Permit 7 1 - A
CITY OF TIGARD
i DEVELOPMENT SERVICES PERMIT #: MEC2003 -00361
c�lil A MECHANICAL PERMIT
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/1/03
PARCEL: 2S101 DC -00200
SITE ADDRESS: 13535 SW 72ND AVE 170
SUBDIVISION: 72ND AVE OFFICE BUILDING ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF 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:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Relocate ductwork to accomodate new walls. Value $500.00
Owner: FEES
PACIFIC NW PROPERTIES LTD PTNSHP Description Date Amount
9665 SW ALLEN BLVD STE 115 [MECH] Permit Fee 7/1/03 $72.50
BEAVERTON, OR 97005 [TAX] 8% StateTax 7/1/03 $5.80
Total $78.30
Phone:
Contractor:
OREGON HEATING + NC INC
PO BOX 397
DUNDEE, OR 97115 REQUIRED INSPECTIONS
Duct Inspection
Phone: 538
Final Inspection
Reg #: LIC 125815
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
Issued By: A d, ,._,„ , . . _ . Permittee Signature: r //i/-
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
MPeh.anical Permit Application
OFFICE USE ONLY
Received Mechanical
Date/By: , Permit No.: I116Z ?p3 - C l
City of Tigard RECEIVED Planning Approval
Date/By: Build Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 JUL 1 2003 Datc'By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
Internet: www.ci.tigard.or.us CITY OFTIGA "! °X 1 )1 I i Cont Day: Case N ® See Page 2for
24 -hour Inspection Request: 3U1 1OE ®IVI , Name/Method: -- - Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
r eik New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
N 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 NrCommercial/Industrial Value: $ 5b0 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 /:=7 - ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add -on air conditioning ** 14.00
Job site address: 1 st ( 5t .) - 72 b% . pue_, Gas heat pump 14.00
Suite #: s21 / 70 ) 1 Bldg. /Apt. #: _ Duct work • / 14.00
Project Name: y�EC Hydronic hot water system 14.00
Cross street/Directions to job site: (for orid radiator boiler
� ( radiator or hydronic system) 14.00
CD Unit heaters (fuel, not electric)
1) s4.►►\ _ b (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
DESCRIPTION OF WORK Gas fireplace 10.00
ad!) u fLo fA- -i- O Flue vent (water heater /gas fireplace) 10.00
net-ti r�(4,l 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: . Fa .t .[ f►t L., J4) ? Environmental Exhaust &Ventilation
' Range hood/other kitchen equipment 10.00
Address: g(e0 S y.,0 A .iti 5 t
City /State /Zip: 8t k) y r < T704;7 5-
Clothes dryer exhaust 10.00
} Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
A PPLICANT ,(' CONTACT PERSON utility rooms) 6.80
ame: .r. ' 1- /� 111 l � Attic/crawl space fans 10.00
Address: Oho , 144-1 4—A C _ O t h e r: 10.00
((TT Fuel Piping
City/State/Zip: .., I * *($5.40 for first 4, $1.00 each additional)
PhoI 3) - Fa (o t:}.Fax: Furnace, etc. **
J Gas heat pump *•
Gas heat Wall/suspended/unit heater **
CONTRACTOR Water heater **
Business Name: E a Fireplace **
Address: p(� (�� 3ci,7 Range
BBQ **
v t or I) K Clothes **
es dryer (gas) •*
Phoie$towS''5..29 Fax: Other: •*
CCB Lic. #: J2.,5 7 Total:
Authorized /�j Mechanical Permit Fees*
Signature: C � /+a/r Date: 7///d3 Subtotal: $
!!! Minimum Permit Fee $72.50 $
t l 1 Plan Review Fee (25% of Permit Fee) $
C ( ff 1 �t L State Surcharge 8% of Permit Fee) punt name) ( ) $
TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/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.
C A • .•- r.r • .• . • t.s ►�,��
Assumed Valuations Per Appliance:
Value Total •�' a • • Description: Qty (Ea) Amount • 1 • ` : • r �.
Furnace to 100,000 BTU, including 955 `•
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
t .
& 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
tol00kBTU '�.'•r,ve �. �- •.
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
t .t -
Air handling unit >10,000 cfm 1,170 „ -r • ,'
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 t,
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:
• •••r • .
..� •••••
•
• z • •
i:lDsts\Perrnit FormslMecPermitAppPg2.doc 01/03