Permit .7 CITY OF TIGARD MECHANICAL PERMIT
T�' I DEVELOPMENT SERVICES PERMIT #: MEC2003 -00505
cif �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/18/03
PARCEL: . 2S102CB -07700
SITE ADDRESS: 13157 SW GRANT AVE
SUBDIVISION: POOLE MLP2001 -00003 ZONING: R -4.5
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SFM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 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:
> 10000 cfm: GAS OUTLETS: 2
Remarks: Installation of gas piping for new water heater and gas fireplace.
Owner: FEES
POOLE, PHILIP & DARLENE Description Date Amount
13144 SW GRANT AVE
TIGARD, OR 97223 [MECH] Permit Fee 8/18/03 $72.50
[TAX] 8% StateTax 8/18/03 $5.80
Phone: 503 670 - 8254 Total $78.30
Contractor:
OWNER
REQUIRED INSPECTIONS
Phone: Gas Line Insp
Mechanical Insp
Reg #: 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 ou to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00
Issued By: j/ _. ea o,,,,,„,„„,,, Permittee Signature: k 4,),
. 6 o�T'�
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next dusiness day
�anical Permit Application ; FOR OFFICE USE ONLY
r Date/By: y /� 6 ¢ j l/ Mechanical L
� , Permit No.: id93 -- CX:10
Planning al Building
City of Tigard
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
j 'I Date /By: Case No.:
Internet: www.ci.tigard.or.us . �, e ' Contact J s r : El See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 �`�`' W Name /Method �' Supplemental Information.
5 ` r.',: 6 "` °'`' ;WORK; `€ 1 , . r`` ' '.i 4 iWC MERCIA& FEE* SCHEDULMSEFCHECKLIS,T :' M
❑ New cons ❑ Demolition Mechanical permit fees* are based on the total value of the work
'( dditio a eplacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
s, , � mechanical materials, equipment, labor, overhead and profit.
) ,1' i; - IGORVOF.CONSTRUGTION :AX z_, . ;_ =3£ -; _
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family ; `e, ZRESIDENTIAL`�°EQUIPM ENT /SYSTEMSFE ;SCHEDULEi'11 :
Description Qty Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling . , __ .
i `r- :i: 4- .A ;FJ®B'SITE,110, RIVIA PION; and,LOCATION ' 7 ' ': ,.„ Furnace - add - air conditioning ** 14.00
Job site address: J3/s7 5 a), of 6/4 Gas heat pump 14.00
Suite #: I B g. /Apt. #: Duct work 14.00
Project N ame: Hydronic hot water system 14.00
Pro J Pp! bp c901P. Residential boiler
Cross street/Directions tb job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, induct, suspended, etc.) 14.00
P Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
Other :Fuel Appliances _ _ .
Tax map /parcel #: Water heater 10.00
R1 ` ; : -' ',' -ITM" iiCtigSCRI+PTION`OF :WORK `; , ,iys g ., :T ;; . Gas fireplace / 10.00
Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
Z iEROPERTY;`OWNER . _. � �-
, � ...�.•� �� Si ;_TEN „ � .,,< :,, -',�� ''' Other: 10.00
_; ANT, eta .4 :�, �, : >. 7 r - . �-���
:. ' Enviironmenfal Exbiuit &>Ventilation ,' , '.- = ;n., ,,.
/ Name: / 7i " . ir/ 4, o00i Range hood/other kitchen equipment 10.00
Address: / , `). (.,,," - , , Clothes dryer exhaust 10.00
City /State /Zip: %/ 92_3 Single duct exhaust
Phone: 70 - 0-z Fax: (bathrooms, toilet compartments,
g 4, ;APPLICANT;`„ , ° ) =i ` ,;� m,_ : ❑°CONTACTliERSON..;- " utility rooms) 6.80
Name: Attic /crawl space fans 10.00
Other: 10.00
Address: =F,uel Piping - •_ - ._
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
[ Furnace, etc. **
Phone: l Fax: Gas heat pump **
E-mail: Wall /suspended/unit heater **
:� ,`;; alit'.' .�` :. Z CO TRACTOR "` :. ` , : ::
� � �,:.�_�. _ - =��.� ._t:om -• Water•he f/ **
Business Name: Ddei Fireplace z 1...,/- **
Range **
Address: 3iS a g,-„,)-,9,/, BsQ **
City /State /Zip: 97 Clothes dryer (gas) **
Phone: 67 ' tt Fax: Other: **
CCB Lic. #: Total:
Authorized s -- Mechan'ical Permit Fees*' i
` /� p - e -0 ., Subtotal: $
Signature: �p C � f Date: O Minimum Permit Fee $72.50 $ '7e SCi
Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $ S. S'U
TOTAL PERMIT FEE $ -7q 3 d
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03 66 e "
1
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information IP
Commercial Fee Schedule:
total °Valuation Permit Fee :
$1 00 to $5,000.00 Minimum fee $72.50
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52
for each additional $100 00 or fraction
thereof, to and including $10,000 00
$10,001.00 to $25,000 00 $148.50 for the first $10,000.00 and
$1.54 for each additional $100.00 or
fraction thereof, to and including
$25,000.00.
$25,001.00 to $50,000 00 $379.50 for the first $25,000.00 and
$1 45 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 and up $742 00 for the first $50,000.00 and
$1.20 for each additional $100 00 or
fraction thereof
Valuation Per Appliance: , _.
Value Total
Description Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
< 3 hp; absorb. unit, 955
to 100k BTU
3 -15 hp; absorb. unit, 1,700
101k to 500k BTU
15 -30 hp; absorb unit, 501k to 1 mil 2,310
BTU
30 -50 hp, absorb unit, 3,400
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL ' $
VALUATION: �a
i. \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03