Permit ` CITY OF TIGARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2002 -00439
AlI 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/7/02
PARCEL: 2S111 CB -00500
SITE ADDRESS: 14805 SW 103RD AVE
SUBDIVISION: DEL MONTE SUBDIVISION ZONING: R -3.5
BLOCK: LOT: 004 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: 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: 1
Remarks: Installation of gas piping for new gas cooktop.
Owner: FEES
MUNHALL, WALTER F JR AND Description Date Amount
JEAN B
14805 SW 103RD AVE [MECH] Permit Fee 10/7/02 $72.50
1
TIGARD, OR 97223 [MECH] Permit Fee 10/7/02 $0.00
[TAX] 8% StateTax 10/7/02 $5.80
Phone: [TAX] 8% StateTax 10/7/02 $0.00
Contractor: Total $78.30
DAVID SMITH
9545 SW KILLARNEY LANE
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone: 503 Gas Line Insp
Final Inspection
Reg #:
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 -00
Issued By: ) �; " (__ 1� `/2a/ Permittee Signature: Ar-
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
'' Mechanical Permit Application
Date received: /o I C t Permit no.: t liC POO $& - 5
� ,j ,,L '';, , .,1 „ A City of Tigard Project/appl.no.: Expire date:
City ofTigard 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
g 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
Li New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: j 1.te Ct j j ' L k ) 1 5 1 Q:t 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: ' - -16 64t) / ‘t..) ZIP: R,l 2 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: 1E -u°rr- AND COMMERICAL/INDUSTRI.AL EQUIPMENTSCHEDULE
C34 > -z4S -'CAP 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 ?A. Yes ❑ No
Air conditioning (site plan required)
Is existing space insulated? g Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: �r t. S 4-- k.,..•CLf ? i...is "t- C,��trJl� State boiler permit no.:
HP Tons BTU /H
Address: Cl. ti-S b44,1„L4...'6...N ( Lt Fire/smoke dampers/duct smoke detectors
City: 11)u>.-t't NJ I State: I ZIP: 17 to v Heat pump (site plan required)
Photl'i 6 - ( ._.. 2, 93 Fax: I E -mail: Install/replace furnace/burner BTU /H
CCB no.: t 1'� G Including ductwork/vent liner CI Yes Cl No
Install/replace /relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): 'l7lry 5.. - -- t'CTA Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: 1 State: 'ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type 1/ IUres. kitchen/hazmat
hood fire suppression system
Name: (.041 z42.- "C M.trrL3 t**- LL Exhaust fan with single duct (bath fans)
Mailing address: 11-1-(5' W :.5 10 3 (C%r's-, Exhaust system apart from heating or AC
City: -- meta. {a4, X I State: ash I ZIP: 1 '? Z - Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: `t �3 6, 7.z) , 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: 1 Fax: 1E-mail: Woodstove/pellet stove
Other:
Applicant's signature: ktkAke /Date: kC --? -C 2-- Other:
Name (print): V.1 BN'.ZE '-i-�. l,l..l -sty(.
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
/ expires if a permit is not obtained Plan review (at %) $
Credit card number: p within 180 days after it has been 8.19 Ex Tres accepted fete. ted as complete.
State surcharge (8%) .... $ 5
Name of cardholder as shown on credit card p p
$ TOTAL $ 7 g r
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 Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code CRY (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
100,000 BTU+
fraction thereof, to and including 2) 17.40
$10,000.00. including ducts & vents
$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 6.80
$1.45 for each additional $100.00 or
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 r Pump Cond
fraction thereof. footnotes below. •*
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
unit .5 -1 mil BTU 35.00
Required for ALL commercial permits only 10) 30 -50 HP; absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1 -1.75 mil BTU 52.20
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, including 955 14) Non - portable evaporate cooler
ducts & vents 10.00 J
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 appliance 445 10.00
permit 805 18) Domestic incinerators 17.40
Repair units
< 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: $
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge $
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 Other Inspections and Fees:
Hood served by mechanical exhaust 656 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 Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL $ *"Residential A/C requires site plan showing placement of unit.
VALUATION: All New Commercial Buildings require 2 sets of plans.
is \dsts \forms\mech- fees.doc 02/11/02
7 ,--
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / / / - G Z AM PM BUP
Location f C( o c 5 ' / 03 r /44 Suite MEC h' -6 U q) y
Contact Person Ph ( ) 24) - 03 a PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING / / •
Post & Beam /
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
LECHAN L
o st eam
Rough -In
Gas Line
Smoke Dampers
Fi
PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspec ion RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA / ,/
Approach/Sidewalk Date ! / ii 6 Inspector ,/� Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL