Permit A I' CITY OF TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2002 -00264
'' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/24/02
PARCEL: 25111 BA -00105
SITE ADDRESS: 14050 SW 97TH AVE
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -4.5
BLOCK: LOT: 028 JURISDICTION: TIG
CLASS OF WORK: OTR 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: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of a/c unit.
Owner: FEES
LARRY STROBECKER Type By Date Amount Receipt
14050 SW 97TH AVE PRMT CTR 6/24/02 $72.50 2720020000
TIGARD, OR 97224 5PCT CTR 6/24/02 $5.80 2720020000
Phone: 503 Total $78.30
Contractor:
TRI -TECH HEATING
6603 NE 137TH AVE
VANCOUVER, WA 98682 REQUIRED INSPECTIONS
• Cooling Unt Insp
Phone: 360- 891 -2002 Final Inspection
Reg #: LIC 101873
EXPIRED
This permit is issued subject to the regulations contained in the Tigard Municipa ode, Efate of Ore.
Specialty Codes and all other applicable laws. All work will be done in acc• - .an- e wit approved
plans. This permit will expire if work is not started within 180 days of is ance or if • rk is suspended
for more than 180 days. ATTENTION: Oregon law requires you to f. low ru ••s adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -0e -0010 rout OAR
952 -001 080. may ob .in copies of these rules or direct q . estions o 0 4 r by calling
rn1» R -A1 RA
Issue p ;;,��! • / Permittee Signature: ,`
Call (503) 6 • -175 by 7:00 P.M. for inspections neede•'the n:�+'f busines day
'Mechanical Permit Application . ,,, � ` ._
A . .,.
Date received: 4 0 AI p ,P- Permit no.:f�l
' ;.. �� City of Tigard Project/appl. no.: E ' e date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 ate issued: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 1 \ \� Case file no.: Payment type:
Land use approval: // \ Building permit no.:
. • - TYPE OF PERMIT
W I & 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: 1 1050 ', 9 fh A i}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: ' Block: Subdivision: *See checklist for important application information and
Project name: Le„,.C_ ( I, ni- (oh a) JcC jurisdiction's fee schedule for residential permit fee.
City /county: � ZIP: • - - 1 & 2FAMILY DWELLING PERMI SCHEDULE
Description and ation 9f work on premises: — _ _ �
AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE •
/� Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air
Is existing space heated or conditioned? CI Yes CI No c
No handling unit CFM
conditioning (site plan required) 1
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: I - I� e „ �/ State boiler permit no.:
1 `� �c_sY 1 ex, LI/�z.��- HP Tons BTU /H
Address: (f Q C0 3 A y 1. 7 3�_ 1„ A c� Fire/smoke dampers /duct smoke detectors
City: i r State:�y�} ZIP: 2 Heat pump (site plan required) ,_
Phone:3( -$�j /- Fax: ( 1 ) _ /9/4E -ma — Install/replace furnace/burner BTU /H
I Including ductwork/vent liner CI Yes GI No
CCB no.: k7 /V7 3 / Install /replace/relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): rte, ( Apt t r ! • e 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 I/ IUres. kitchen/hazmat
hood fire suppression system ,
Name: c / & \-\ ' Q r Exhaust fan with single duct (bath fans)
Mailing address: L
9 (3 Q:C) 'S S -7 ` Q
�+� it -�— Exhaust system apart from heating or AC
City: I 1 0.s;- I State:0QI ZIP:' 7 Da T Fuel piping and distribution (up to 4 outlets) —
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: I E -mail: Woodstove/pellet stove
Other:
Applicant's signature:le�,b e- ,�,,. Date: (Q Z
/ ?O /b, Other:
Name (print): F --, r t C of c I , e,3 •
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
/ / expires if a permit is not obtained Plan review (at %) $
_. Credit card number:
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card $ �IO 6 ��� aer D TOTAL $ 78 • 36
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
Table 1A Mechanical Code Qty (Ea) Amt
$1.00 to $5,000.00 Minimum fee $72.50 1) Furnace to 100,000 BTU
$5,001.00 to $10,000.00 . $72.50 for the first $5,000.00 and including ducts & vents 14.00
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
fraction thereof, to and including $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
including vent 14.00
fraction $1.54 r each thereof, , to and including or 4) Suspended heater, wall heater
n r, to anluding ) p 14.00
$25,000.00. or floor mounted heater •
$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, thatapplyn.. '' Boiler" . , Heat Air ., ° ,
k
$1.20 for ezich additional $100.00 or For item 7-11,'ee . or . ,Pump ' "Cond .
I fraction thereof. footnotes below.-- Comp * - '.`"'
7) <3HP;absorb unit
to 100K BTU 14.00
ASSUMED VALUATIONS PER APPLIANCE: 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: ' - : $
Commercial or industrial incinerator 4,590 ., - -
Other unit, including wood stoves, 656 8% State Surcharge . $
inserts, etc. o .
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) ". ` $
Each additional outlet 63 Required for ALL commercial permits only
TOTAL COMMERCIAL . .. . ' ,,. $ TOTAL RESIDENTIAL PERMIT FEE: ' . $
VALUATION: • ... ., . ,
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.
' A/C requires site plan showing placement of unit.
is \dsts \forms\mech- fees.doc 10/11/00
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