Permit YC I T OF TIGARD MECHANICAL PERMIT
4-h is DEVELOPMENT SERVICES PERMIT #: MEC2000 -00477
`�'�' 4 13125 SW H all Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/7/00
PARCEL: 1 S126C0 -00100
SITE ADDRESS: 09225 SW HALL BLVD E
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS: 1
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:
Remarks: Relocation of existing heating vents.
Owner: FEES
MENASHE, R BARRY Type By Date Amount Receipt
621 SW ALDER, STE 605 PRMT CTR 12/7/00 $72.50 2720000000
PORTLAND, OR 97205 5PCT CTR 12/7/00 $5.80 2720000000
Total $78.30
Phone:
Contractor:
TENANT
REQUIRED INSPECTIONS
Misc. Inspection
Phone: Final Inspection
Reg #: 4
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 , itfication Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR'952- 001 -0080.
You ay obtain copies of these-rul or direct questions to OUNC by calling (503)246 -9189.
Issue By: , , y�. Ki/ _/,j Permittee Signature: </ �,O/'a ,
Call (503) 639 - 75 by 7:00 P.M. for inspections needed the next business day
r Mechanical Permit Application
Date received: AA- 7-00 Permit no.: iyi / ao !/ 7
t^ _' - City of Tigard A al,L '1 � g Project/appl. no.: Expire date: •
CiryofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 .,,, p a o Va-7 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 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: 6q 2.2.5 $Lid H4(I 13Li'J9 Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: F value of all mechanical materials, equipment, labor, overhead,
4 T ax map /tax lot/account no.: profit. Value $
Lot: IBlock: I Subdivision: - *See checklist for important application information and
Project name: P.my,idi Dino •rat i pr4U2...4Ar jurisdiction's fee schedule for residential permit fee.
City /county: Tpd/ i tiff , ch I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
. Description and location of work on premises: re•dxah;/ at AND COMMERICAL/INDUSTRIAL EQUIPMENT SCHEDULE
e Y's &15 h¢417n)' tk #i rS Fee(en.) Total
Est. date of completion/inspection: ja - 27 -co - Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? Pk ❑ No Air handling unit CFM es
Air conditioning (site plan required)
Is existing space insulated ?Yes ❑ No Alteration of existing HVAC system I •
' MECHANICAL CONTRACTOR ' Boiler /compressors
Business name: ,Pt' =:Y1 _ t _ _ - -` _._State boiler permit no.:
•�� _ 21 YYl t HP Tons BTU /H
Address: g 7 .. �• ,4fc /7 � t> / " Fire /smoke dampers /duct smoke detectors
i City: rig-Ay/4_, State 22,I ZIP: ' 7a 23 Heat pump (site plan required)
Phone:51 . — f q e fc Fax: E -mail: Install/replace furnace/burner BTU /H
/ S Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: Install/replace/relocate heaters - suspended,
City /metro lie. no.: wall, or floor mounted
Name (please print): 5 - a t Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: c/Ake_ as rit 6h UL (Per i•t Di nd ar-_a4 zinr'' j 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 IUres. kitchen/hazmat
/ hood fire suppression system
Name: Ba 12 /Y) emeis h G Exhaust fan with single duct (bath fans)
Mailing address: 6,21 , j w ft /e. tr- i , f f� 06.5— Exhaust system from heating or AC
City: ►' f 1wt f I State:6/2 I ZIP: i 7 LQ,S Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: 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: I State: ZIP: Insert - type
Phone: I Fax: I E -mail: Woodstove /pellet stove
Other:
Applicant's signature: 1 In Date: 12-7-06 _Other:
Name (print): f kei • ► $p i, / _
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7o`' (]
CI Visa CI 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 %) .... $ ,61 r 0
Name of cardholder as shown on credit card accepted as complete.
$ J
!!1
TOTAL $ � d
Cardholder signature Amount 440 -4617 (6 /OO 1COM)
•
MECHANICAL PERMIT FEES �a.' 4.
,.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
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+ 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
$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 -1 1; See_ 4 ors "Pump :.Cond
footnoteStelo
fraction thereof. w: "'; :Cornp *Z '
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: ::. 4',, ,,: , °''' 0 :' $
Commercial or industrial incinerator 4,590 4 ' %, 4
Other unit, including wood stoves, 656 8% State Surcharge $
inserts, etc. ':�;�:'
Gas piping 1-4 outlets 360 . 25% Plan Review Fee (of subtotal) ;' ". y` = $
Each additional outlet 63 Required for ALL commercial permits only ;`4, „ ' #`k
TOTAL COMMERCIAL ' ,.. .. " = $ TOTAL RESIDENTIAL PERMIT FEE: ' < ,- $
s-ti;
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 (minimum
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.
is \dsts \forms\mech- fees.doc 10/11/00