Permit -.d
.„,
CITY OF TIGARD MECHANICAL PERMIT
I. DEVELOPMENT SERVICES PERMIT #: MEC2001 00210
-- - -, 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/14/2001
PARCEL: 2S 109BA -06900
SITE ADDRESS: 13874 SW LEAH TERR
SUBDIVISION: HILLSHIRE SUMMIT NO. 2 ZONING: R -7
BLOCK: LOT: 055 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of furnace for hot tub.
Owner: FEES
NAEGELI, JOHN F + DIANA M Type By Date Amount Receipt
13874 SW LEAH TERR PRMT CTR 06/14/20C $72.50 2720010000
TIGARD, OR 97224 5PCT CTR 06/14/20C $5.80 2720010000
Total $78.30
Phone:
Contractor:
OWNER
REQUIRED INSPECTIONS
Mechanical Insp
Phone: Final Inspection
Reg #:
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 - 00
You may obta>0 opies of these, ules or direct questions to OUNC by calling (503)246 -9189.
/
Issue By: A , ` , / ' Permittee Signature: Qe1y l� ,�fAi
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Application
Date received: , y O 1 Permit no. `2W 7 -.0 /Q
Alo.
�' �'l i C ity of Tigard
`, g Projec t/appl. no.: Expire date:
City of Tigard Address 13125 SW Hall Blvd, Tigard OR 97223 Dateissued: By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Paymenttype:
Land use approval: Building permit no.:
TYPE OF PERMIT •
& 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction �,Additio r alte ration rep'. cement 0 Other:
JOB SITE INFORMATION ' COMMERCIAL VALUATION SCHEDULE
Job address: 1,3 a , 7 1 5 W L.-1 -0 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: jurisdiction's fee schedule for residential permit fee.
City /county: 'T1411 Q p I ZIP: 7 12,,c 1 & 2 FAMILY DWELLING PERMIT[' F 0 SCHEDULE -
Description and location of work on premises: AND COMMERICAL(INDUSTRIAL EQUIPII ENTSCHEDULE
S PY+ Fee(ea.) Total
Est. date of completion/inspection: A U G / Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? 0 Yes 0 No
Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
MECHANICAL CONTRACTOR ' Boiler /compressors
Business name: c, V(, /V ,,„ ( . State boiler permit no.:
BTU /H
Address: Fire/smoke dampers /duct smoke detectors
City: State: ZIP: mp (site lan required)
Phone: Fax: E- mail: I l efurnace/b rner /d6 BTU /H I
Including ducrwtlrK✓vent liner 0 Yes O 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
O %VNER Hoods, Type U II/res. kitchen/hazmat
N N
- \ hood fire suppression system
,. L4
Name: t'_ i % L t Exhaust fan with single duct (bath fans)
Mailing address: 1 3 Q 7 4 -S tAi L-S-A. (-,i. Exhaust system apart from heating or AC
City: I State:c9 Q. I ZIP: ri -r �L
Fuel piping and p d Oil
(up to 4 outlets)
Y `t° i ts, i4 4� Type:
' Phone: SO 140 - el ax: E - mail: Fuel piping each additional over 4 outlets 1 '
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace _
City: • I State: I ZIP: Insert - type
Phone: I Fax: I E -mail: Woodstove/pelletstove
Other:
Applicant's signatur l ...(►. Date: 6 1 1J f Other: ,
Name (print): X o (4 N /V 4-1e-er dat_
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 1 �/�
❑ Visa ❑- MasterCard Notice: This permit application Minimum fee $
Credit card number:
/ / expires if a permit`is not bbtaiii d Plan review (at %) $ .J KU
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete. TOTAL $ �TJ 3 0 . • $
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
Table 1A Mechanical Code CRY (Ea) Amt
$1.00 to $5,000.00 Minimum fee $72.50 1) Furnace •to 100,000 BTU
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and including ducts & vents 14.00
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
fraction thereof, to and including 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 Check4all that apply`.,. -; , Heat . Air,. _ ' ,_ ,
$1.20 for each additional $100.00 or For =11, ,See': , s' or. ., . , Pump, • ' ' ;,.
fraction thereof. ' footr i otes 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 induding 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
Air handling unit to 10,000 cfm 656 19) Commercial or industrial type incinerator 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: ;:e 7 . '_ " ' $
Commercial or industrial incinerator 4,590 .
Other unit, including wood stoves, 656 8% State Surcharge $. - •, - ,' ;', - , $
inserts, etc. -a
Gas piping 1-4 outlets 360 - 25% Plan Review Fee (of subtotal) '` < ''' " $
Each additional outlet 63 ,..`4,-; - Required for ALL commercial permits only ', ° - ' "
TOTAL COMMERCIAL TOTAL RESIDENTIAL PERMIT FEE: i;� ''' > $
VALUATION: -,2',,,: -
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 Boller 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
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