Permit C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2003 -00158
.. 13125 SW Hall Blvd., T igard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/1/03
PARCEL: 2S104DA -20100
SITE ADDRESS: 13088 SW PRINCETON LN
SUBDIVISION: QUAIL HOLLOW - SOUTH ZONING: R -4.5
BLOCK: LOT: 027 JURISDICTION: TIG
CLASS OF WORK: NEW 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:
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: GAS OUTLETS:
> 10000 cfm:
Remarks: Installation of gas fireplace insert.
Owner: FEES
BROWNSTONE QUAIL HOLLOW LLC Description Date Amount
12670 SW 68TH PKWY STE 200 [MECH] Permit Fee 4/1/03 $72.50
PORTLAND, OR 97223 [TAX] 8% StateTax 4/1/03 $5.80
Phone: 503 - 598 - 7565 Total $78.30
Contractor:
THERMOTECH
26716 S. BOLLAND RD.
CANBY, OR 97013 REQUIRED INSPECTIONS
Phone: 503 - 263 - 8900 Mechanical Insp
Final Inspection
Reg #: LIC 118695
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
P, Issued By: Permittee Signature
• Call (503) 639 -4175 by 7:00 P.M. for inspections need-d - next business day
Mechanical PernitEC61iiittOn FOR OFFICE USE ONLY
echanical
R D e a c te/B eive y d : ii///0-5 mechanical
No.:Haws -
City of Tigard APR 0 1 2003 Planning Approval
Date/By: Build
CITY ing
Permit No.:
13125 SW Hall Blvd. Plan Review • Other
Tigard, Oregon 97223 BUILDiN OF TIGAR r) an ivic . Date/By: Permit No.:
Phone: 503-639-4171 Fax 503-598-1761V " '`-' w k Post Land Use
Al* 0,,,,,0: ,i r, Date/By: Case No.:
Internet: www.ci.tigard.or.us 14 Contact uris.: El See Page 2 for
24-hour Inspection Request: 503-639-4175 ''" Name/Method: ( 7/) Information.
. - - ' ,, '„; . y , TYPE-OF r, .., , ::,-,:.;;:, .. . - ''.COMMERCIALFEE* SCHEDULE - USE CHECKLIST ', .. 4..
El New construction 111 Demolition Mechanical permit fees* are based on the total value of the work
Iii Addition/alteration/replacement 0 Other: performed. Indicate the value (rounded to the nearest dollar) of all •
- ; , CATEGORY OF CONSTRUCTION - -
mechanical materials, equipment, labor, overhead and profit.
: ' ^ • : ' !. , '
ri 1 & 2-Family dwelling 0 Commercial/Industrial Value: $ See Page 2 for Fee Schedule
El Accessory Building 0 Multi-Family - EQUIPMENT/SYSTEMS FEE* SCHEDULE'
Description - I Qty I Fee(ea.) I Total
0 Master Builder 0 Other: Heating/Cooling
JOB SITE INFORMATION and LOCATI \ ION ` ' Furnace - add-on air conditioning _ 14.00
Job site address: I 9:)•31. -51-4) 0.4 tjr-OON-) Gas heat pump 14.00
Suite #: I Mai:1M Duct work 14.00
Hydronic hot water system 14.00
Project Name: & Q 14t1_ cc-) - ,S 777( Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in-duct, suspended, etc.) 14.00
L 1464.04.) Lot #: 21 Repair Other Fuel Appliances
11)41, Flue/vent (for any of above)
units 10.00
Subdivision:
12.15
4
Tax map/parcel : Water heater 10.00
DESCRIPTION OF WORK - 1 Gas fireplace / - 10.00
Flue vent (water heater/gas fireplace) 10.00
-wr fp 'pr;•- fir, Fr r r , f Log lighter (gas) 10.00
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
Iii:pROPERTY ' WNER` Ai. 1DTENANT4 • - Other: 10.00
Islame: 1 2 U.0 , ... Environmental Exhaust &
Range hood/other kitchen equipment moo
Address: /A Z 70 stj 6 /P-' /7ez.Jy ,
Clothes dryer exhaust io.00
City/State/Zip :irook 77,9-A/6 trAs i7A,Z..7 Single duct exhaust .
Phone: Sf - IS 6.,5 Fax: (bathrooms, toilet compartments,
0 APPLICANT 1 _ _ , 0 CONTACT PERSON - ' utility rooms) 6.80
Name: Attic/crawl space fans 10.00
Other: 10.00 ,• C Fuel Piping Address: _ , .
City/State/Zip: _ **($5.40 for first 4, $1.00 each additional)
**
Phone: I Fax: _ Furnace, etc.
Gas heat pump **
E-mail: - Wall/suspended/unit heater **
, . .. , ..,
', .. '..: `;. '. - ' • Name: CeITR `,":'-''" 'i. ' Water heater ,_ •
Business Ne: ---1- Fireplace lit **
_
Address: at 6 74, S., A d 4,44--Ano AZ Range **
-
BBQ **
City/State/Zip: - 6 y, DA- 9 7o/....? Clothes dryer (gas) **
a _ .
Phone: ,,, e,...? —4' - 00 ] Fax: Other: *5
CCB Lic. #: //ePp—,C Total:
Authorized t atiii /5 . Me Permit Fees*
Signature: / Ii Date: Subtotal: $
-
Minimum Permit Fee $72.50 _ $ 7..Z. .5
Plan Review Fee (25% of Permit Fee) _ $ ,
(Please print name) State Surcharge (8% of Permit Fee) $ -5 " , PO
TOTAL PERMIT FEE $ 24', 3 6
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri-County Building Industry Service Board.
180 days afterlt ha i been accepted as complete.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard -
Page 2 - Supplemental Information
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.
:Assumed 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: -
is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03
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