Permit CITY TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2002 -00071
�•I�l DATE ISSUED: 2/15/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
/I PARCEL: 2S112BD -00100
SITE ADDRESS: 14660 SW 76TH AVE 0769 6V
SUBDIVISION: TIFFANY COURT APT' ZONING: R -12
BLOCK: LOT: 065 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: MF UNIT HEATERS: VENT FANS: 1
OCCUPANCY GRP: R1 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
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Remarks: Installation of bathroom exhaust fan.
Owner: FEES
BOROS, STEFAN A + FIVIA Type By Date Amount Receipt
PO BOX 1890 PRMT CTR 2/15/02 $72.50 2720020000
GRESHAM, OR 97030 5PCT CTR 2/15/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
S.A. HEATING & A/C
8301 SE BUFFORD LN.
PORTLAND, OR 97236 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 503 -762 -5187 Duct Inspection
Reg #: LIC 86086 Final Inspection
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling
( nM9Lt .q1 Rq
Issue By: II_. ,` . � Permittee Signature: al'
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next busines day
Mechanical Permit Application
Date received: t$ 0 y Permit no.: f iriE( ).00 , -011
�i4 I .
.I :..I � _ City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial * Multi- family ❑ Tenant improvement
0 New construction ❑ Addition/alteration/replacement ❑ Other:
.10B SITE INFORMATION , • : • COMMERCIAL VALUATION SCHEDULE ' •
Job address: A �� 6 w , 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: IBlock: ISubdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: 7 j (1 D ZIP: 1 & 2 FAMILY, DWELLING PERMIT FEE SCHEDULE
Des tion a d location of work on premisest AND' COMMERICAL /INDUSTRIAL EQUIPMENTSCHEDULE
It` r , Z ii - t 7�. 46 tg4 VO • Fee (ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? ❑ Yes ❑ No Air handling unit CFM
g P Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
111F (71/6 State boiler permit no.:
Business name: / p � � � HP Tons BTU /H
Address: 0 S 4�(3 De. L_ Ai Fire/smoke dampers /duct smoke detectors
City: ' 'j l i I State: 0 /2 I ZIP: 9 - 7o2. ,C Heat pump (site plan required)
Phone:ax: I E -mail: Install/replacefurnace/burner BTU /H
(� r Including ductwork/vent liner 0 Yes O No
CCB no.: 7J (j Install/replace /relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): ') A e) ,l•£ Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
• Absorption units BTU/H
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U IUres. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
State: ZIP: Fuel piping and distribution (up to 4 outlets)
City: I I Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: • I State: I ZIP: Insert - type
Phone: I Fax: E -mail: Woodstove/pellet stove
Other:
Applicant's signaturep7,ctig te-krail Date: 2- (s i Other:
Name (print):
Not all jurisdictions accept credit cards, please call jurisdiction for. more information. Permit fee $ 7 L C:5
❑ Visa 0 MasterCard Notice: This permit application Minimum fee $
Credit card number /
expires if a permit is not obtained Plan review (at %) $
w ithin 180 da s after it has been 60
Expires y State surcharge (8 %) .... $
Name of cardholder as shown on credit card $ accepted as complete. TOTAL $ u. •y
�
Cardholder signature Amount 440.4617 (6/00 /COM)
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MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
.TOTAL (VALUATION .a :PERIV IT FEE:' '-. - 1:::; , ',. - 1.:
- •-;," Tat e M echanlcal;;Gode . ' Qty '
$1.00 to $5,000.00 Minimum fee $72.50 '(?).7,t, i# �. Amt otal
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 1.00,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 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 alltithat apply': Boiler, ' Heat ',Air
$1.20 for each additional $100.00 or For 'itenis'7 11, see <or Pump Con d -
fraction thereof. footnotes below: Com
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 35.00
Required for ALL commercial permits only unit .5 1 mil BTU
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
12) Air handling unit to 10 CFM
ASS,LIMED`;VALUATIONS'FER APPLIANCE z A 10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Furnace > 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
101 k 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: l ` `` t i
>1.75 mil. BTU ' r" ' � 6 $
Air handling unit to 10,000 cfm 656 8% State Surcharge 7 WVfi t, $
Air handling unit >10,000 cfm 1,170 , ? 1Z
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE r -' $
Vent fan connected to a single duct 446 t -
Vent system not included in 656 f y ° °' ,ti...
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator 1,170 $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, including 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 g $ ** Residential A/C requires site plan showing placement of unit.
VALUATION:. All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms\mech - fees.doc 12/26/01