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CITY OF TIGARD MECHANICAL PERMIT
Hr DEVELOPMENT SERVICES PERMIT #: MEC2002 -00052
,�,(: 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/5/02
PARCEL: 1S136AA-01500
SITE ADDRESS: 10313 SW 69TH AVE
SUBDIVISION: FUR VALLEY ZONING: R -4.5
BLOCK: LOT: 006 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 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: 1
> 10000 cfm:
Remarks: Run 1 duct line from existing line to new room.
Owner: FEES
LUKE -DORF Type By Date Amount Receipt
10313 SW 69TH PRMT CTR 2/5/02 $72.50 2720020000
TIGARD, OR 97223 5PCT CTR 2/5/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
REQUIRED INSPECTIONS
Mechanical Insp
Phone: Duct Inspection
Reg #: 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 -0010 thro - • , OAR 952 - 001 -0080.
You may obtai opies of these rules or direct questions to OUNC by in• 1 )246 -9189
Issue By:,� Permittee Signature: / �� .
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next busineF 11,
"1 Mechanical�Permit • i i lication
. Date received: Permitno.:MECa00a •,0a0
.4.4' ')ii City of Tigard 17 Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd i s 97223 Date issued: By: 16 I Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
i VIT OF l' :1011T
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Other:
JOB SLUE INFOIThIATION COii1IERCIAL VALUATION SCHEDULE
Job address: /03 ( 3 & ? 1 /ME E 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: I Block: I Subdivision: *See checklist for important application information and
Project name: Lae-E. - lD IZ F , Lx.) c . jurisdiction's fee schedule for residential permit fee.
City /county: TG /OP)) /WA� I ZIP: g 7 2L 3 1 & 2 FAN111,V DW1'EI.LING PERMIT F'il•: SCHEDULE
Description and location of work on premises: Rijn.' je•W 1j.cT AND COMi\1I :RICAI.IlNDUSTRIAL EQUI l'1II NI•SCIII DULL.
4 - 1 /4- Fd.Gr" - Ex.! ST l hl la /../ tu r Tor Nr tks doe, w+ Fee (ea.) Total
Est. date of completion/inspection: 2/5102- Desaiildon Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or con itioned ?,'Yes 0 No
Air conditioning (site plan required)
Is existing space insulated? Yes 0 No Alteration of existing HVAC system
Boiler /compressors
Business name: '7o N / (s 6 I /J 5 State boiler permit no.:
HP Tons BTU/H
Address: /6 31 3 S. yu 6 5 114 /0 ✓r • Fire/smoke dampers/duct smoke detectors
City: Ti V 10 2 b I State: D Q4 ZIP: 9 7 L 2- 3 Heat pump (site plan required)
Phone: 5-- E j( g (o ( Fax: 5"y8 44634E -mail: Install/replace fumace/bumer BTU /H
Including ductwork/vent liner 0 Yes 0 No
CCB no.: , Install/replace/relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
Refriger
Absorption units BTU/H
Name: TOIiL, EA (9(, / IQ .5kTlsl- (2..c*,i ,,l $ te Q,6 Chillers HP
Address: Co 1 'ressors HP
/a i �Lil �oq t /4 l� F n , nmen ex and ventilation:
City: 7/6 L OA 1 State: 012 ZIP: 1 2 2- 3 Appliance vent
Phone: 5"9 ", 1 1Q, , Fax: y9f, et. 3 E -mail: Dryer exhaust
Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: 4-Lt LfC.. - 2; - CAI G • Exhaust fan with single duct (bath fans)
Mailing address: /0 3 0 'Std 67 9 tu - At h' Exhaust system apart from heating or AC
Fuel piphig and distribution (up to 4 outlets)
City: 776IQ 0-6 S tate: 0 MP: 1 Z Z 3 Type: LPG NG Oil
Phone: Q, / / 24 Fax: 8 , 34 E - mail: F leu piping each additional over 4 outlets
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: tate: I ZIP: Insert - type
Phone: _ . E -mail: r-Woodstove/pelletstove
Other:
Applicant's signature: /.1 �` �a L O. , . r I
N ame (print): yr .A.. ' J // b) 1/;
' Na as jurisdictions accept credit cards, please call jurisdiction for more infatuation. Permit fee $ 7o. • S
O Visa 0 MasterCard Notice: This permit application Minimum fee $
/ expires if a permit is not obtained Plan review (at %) $
Credit card number: E within 180 days after it has been
Name of cardholder as s hown oo aedit card accepted as complete. State surcharge (8%) .... $ S-
. $ TOTAL $ —7 V. 3
Cardholder signature Amami 440 -4617 (6/00/C'OM)
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) 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 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. C o m p
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
Fumace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Fumace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor fumace 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 applicance 445 10.00
permit 18) Domestic incinerators
Repair units 805 17.40
3 hp; absorb. unit, 955
to BTU
19) Commercial or industrial type incinerator
to 100k BTU 69.95
3-15 hp; absorb. unit, • 1,700 20) Other units, including wood stoves •
101k 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 dm 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:
Domestic incinerator 1,170 1. Inspections outside of normal business hours (minimum charge -two hours)
$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, induding 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 • 63
* State Contractor Boller Certification required for units >200k BTU.
TOTAL COMMERCIAL • ` $ "Residential A/C requires site plan showing placement of unit
VALUATION:. 1,,. '. ° >" All New Commercial Buildings require 2 sets of plans.
i:ldsts\formsirnech- fees.doc 12/26/01
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