Permit CITY T I CAA R D MECHANICAL PERMIT
ul DEVELOPMENT SERVICES PERMIT #: MEC2002 -00068
I 13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/15/02
PARCEL: 2S112BD -00100
SITE ADDRESS: -9 - 580"SW BONITA RD
SUBDIVISION: TIFFANY COURT APT. ZONING: R -12
BLOCK: I c.�l � ; a'�1 LOT: 065 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: MF UNIT HEATERS: VENT FANS:
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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
•
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm:
GAS OUTLETS:
Remarks: Replace vent for water heater.
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
Duct Inspection
Phone: 503 - 762 -5187 Final Inspection
Reg #: LIC 86086
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
rW1194F_a1 R� // Issue By: % �` ,t . Permittee Signature: � �` 5' /( 4
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
•_ . ii
Mechanical Permit Application. �y
Date received: 6/a ' Permit no.:h) ccdza - U
. 4'il City of. Tigard Projecdappl. no.: Expire date: •
City of Tigard Addres'S: 13125 SW Hall Blvd, Ti OR 97223 Date issued: By:a Receiptno.:
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 ❑ Commercial/industrial XMulti-family ❑ Tenant improvement
❑ New construction IN ' ddition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE '
Job address: . 76 0 5 Lk5 N I TA IR l 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: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work o premises: •.0 1 A AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
LlJa.T.th., lkI Ai JJ-AAt 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? ❑ Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: 6, .p , ' f 6 A- State boiler permit no.:
HP Tons BTU /H
Address: 5 30 ( S L 1101 F O]Qb LA1 Fire/smoke dampers/duct smoke detectors
City: f C) l e � 0 I State: ()R I ZIP: � 7 v� 3 6 Heat pump (site plan required)
Phone: l 05 'J ax: E-mail: /
g
--- Install/replacefurnace/burner BTU /H Including ductwork /vent liner ❑ Yes Cl No
CCB no.: 0 ,� • /a.iN 70 3 Install/replace/relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): 6'7 E T 7A tE` O ?7' Vent for appliance other than furnace .
Refrigeration:
CONTACT PERSON
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 I Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans) •
Mailing address: Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E - mail: Fuel piping each additional over 4 outlets •
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: • I State: I ZIP: Insert -type
Phone: j Fax: 1E-mail: Woodstove/pelletstove
2'/ O0( Other:
:�CZ � �+
Applicant's signature 3 Date: Other:
Name (print) . t<.u71 h�
•
Not all jurisdictions accept credit cards, please call jurisdiction information. sdiction for more inform Permit fee $ 7., 1 0
Notice: This permit application Minimum fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on coedit card accepted as complete. TOTAL $ /
Cardholder signature Amount 440-4617 (6✓00 /COM)
•
•
MECHANICAL PERMIT FEES -� - '
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: ,.. PERMIT FEE :. - - Description:' . . Price ' Tot
$1.00 to $5,000.00 Minimum fee $72.50 Table . Mechanical•Code ` Qty (Ea) ' Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 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 induding 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: $ 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
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
Furnace to 100,000 BTU, induding 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Furnace > 100,000 BTU induding 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
>1.75 mil. BTU 50 Minimum Permi Fee $72. / SUBTOTAL: $
Air handling unit to 10,000 cfm 656 8% State Surcharge P 1 ".. -;; $
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
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1,170 1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator 1
$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 Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL � $ **Residential A/C requires site plan showing placement of unit.
Y *b
VALUATION:. . 4' . ,4.?. _ . i ' :r All N Commercial Buildings require 2 sets of plans.
is \dsts \forms\mech - fees.doc 12/26/01