Permit CITY T I G A R D MECHANICAL PERMIT
6, DEVELOPMENT SERVICES PERMIT #: MEC2001 -00111
Ill ' DATE ISSUED: 4/4/01
' ' � ``�'' 13125 SW Hall Blvd., Tigard,.O - )97223 (503) 639 -4171
PARCEL: 2S112AC -01200
SITE ADDRESS: 14865 SW 74TH A V E '
SUBDIVISION: FANNO CREEK ACRE - TRACTS ZONING: I -P
BLOCK: LOT: 020 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: 1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 5
> 10000 cfm:
Remarks: Installation of 1 water heater vent and 5 gas outlets for: 2 griddles, 1 stock pot stove, 1 gas fryer and 1 water
heater vent. HOOD & FANS TO BE SUBMITTED UNDER SEPARATE PERMIT.
Owner: FEES
KNHS DEVELOPMENT CO Type By Date Amount Receipt
26262 S MERIDIAN RD PRMT CTR 4/4/01 $72.50 2720010000
AURORA, OR 97002 5PCT CTR 4/4/01 $5.80 2720010000
PLCK CTR 4/4/01 $18.13 2720010000
Phone: Total $96.43
Contractor:
SUPREME COMFORT HEATING
9425 SW COMMERCE CIRCLE #16
WILSONVILLE, OR 97070 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 682 -1985 Mechanical Insp
Reg #: LIC 21892 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 through OAR 952- 001 -0080.
You may obtai copies of these rules or direct questions to OUNC by calling (503)246 -9189.
Alp Issue By: .4.7A0 A .. - Permittee Signature: D
all (503) 639 -4175 by 7:00 P.M. for inspections needed the next busin ss day
o TT ,
Mechanical Permit Application
Date received: WO/ / Permit no.: /y &'C ZDO - O7 //
tr la_ 4?), - City of Tigard . � � Project/appl. no.: Expire date:
City of Tigard Address 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 Date issued: By: lipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: / t/ ' (, s--- 5 4) '7 ( fr t!E 5 0 /TE 2:7 Co Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: L 7 0 value of all mechanical mate matefiials, equipment, labor, overhead,
Tax map /tax 1ot/accountno.: profit. Value $ .3 �D ®V
Lot: I Block: I Subdivision: *See checklist for important application information and
Project name: Ff - ,V, F - U5'1A/&" 5 � : jurisdiction's fee schedule for residential permit fee.
— City /county_ 7/6 /2 0 ZIP: Q 7 -2.-2 's 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPIMENTSCHEDULE
49 4/) 4/II Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? 2itYes ❑ No Air conditioning (site plan required)
Is existing space insulated ?Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR ' Boiler /compressors
State boiler permit no.:
Business name:
/"� Co �/ �/ HP Tons BTU /H
Address:9Z5 Ste, Gf?r C, • /-- Fire/smoke dampers /duct smoke detectors
City: / State: U/. ZIP: ,, 7i Heat pump (site plan required)
Phone jpQL - ,0 ff< Fax: 6 ..--704 E-mail: InstalUreplace furnace/burner TU /H
Including ductwork/vent Line Yes o
CCB no.: ,L /,,' 2 — FnstalUreplace/relocateheaters- suspended,
City /metro lic. no.: / wall, or floor mounted ry
Name (please print): / ., j , - phi Vent for appliance other than furnace 1N' 1' / ,
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: C - z A/ALSO I!/ Chillers HP
Compressors HP
Address:PO v X / s-,7 Environmental exhaust and ventilation:
City: ft Uno AA- I State:q/ I ZIP:9 7 O v Z Appliance vent
Phone678- {,7fy -/$7 p' Fax , , - /..7_ 33 E -mail: Dryer exhaust
OWNER Hoods, Type 1/ II/res. kitchen/hazmat
hood fire suppression system
Name: /.I� - ,J14b CA G1-K 0-e/1 I-4-C.— Exhaust fan with single duct (bath fans)
Mailing address: , 0 1:3 D, try Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City: nr ftjn 4 I Statepi't 1 ZIP4 7 0.0 ? Type: LPG NG Oil
PhoneSo3 —C7 _, 7 ax: E-mail: Fuel piping each additional over 4 outlets
Process piping (schematic required '�/ 0
Number of outlets if 0 n 2.N. of ileftr •
Name: AID o(/ �S_ Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: I Fax: 1 E -mail: Woodstove/pellet stove
Other: G v ; ci d% I e 2
Applicant's signature: 1 Date: Other: ,C, k Po f S 4 e
Name (print): /. ot c Fv y r /
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee / $
J
❑ Visa 0 MasterCard Notice: This permit application Minimum fee // $ AP,
/ / expires if a permit is not obtained Plan review (at oZ✓ %) $ ' /3
Credit card number: w ithin 180 days after it has been
Expires y State surcharge (8 %) .... $ p 5; PO
Name of cardholder as shown on credit card $ accepted as complete. TOTAL $ / 6 93
Cardholder signature Amount 440 -4617 (6/00 /COM)
MECHANICAL PERMIT FEES ,
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: 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 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 - --A ,- `rA"r
$1.20 for each additional $100.00 or For `items 711, see or Pump iCond ."
fraction thereof. footnotes; below e, Comp* "', ',, q , ' '.'! ; u
7) <3HP;absorb unit
ASSUMED VALUATIONS PER APPLIANCE: to 100K BTU 14.00
8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount 9) 15 -30 HP; absorb
Furnace to 100,000 BTU, including 955 unit .5 -1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Furnace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents . 11) >50HP: absorb
Floor furnace including vent 955 unit >1.75 mil BTU 87.20
Suspended heater, wall heater or 955 12) Air handling unit to 10,000 CFM .
floor mounted heater 10.00
Vent not included in applicance 445 13) Air handling unit 10,000 CFM+
permit 17.20
Repair units 805 14) Non - portable evaporate cooler
< 3 hp; absorb. unit, 955 10.00
to 100k BTU 15) Vent fan connected to a single duct
3 -15 hp; absorb. unit, 1,700 6.80
101k to 500k BTU 16) Ventilation system not included in
15-30 hp; absorb. unit, 501k to 1 2,310 appliance permit 10.00
mil. BTU 17) Hood served by mechanical exhaust
30 -50 hp; absorb. unit, 3,400 10.00
1 -1.75 mil. BTU 18) Domestic incinerators
>50 hp; absorb. unit, 5,725 17.40
>1.75 mil. BTU 19) Commercial or industrial type incinerator
Air handling unit to 10,000 cfm 656 69.95 •
Air handling unit >10,000 cfm 1,170 20) Other units, including wood stoves
Non - portable evaporate cooler 656 10.00
Vent fan connected to a single duct 446 21) Gas piping one to four outlets
Vent system not included in 656 5.40
appliance permit 22) More than 4 -per outlet (each)
Hood served by mechanical exhaust 656 1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL: Wil i. �� $
Commercial or industrial incinerator 4,590 t„` i, k
Other unit, including wood stoves, 656 8% State Surcharge f g '' $
inserts, etc. :304-tli44T
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $ .
Each additional outlet 63 „ -- t
Required for ALL commercial permits only .r ,,, ,
TOTAL COMMERCIAL ' .k,; $ TOTAL RESIDENTIAL PERMIT FEE x � i�= $
VALUATION: , ', 1 " ,
Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge -two hours)
$72.50 per hour.
2. Inspections for which no fee is specifically indicated (minimum charge -half hour)
$72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimum
charge -one -half hour) $72.50 per hour
"State Contractor Boiler Certification required for units >200k BTU.
** Residential A/C requires site plan showing placement of unit.
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