Permit C ITY OF TIGARD MECHANICAL PERMIT
��� DEVELOPMENT SERVICES PERMIT #: MEC2003 -00004
..� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/8/03
PARCEL: 2S112DC -00100
SITE ADDRESS: 15705 SW 72ND AVE
SUBDIVISION: OREGON BUS. PARK III ZONING: I -L
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: F1 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: 1 <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Tenant Improvement - drying room
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI [MECH] Permit Fee 1/8/03 $72.50
PORTLAND, OR 97224 [MECPLN] Plan Rev 1/8/03 $18.12
[TAX] 8% StateTax 1/8/03 $5.80
Phone: Total $96.42
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON
STE 1 REQUIRED INSPECTIONS
PORTLAND, OR 97202
Mechanical Insp
Phone: 239 -4600
Final Inspection
Reg #: LIC 33135
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: Permittee Signature��
Call (503 6394175 by 7:00 P.M. for inspections needed the next business day
sfB _ /e0 0 TC-
Mechanical Permit Application FOR OFFICE USE ONLY
A . Received Mechanical
CO " 3 Date/By: 1 I S ( Permit No 2493' 2X?() t
U 7 20 G �- Planning Approval Building
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. • Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post-Review Land Use
/�� „ m .17� ; a�A Date/By: Case No.:
Internet: www.ci.tigard.or.us - . e Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503 - 639 - 4175 Name/Method: _ Supplemental Information.
TYPE OF WORK • COMMERCIAL FEE* SCHEDULE - USE CHECKLIST •
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
11,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 EtCommercial/Industrial Value: $ 1 2 r OULD See Page 2 for Fee Schedule
i RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
El Accessory Building ❑ Multi- Family Description 1 Qty 1 Fee(ea.) 1 Total
_ ❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add - on air conditioning ** j 14.00
Job site address: (c-• 7 ( 1S , 72su0 Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: 1 Dorf 04i P/Cy / , A - Hydron t hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Lot #: Repair units 12.15
Subdivision: Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
DESCRIPTION OF WORK Gas fireplace 10.00
,nD 446'- , 2t77c6 v G ' - - 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
0 PROPERTY OWNER • • 1 $TENANT Other: 10.00 _
Name: /Vl (56L� Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: (57o S St.J ?2.N a /I've • Clothes dryer exhaust 10.00
City /State /Zip: -n6 /t aL' ox. 7 23 Single duct exhaust .
Phone: 62p - fq o 7 Fax: (bathrooms, toilet compartments,
APPLICANT . ❑ CONTACT PERSON utility rooms) 6.80
Name: - "")L(-. 5 .��$-..7,-) Attic /crawl space fans 10.00
Other: 10.00
Address: 1 13 e-x j( per- - Fuel Piping
City /State /Zip: PSEJtrre 67L- 170255— * *($5.40 for first 4, $1.00 each additional)
Furnace, etc. **
Phone: 6�1 2� Z Fax: 6�{( 17 B6 Gas heat pump .4.
E -mail: Wall/suspended/unit heater **
CONTRACTOR Water heater **
Business Name: ` tyk CJ /, 717A16 Fireplace **
**
Address: (3 h [ /?� Range
BBQ **
City /State /Zip: jc7,5,ta"„if an. 7 7Z 2-- Clothes dryer (gas) **
Phone:0 - 63) 251 - ydoo I Fax :(st ate- 1035 Other:
7 Total:
CCB Lic. #: 3 -0 G ? 1 d Mechanical Permit Fees*
Authorized Subtotal: $
Signature: - t!_ % /� /_� Date: ( • ? {} 3
>m Minimum Permit Fee $72.50 $ 1 2 • So
d�
S 02' At� Plan Review Fee (25% of Permit Fee) $ /9, . / Z
(Please print name) State Surcharge (8% of Permit Fee) $ q , o
TOTAL PERMIT FEE $ 9� . c7 y 3
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.
Assumed Valuations. Per. Appliance: •
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor fumace 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:
i:\Dsts\Permit Forms\MecPermitAppPg2.doc 01/03