Permit C ITY OF TIGARD MECHANICAL PERMIT
Al VELOPMENT SERVICES PERMIT #: MEC2002 -00062
1� .. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/2/02
PARCEL: 2S1 14A0 -01500
SITE ADDRESS: 17005 SW 92ND AVENUE
SUBDIVISION: ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: 1 VENT FANS: 2
OCCUPANCY GRP: S2 VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 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:
> 10000 cfm: GAS OUTLETS:
Remarks: Maintenance Building - Phase II of Cook Park Master Plan expansion.
Owner: FEES
TIGARD, CITY OF Type By Date Amount Receipt
13125 SW HALL
TIGARD, OR 97223
Total
Phone:
Contractor:
•
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Mechanical lnsp
Phone: 692 -1565 Heating Unt lnsp
Reg #: LIC 5193 Final Inspection
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 -00 ffi-0. Y
0ou may obtain copies of these rules or direct questions to OUNC by calling
(tinf a -A1 RA /
Issu B y: k ..I,tom / to Ai i_I ) Permittee Signature: r� _,,iie,i ;i mar A
/
Call (503) 63:-4175 by 7:00 P.M. for inspections needed the nex • usiness day
H Pt- o..)r - rJCE__. 1t,1J
MechanicalPermit Application'
Date received: 1 69/ Permit no.: e -, 006A v is
, City of Tigard Project/appl.no.: Extiredate:
of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223
City f 8 Phone: (503) 639-4171 Date issued: 'c y• • I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment'type:
Land use approval: CUP 02010 - 000 / Building permit no.:
TYPE OF PERMIT •
❑ 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: / 7065" 5 14.3 'fa ' 1 O . 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:( 1- Ps ttJTI.,N.V1 6c.t.:r . jurisdiction's fee schedule for residential permit fee.
City /county: �rl' ii.A6 t,04 , I ZIP: 2 3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and Ideation tf work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENT SCHEDULE
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? ❑ Yes ❑ No
space insulated? ❑ Yes ❑ No Air rati conditioning existing HVAC C system
Is existing P Alteration of existing HVAC system
MECIIAN CONTRACTOR Boiler /compressors
- - -- - — - - - -- - - - - - - -- State boiler permit no.:
ARROW MECHANICAL HP Tons BTU /H
Fire /smoke dampers/duct smoke detectors
10330 S W TUALATIN RD Heat pump (site plan required)
TUALATIN OR 97062 Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
PH: 503 -692 -1565. CCB #: 5193 Install /replace /relocate heaters- suspended,
wall, or floor mounted
Name (please print): 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 U lUres. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: State: ZIP: Fuel piping and distribution (up to 4 outlets)
Y I tate: I 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
pp eguipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: 3'.i F t : tits Email: O W�edstovelpel l et stove I
Applicant's signature: I Dater --//-0 2., _ Other:
Name (print): � 4; .
Not all jurisdictions accept credit c.. , please cal information. risdiction for more infoa Permit fee $
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
. $ TOTAL $
Cardholder signature Amount , 440 -4617 (6/00 /COM)
MECHANICAL PERMIT FEES r,_
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 . 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 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. Co mp
Minimum Per • , ee $72.5+ SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU 14.00
8% State Surcharge $ 8) 3 -15 HP; absorb 25.60
unit 100k to 500k BTU
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
12) Air handling unit to 10 CFM
;ASSUMED VALUATIONS PER APPLIANCE: 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
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 s) 955 10.00
o' � appliance permit
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 •
101kto500kBTU 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: . -h .,;. , $
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge _' `,, - ... :,::-
urcharge - $
Air handling unit >10,000 cfm 1,170 � ; ° ..;
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct o2 446
Vent system not included in 656 -
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
Domestic incinerator 1 170 1. Inspections outside of normal business hours (minimum charge -two hours)
$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.
:W;,, , - r„ $ ** Residential A/C requires site plan showing placement of unit.
TOTAL COMMERCIAL v
VALUATION:. tf - ', - -'.
All New Commercial Buildings require 2 sets of plans.
is \dsts \forms\mech- fees.doc 12/26/01
CITY OF TIGARD 24 -Hoiur
BUILDING - Inspection Line: (503) 639 -4175 0 '90 2 —0 p 44
INSPECTION DIVISION Business Line: (503) 639 -4171 ..
t • a R64 — Doo 7 aZ
Received Date Requested lb AM PM BUP
Location 17 on s 7. IUD Suite d a 7
- 3
Contact Person C ytA MA- Ph ( ) /5 PLM
Contractor Ph ( SWR
BUILDING Tenant/Owner Q� f zd ELC
Footing
Foundation ELC
Access:
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:
Othe
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain :
Shower Pan d A
Other:
Final
PASS PART FAIL t2,
MECHANICAL
Post & Beam ,6/
- o • - n 1 \t\ A N
Gas Line
Smoke Dampers
Fir
4 Sr)ART FAIL TRICAL
Service
Rough -In
1j4P
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 [] Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA
Approach/Sidewalk Date ,/a/-7 '2 — inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL