Permit l
` w CITY OF TIGARD MECHANICAL PERMIT
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�l DEVELOPMENT SERVICES • PERMIT #: MEC2002 - 00013
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/4/03
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PARCEL: 1S135DA-01400
SITE ADDRESS: 11515 SW HALL BLVD
SUBDIVISION: ZONING: C -
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 8
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 8 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: ASHRAM: Mechancial systems for addition to existing SF residence and change of use as a congregate residence.,
Owner: FEES
BRAHMAPREMANANDA ASHRAM /TEMPLE Description Date Amount
11515 SW HALL BLVD
TIGARD, OR 97223 [MECH] Permit Fee 11/4/03 $131.78
[TAX] 8% StateTax 11/4/03 $10.55
Phone: Total $142.33
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED INSPECTIONS
Phone: 503-453-4822 Mechanical lnsp
Cooling Unt lnsp
Reg #: LIC 62196 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 -00
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Issued By C lGi: l'�,Y�c�� Permittee Signature: It/
Call (503) 639 -4175 by 7:00 P.M. for inspections neede the next business day
A MechanicalPermit Application Date received: / 7 0� Permitno.:1/feAne (.iii,! .iE v.cp. �t'r 1 i A
11-1."411 City of Tigard Project/appl. no.: Expire date: •
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 �5 f j y� A Case file no.: Payment type:
Land use approval: Building permit no.:
- ` TYPE OF PERMIT : .
❑ l & 2 family dwelling or accessory 121 Commercial/industrial ❑ Multi family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION . , COMMERCIAL VALUATION' SCHEDULE
rdobtaddress: I IS 15 5 .11/4_1._ l_WP • 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.: 1 1 35 4:7a •
110 (�'d /'J -profit. Value $ .
Lot: (Block: Subdivision: *See checklist for important application information and
Project name: `• i t A '. . >,66, i c y risdiction's fee schedule for residential permit fee.
City /county: _ G rp ZIP: Q , .- — 'Z 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of 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: .
Is existing space heated or conditioned? ❑ Yes ❑ No Air c unit l CFM g
Air conditioning (site e p pll an required)
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
State boiler permit no.:
Business name: - . TIM/ / � HP Tons BTU /H
Address: Fire/smoke dampers/duct smoke detectors
City: State: I ZIP: Heat pump (site plan required)
Phone: I Fax: E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: Install /replace /relocate heaters - suspended,
City /metro lic. no.: 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 II/res. kitchen/hazmat
�'`
hood fire suppression system
Nam , 4r H M 4, I\c I ., M4 }J ci.4 7a A6 h FA M • Exhaust fan with single duct (bath fans)
i [Mailin addiesss :i j 1 . W- 4 4,- LL olio /.....•11: _ Exhaust system apart from heating or AC
7....._.
Fuel piping and distribution (up to 4 outlets)
< Ci� y - . I� I Stat° Z 2 _ Type: LPG NG Oil
Phone: =NO 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: e LFax: -mail: Woodstove/pellet stove
Other:
Applicarit's_`signature: ( t " 2 ate: Other:
Name (grin[ ANiti Acg ^ le-•OH .
Not all jurisdictions accept credit cards, please all jurisdiction for more information Permit fee
Notice: This permit application
❑ Visa CI MasterCard 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 %) .... $ / s
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL $ / ^ 3
Cardholder signature Amount 440 -4617 (6100/COM)
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MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
a 4 ' :.< f , ; Desciiption: . ''' • . -,a,, - ` ; % Price. Totaf
TOTALVALUATION . =PERMITk , • „
$1.00 to $5,000.00 Minimum fee $72.50 <TableAA °Mechanical Code. ;, .,;.. Qty ) •'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 ..Checknall that :apply:: -, , , . Boiler _- ''- Heat ;Air. _
.$1.20 for each additional $100.00 or For "items 7 -11 see , , or % Pump Conti - s
fraction thereof. =footnotes below ,.Comp
Minimum Permit Fee $72.50 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
2 5% Plan Review Fee (of subtotal) $ 9) 15-30 HP; absorb 35.00
Required for ALL commercial permits only unit .5 -1 mil BTU
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
12) Air handling unit to 10 CFM
ASSU M ED;;VALUgThONS;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 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust -
Vent not included in applicance 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: ,',..<4,.:! n.- ' ` �: $
>1.75 mil. BTU •. "` `;
( - Air handling unit to 10,000 cfm 656 8% St Surchar e = F ,1
Air handling unit >10,000 cfm 1,170 Surcharge
4 -;,i , ,: , . , NO
,e:,,.:'
evaporate cooler TOTAL RESIDENTIAL PERMIT FEE: Mt' ='r` $
(/ Vent fan connected to a single duct 5 446 656
a
_ � �
' : .. fly
Vent system not included in 656
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1,170 1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator $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 PP 9 I in 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.
` A/C requires site plan showing placement of unit.
TOTAL COMMERCIAL W :' 'g:t 1A,1, $
..
,VALUATION:. t A ll New Commercial Buildings require 2 sets of plans.
is \dsts \forms\mech- fees.doc 12/26/01
CITY OF TIGARD • 24 -Hour
BUILDING Inspection Line: (503 9 -4175
INSPECTION DIVISION Business Line: ( 3) 6417 MST
/ �s-7 BUP
Received Date Requested ( // � A PM BUP
Location / l ( uf Suite , 2- 006 / 3
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
•
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: /Q / SIT
. Post & Beam U J vl
(2 .4/1 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
r je)%'
Post & Beam •
Under Slab
Rough -In
Water Service •
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
L
Post& Beam
Rough -In
Gas Line
Dampers
4/11r0 PART FAIL
tip RICAL
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 ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA k VCR. (6
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
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