Permit 'J
C ITY OF TIGARD MECHANICAL PERMIT
D EVELOPMENT SERVICES PERMIT #: MEC2001 -00336
r DATE ISSUED: 9/25/01
�'''�'` " � J I° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1 S 136CA -03700
SITE ADDRESS: 11260 SW 79TH AVE
SUBDIVISION: FRIENDLY ACRES ZONING: R -4.5
BLOCK: LOT: 011 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 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: 1
FURN > =100K BTU: < =10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace duct work in crawl space.
Owner: FEES
CRAUGHAN, MICHAEL J + MARCHETA Type By Date Amount Receipt
11260 SW 79TH AVE PRMT CTR 9/25/01 $72.50 2720010000
TIGARD, OR 97223 SPOT CTR 9/25/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
BELL HEATING
15550 SE PIAZZA AVE
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS '
Duct Inspection
Phone: 503 - 656 -1184 Final Inspection
Reg #: LIC 447
PLM 3 -286PB
EXPIRE()
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. Yom may obtain copies of these rules or direct questions to OUNC by calling
(I fA 94R_Q1 .i j�
Issue By: . /111tt/ - - Permittee Signature: ���
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
T 1
Mechanical Permit Application
Date r eceived: 9 jZ5 /Q/ P ermitn o.:
i Cl of Tigard P ro ect/a 1 no.: Ex ire date:
,..' b J PP. p'
Address: t?3125 SW Hall Blvd, Tigard OR 97�-��
City of Tigard - Date issued: By5 r "_ --eipt no.:
Phone: (50) 639 -4171
Fax: (503) 598 -1960 Case file no.: Paymenttype:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi family 0 Tenant improvement
0 New construction ❑ Addition/alteration/replacement 0 Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: / /2 (., C2 SW 79 /9l/e. 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: 77 _ I ZIP: 9 72.23 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and lob&ation of work on pre ices: �e pi i.e. AND COMMERICAL /INDUSTRIAL EQUIPMENTSCHEDULE
_nk Uf7.Jnrk T' r e a i/p et. ( -e . 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? Ig Yes ❑ No Air conditioning (site plan required)
Is existing space insulated ?S Yes ❑ No Alteration of existing HVAC system /
MECHANICAL CONTRACTOR Boiler /compressors
Business name: State boiler permit no.:
/l /��P��fi Zn G . HP Tons BTU /H
Address: ,TS Sr Pik five, Fire/smoke dampers /duct smoke detectors
City: G /44 .41. state: 07 -- I ZIP: 97 015 i Heat pump (site pl r ( -
Phone: 454_ j j -y/ I Fax: 65 752)1 E -mail: InstalVreplacefurnace / bumer BTU /H
Including ductwork/vent liner O Yes ❑ No
CCB no.: S/5/ 7 InstalVreplace/relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): IP, /., i , /I Vent for a i pliance other than furnace
CONTACT PERSON Refrigeration:
Effil Absorption units BTU/H I■■
Chillers HP
Compressors HP _
Address: / Sr A Q ,zZa_, Ave., Environmental exhaust and ventilation:
City: G/ac f Gi.vyt/, S I State:6 - I ZIP: 4 70/s Appliance vent ,■■
Phone: 2. . • _ g • 3� Fax: 65 S'// E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat ■ -
Exhaust e system
duct
Name: Name: ��/774., r k P f � C /-/-6... ,, ,,, A �, Exhaust t fan with th single duct (bath fans)
Mailing address: , 4 , c. A li l 7 -"u , Exhaust system apart from heating or AC
Fuel pip ( g and distnbution (up to 4 outlets) III -
City: 7 - 7 9 , , r _ State: c -ZIP: 22. 7 Z Type: LPG NG Oil
Phone: u _ - 7f Fax: E -mail: Fuel piping each additional over 4 outlets III
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: 1 Fax: 1E-mail: Woodstove/pelletstove
Other:
Applicant's signature: ,, R// I Date: Other:
Name (print): /7 , 9ei/ r I �7
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ / -SO
Cl Visa 11 MasterCard < Thi perm app Minimum fee $
expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / Expires within 180 da s after it has b een State surcharge (8 %) .... $ S ,2-0 Name of cardholder as shown on credit card $ accept�as ! i E TOTAL $ 4 . 3.0
Cardholder signature Amount i`_ 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) 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 14.00
$1.54 for each additional $100.00 or including vent
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 Foritems 7 1:1, see ; ,. or , .P14111) Co("d a
fraction thereof. footnotes below ; _ C om p
7) <3HP;absorb unit
ASSUMED VALUATIONS PER APPLIANCE: 8) 3-15 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 fumace 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
- - Pecair_ijnits 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
>50 hp; absorb. unit, 5,725 18) Domestic incinerators 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: ' , $
Co or industrial incinerator 4,590
Other unit, including wood stoves, 656 8% State Surcharge ¶€5 : $
inserts, etc. °
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) 4 $
Each additional outlet 63 Required for ALL commercial permits only ;:t, P
5 : - " S
TOTAL COMMERCIAL = 5 ? �� $ • TOTAL RESIDENTIAL PERMIT FEE 7 � 0, $
VALUATION: s' 4 9 * Y _
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 Boller Certification required for units >200k BTU.
"'Residential A/C requires site plan showing placement of unit.
is \dsts \forms\mech - fees.doc 10/11/00 .