Permit CITY OF TIGARD
MECHANICAL PERMIT
I; DEVELOPMENT SERVICES PERMIT #: MEC2001 -00100
.�� I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/27/01
PARCEL: 2S114BB -10700
SITE ADDRESS: 16114 SW 104TH AVE
SUBDIVISION: SWANSONS GLEN ZONING: R -12
BLOCK: LOT: 048 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: 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
<= 10000 cfm: OTHER UNITS: 1
FURN > =100K BTU: GAS OUTLETS:
> 10000 cfm:
Remarks: Installation of exterior NC unit. Do not install within the established setback
Owner: FEES
FISHER, MARK R /ELIZABETH AN NE Type By Date Amount Receipt
16114 SW 104TH AVE PRMT CTR 3/27/01 $72.50 2720010000
TIGARD, OR 97224 5PCT CTR 3/27/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 453 -4822 Final Inspection
Reg #: LIC 62196
EXPI RED
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 (503)246 -9189.
Issue By: / _ Permittee Signature: 1/ /- -
i
Call (503) 639 -4175 by 7:00 P.M. for inspections need id the next business day
Mechanical Permit Application
Date received:'7) f 1 I p Permit no.:( .€ 2 Qp )- c /00
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
p 4 . 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement Cl Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /KO{ &) / 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: I Subdivision: *See checklist for important application information and
Project name: s jurisdiction's fee schedule for residential permit fee.
City /county: 7744-& /(,�jr �• I ZIP: q ,2,2.4 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and locatior(o work on premises: / AND COMMERICAL /INDUSTRIAL EQUIPMENT SCHEDULE
4-, o87- - IV C- 6141/r" deg- yi Fee(ea.) Total
Est. date of completion/inspection: 3 - 2.8 ZJ/ 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
Air conditioning (site plan required) / /41C° �G
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system /`
MECHANICAL CONTRACTOR Boiler /compressors
Business name: L ( 07 4, C G # State boiler permit no.:
e HP Tons BTU /H
Address: f 4, 5 2 5 Co 72,4d Fire/smoke dampers /duct smoke detectors
City: 4..7l4j(JD I State: eie I ZIP: et 712K Heat pump (site plan required)
3
Phone: 5 - L3r '/$21. I Fax:go ; E- mail: / Install/replace furnace/burner rn BTU /H
CCB no.: 6i 196 Including ductwork/vent liner ❑ Yes Cl No / / c1i /�
Install/replace/relocate heaters - suspended,
City /metro lic. no.: / //9 wall, or floor mounted
Name (please print): 0? 0W- 1 to Lr Vent for ap liance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU /H
Name: A ic_ 1 P-.L_ Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: S03- Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U IUres. kitchen/hazmat
hood fire suppression system
Name: of >_ - 04 J7f- / Exhaust fan with single duct (bath fans)
Mailing address: ( - ai O ilK Exhaust system apart from heating or AC
Fue piping and distribution (up to 4 outlets)
City: 77 614g .` M ZIP: Cy. Type: LPG NG Oil
Phone:5 --(p r 4 -`" Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: State: ZIP: Insert -type
Pie: Woodstove/pellet stove
F E- il: a O�
Applicant's signature: 1, Date:,$ •27.-07. Other:
Name (print): j e__A/. G/,r4g2.L
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ ZE s a
❑ Visa O MasterCard Not Th permit application Minimum fee $ - 7.2.• 50
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ 5.8d
Name of cardholder as shown on credit card accepted as complete.
EXP1R I AL $ 73
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
$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
including ducts & vents 14.00
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
$10,000.00.
fraction thereof, to and including 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 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 **
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.
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $
Each additional outlet 6 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 (minimul
charge -one -half hour) $72.50 per hour
* State Contractor Boiler Certification required for units >200k BTU.
** Residential A/C requires site plan showing placement of unit.
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