Permit C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00295
., I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/27/03
PARCEL: 1 S136DA -00101
SITE ADDRESS: 11410 SW 68TH PKWY
SUBDIVISION: PERS SITE 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: 3 DOMES. INCIN:
ELE 3 - 15 HP: 2 COMML. INCIN:
MAX INPUT: 316,040 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: 1 GAS OUTLETS:
> 10000 cfm:
Remarks: TI hvac
Owner: FEES
OREGON, STATE OF PUBLIC Description Date Amount
EMPLOYEES' RETIREMENT FUND [MECPLN] Plan Rev 6/5/03 $25.73
11410 TIGA RD, OR 9 7223 SW PKWY [MECH] Permit Fee 6/5/03 $0.38
GA 97223
[MECH] Addl Permit 6/27/03 $102.52
Phone: [TAX] 8% StateTax 6/27/03 $8.23
Contractor: Total $136.86
COLLINS MECHANICAL
PO BOX 900
REQUIRED INSPECTIONS
Phone: 503 - 723 - 0139 Mechanical Insp
Mechanical Insp
Reg #: LIC 146993 Cooling Unt Insp
Cooling Unt Insp
Cooling Unt Insp
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 to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
4
Issued By: Permittee Signature: _ ,/7 /4.
Call (503175 by 7:00 P.M. for inspections needed the next business day
Mechan Permit Application FOR OFFICE Me ani , v
Received Mechanical �i
DateBy: f,•� -' i 'ii v3 Permit No.:�F4„v003 — ' -k /.
CI of Ti and Planning Approval Building
J g Date/By: Permit No.:
13125 SW Hall Blvd. 7 \� n Plan Revie Other
Tigard, Oregon 97223 (ra % 1 . DatulBy_ Z3' Permit No.:
(0, 1 � Post- Review Land Use
Phone: 503 -639 -4171 Fa);
D i )' `\ Date/By: Case No.:
Internet: www.ci.tigard.or.us�I I I
5, t .. w , — e` " ' I ., Contact An is.: ® See Page 2 for
24 -hour Inspection Request: 503-60441 95 " Name/Method: Supplemental Information.
;IIN 0 t: - fl( " i lc CY-
�� ?(_, 1 \. t
TYPE OF4 %lORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
NI 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 [St Commercial/Industrial Value: $ 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: / /¢ /o Ow 68 p w•sy Gas heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work 14.00
Project Name: /-2,5 Serb /Telet o R i4wodie1 Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site:
(for radiator or hydronic system) 14.00
i zelles Re/ ee 8/ �- 5 Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: 1 Lot #: Repair units 12.15
#: Other Fuel Appliances
Tax map/parcel
Water heater 10.00
DESCRIPTI OF WORK Gas fireplace 10.00
/ /VA C. (90 rrt�/�, As' cy . a4c c-) Flue vent (water heater /gas fireplace) 10.00
Poo-frtode /0f Sarver' e 7- e/ecogot . /t(t7P'xtS Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue /vent 10.00
❑ PROPERTY OWNER 11$1 TENANT Other: 10.00
Name: Jett b1/4 4 Lest p / D y ales /fi / rV sn� f SYS/� Environmental Exhaust & Ventilation
Address: / /4/0 ,t, 6 L a zit /1 PS1'r � Range hood/other kitchen equipment 10.00
Clothes dryer exhaust 10.00
City /State /Zip: Ti r2 , D XC. e/7Z 7-3
Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
❑ APPLICANT J$( CONTACT PERSON utility rooms) 6.80
Name: 0j a'W Ns A,r. �ApM+N Svcs Attic/crawl space fans 10.00
Address: / zz.s reeyy £,. S.E U /on Other: 10.00
Fuel Piping
City /State /Zip: 420/ s pR_ 173o/ * *($5.40 for first 4, 51.00 each additional)
Phone: So-378-am x 4qs I Fax: 503 -313 -72"I D Furnace, etc **
Gas heat pump
E -mail: lOria vt . t.LA r1S Q 5Irak .0.-. tre.d Wall/suspended/unit heater **
CONTRACTOR Water heater **
Business Name: ( „ ',ou_i,/5 /)?j/,J/(41_.- Fireplace •*
Address: Range **
P,O. ejoA �DlI BBQ **
City /State /ZipOgE j d V (^ / I�� Clothes dryer (gas) **
Phone: 7 3 . 723_0, '.,c3 1 Fax: Other: * *
CCB Lic. #: /!,6( oq_ , y d o a 9 Total:
Authorized Mechanical Permit Fees*
S ature: '1•! iI Dater-5=)3 Subtotal: $ k2M. ;.q
Minimum Permit Fee $72.50 $
3444 W . MS Plan Review Fee (25% of Permit Fee) $ 25 �
(Please print name) State Surcharge (8% of Permit Fee) $ Z3
TOTAL PERMIT FEE $ / ;;4 , no
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri- County Building Industry—Service Boar..
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units. Ill ` • •
i :\Dsts\Permit Forms\MecPermitApp.doc 01 /03
v
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 (i tof Q? 00 3 - 23 A 5
< 3 hp; absorb. unit, 9 55
to look BTU 3 2-8 6 s — •c4 . if 9,5 .
3 -15 hp; absorb. unit, 1,700 /i 0 O � /s /0
101k to 500k BTU 1
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 (a 3
Air handling unit >10,000 cfm 1,170 • • / • -.
Non - portable evaporate cooler 656 /O a . 9"s6 • /6 2, 90
Vent fan connected to a single duct 446
Vent system not included in appliance 656
pC 5`, 7, 3 • 3 d
permit
Hood served by mechanical exhaust 656 .. ' . --
Domestic incinerator 1,170 ., 2 3 , • ,�
Commercial or industrial incinerator 4,590 ``/ /0 2, s , Z
• Other unit, including wood stoves, 656 /j / (C I G ; J
inserts, etc. `a`� O (D . - . .4'd / / i deA/)+ , ► / -
Gas piping 1-4 outlets 360 . , . .
Each additional outlet 63 • • . '
TOTAL COMMERCIAL $/
VALUATION: (0 1 f
/9L/ _ f_ 00 - 2-0
X. /.S •
2 , o 70
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