BBQ **
City /State /Zip: 7» lP O DT Range **
Q 220a Clothes dryer (gas) •*
Phone: ut -a 1 Fax: .,3L, 16 2S Other: •*
CCB Lic. #: / Total:
Authorized ermit
Signature: Date: -2" 7 Subtotal: $ �� . ,SD
Minimum Permit Fee $72.50 $
Q /V t ' Ian Review Fee (25% of Permit Fee) $ /$, / - S
(Please print name) State Surcharge (8% of Permit Fee) $ S
TOTAL PERMIT FEE $ 9/,,, 43
Notice: This permit application expires if a permit is not obtained within *Fee met'. . . • a set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan requir . , • . :_ C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
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
Fumace > 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