Permit CITY OF TIGARD MECHANICAL PERMIT
a 11� DEVELOPMENT SERVICES PERMIT #: MEC2001 -00441
�' I 13125 SW Hall Blvd., Tigard, OR 9 (503) 639 -4171 DATE ISSUED: 1/28/02
PARCEL: 1 S136AA -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: SR3.2 VENTS W/O APPL: VENT SYSTEMS:
STORIES: 2 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: extending duct work to new bedrooms
Owner: FEES
LUKE -DORF Type By Date Amount Receipt
10313 SW 69TH PRMT CTR 1/28/02 $72.50 2720020000
TIGARD, OR 97223 5PCT CTR 1/28/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
REQUIRED INSPECTIONS
Mechanical Insp
Phone: Final Inspection
Reg #:
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 NC by calling
lr,(L117dR -Q1 • i
Issue By: // Permittee Signature: /
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next busi s ay
r Mechanical Permit Application
Date received: /, 0/ Permitno.: Kf/c,�/ 1[/U
, I:i ..'ill' City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF I'ERi\1IT
O 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
O New construction 0 Addition/alteration /replacement 0 Other:
.1011 SITE INFORMATION COi\1i\1ERCL\I. YALUA7ION SCHEDULE
. Job address: /rota. 5,A.) 4' ' Ter- T14 Q a ■ , C' -2.7,4. 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.:l 573 4,413 —015-00 profit. Value $ .
Lot: (:, IBlock: (Subdivision: Z Oge,t.4 *See checklist for important application information and
Project name: f jurisdiction's fee schedule for residential permit fee.
City/county: IZIP: 1 & 2 FAMILY DWELLING PFRMIT FEE SCHEDULE
De ption andpcation of work on premises: AND COMMERICAIJINDUSTRLV. EQU1PM ENT SCHF. DULE
i re Zi -e.4e, D-44..4 c dos./ ../ZZ-,• A6. Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: IiVAC:
Air handling unit CFM •
Is existing space heated or conditioned? 0 Yes 0 No
Mr conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
Boiler /compressors
Business name: e'lf? State boiler permit no.:
HP Tons BTU/H
Address: Fire/smoke dampers/duct smoke detectors
City: I State: I ZIP: Heat pump (site plan required)
Phone: I Fax: I E -mail: Install/replace furnace/burner BTU /H
CCB no.: Including ductwork/vent liner 0 Yes 0 No
Install/replace/relocate heaters- suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
� Absorption units BTU/H
Name: / O ilt E. f 6 ` INS— Chillers HP
Address: t 1R D B &Pi 'l.0 7 41 Compressors HP
IN�r*onmental exhaust and ventilation:
City: -no R Q I State: I ZIP: ' 2 2.3. Appliance vent
p6 ,2 - Phone: rs ! Fax: E -mail: Dryer exhaust
Hoods, Type I res. kitchen/hazmat
hood fire suppression system
Name: ie / — Q /1/t; . Exhaust fan with single duct (bath fans)
Mailing address: CO / ' " Exhaust system a • art from heating or AC
City: — TM A2 , State: D i ZIP: T
ere p p , : an • ' on up to 4 outlets)
Type: LPG NG Oil
Phone:
,sip, /1 F ax: 5 $63 - mail: Fuel piping each additional over4 outlets
ocess p p g (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: 1 State: I ZIP: Insert -type
Phone: `,Fax: E -mail: Woodstovelpelletstove
Other:
Applicant's signature: /Au Date: / y d / Other:
Name (print): 'Torn i2-/66 /hi
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7p
CI Visa ❑ MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at %) $ 5 ' .
Expires within 180 days after it has been
State surcharge (8%) .... $ i
Name of cardholder as shown on credit card accepted as complete. sIiY TOTAL $ A I
Cardholder signature Amount 440 - 4617 (6A0/COM)
MECHANICAL PERMIT FEES ^
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT EEE: Description: Price Total
$1.00 to $5,000.00 Minimu fee $72. Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for a rst $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 Furnace
$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. Comp* **
Minimum Permit Fee $72.50 SUBTOTAL: to
7) 100K Bb unit
$ �yZ CD to 100K BTU 14.00
// 8) 3 -15 HP; absorb
8% State Surcharge $ s 80 unit 100k to 500k BTU 25.60
9) 15-30 HP; absorb
25% Plan Review Fee (of subtotal) $ unit .5-1 mil BTU 35.00
Required for ALL commercial permits only 10) 30 -50 HP; absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1 -1.75 mil BTU 52.20
- / 1.� 30 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
duds & vents 10.00
Fumace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor furnace 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 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 cfm 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 Other Inspections and Fees:
Hood served by mechanical exhaust 656 1. Inspections outside of normal business hours (minimum charge -two hours)
Domestic incinerator 1,170 $72.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge - half hour)
Other unit, including wood stoves, 656 $72.50 per hour
inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum
Gas
piping 1 - 4 outlets 360 charge - half hour) $72.50 per hour
PP 9
Each additional outlet 63 *State Contractor Boller Certification required for units >200k BTU.
Residential A/C requires site plan showing placement of unit
TOTAL COMMERCIAL $
VALUATION:
iAdsts\forms\mech- fees.doc 08/06/01 •