Permit 9
- �~ CITY bF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2002 -00032
M�i DEVELOPMENT SERVICES DATE ISSUED: 1/16/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S115BC -09400
SITE ADDRESS: 16780 SW ROYALTY PKWY
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS: 1
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:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Installation of water heater electric to gas conversion.
Owner: FEES
BOHM, RUDOLPH L SR + RUBY W TR Type By Date Amount Receipt
16780 SW ROYALTY PKWY PRMT CTR 1/16/02 $72.50 2720020000
KING CITY, OR 97224 5PCT CTR 1/16/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 503 - 624 -4880 Final Inspection
Reg #: LIC 81837
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 -0080.
You may obtai copies of these rules or direct questions to OUNC by calling (503)246 -9189.
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Issue By: Permittee Signature: G 0
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
. - MechanikaIf ermit Application
Datereceived: -1(„ _ Y Permit no.: �f (� --e Z
''r:�� I City of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: U
Phone: (503) 639 -4171 Y f Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
& 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other:
JOB SITE INFORMATION CO!S1MERCIAL VALUATION SCIEDULE
Job address: /67 8v .5, L /Q 7 4 7 f G✓4 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: (Block: I Subdivision: *See checklist for important application information and
Project name: t G 0—Z, g„,,(..; jurisdiction's fee schedule for residential permit fee.
City /county: /c /mss C;(-7 I ZIP: 4 17 2-Lc! 1 & 2 FAMILY DWELLING PERMIT FII: SCHEDULE
Description and loca'Gon of work on premises: AND CO11MERICAL /INDUSTRIAL EQUIPiM ENT SCIIEDULE
Al lef loYi v- £( G4+ i_c_ -/moo 6 As Fee (en.) 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? 0 Yes 0 No Air handling unit CFM
Air conditioning (site plan required)
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system
Boiler /compressors
Business name: State boiler permit no.:
Q r V �� pZU'^^ �' )'� t'+ �- HP Tons BTU/H
Address: e. 0. (2 c 2 35 gS Fire /smoke dampers/duct smoke detectors
City: T .4...--A I State: I ZIP: Heat pump (site plan required)
Phone: (cZY I Fax: �2Y /�3I E -mail:
III/replacefurnace/burner BTU /H
�' n Including ductwork/vent liner 0 Yes O No
CCB no.: 2/ Q 3 Install/replace/relocate heaters - suspended,
City /metro lic. no.: t: i r/ — Ti g a ,,, ( a 6 0 3 wall, or floor mounted
Name (please print): ! iV Vent fora fiance other than furnace by hf'
Re era on:
Absorption units BTU/H
Name: W / E3v7 jN e- - Chillers HP
Address: l Compressors HP
/� Environmental exhaust and ventilation:
City: - , vi I State: I ZIP: Appliance vent
Phone: ' Fax: - E -mail: Dryerexhaust
Hoods, Type Il/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust s stem apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets) I
K
Type: LPG NG Oil
Phone: Fax: E - mail: Fuel i ing each additional over 4 outlets
rocess p p g (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorativefireplace
City: I State: I ZIP: Insert - type
Phone: I Fax: I E -mail: Woodstovelpelletstove
Other:
Applicant's signature: . I Date: Other
Name (print):
Sri
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7d`•
0 Visa 0 MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Plan review
Cred;t card number: E withi 180 days after it has been ( at % ) $
Expires State surcharge (8%) .... $ S _ g 4
Name of cardholder as shown on credit card $ accepted as complete. TOTAL $ g • 3
Cardholder signature Amount 440 -4617 (MIOICOM)
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MECHANICAL PERMIT FEES -
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: Description: Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Oty (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+
$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 Check all that apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see or Pump Co d
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
25% Plan Review Fee (of subtotal 9) 15-30 HP; absorb
$
Required for ALL commercial permits only unit .5 1 mil BTU 35.00
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20
unit 1 -1.75 mil BTU ,
11) >50HP; absorb
unit >1.75 mil BTU 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12) Air handling unit to 10,000 CFM 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 18) Domestic incinerators
Repair units 805 17.40
< 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
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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: $
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge $
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not included in 656
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator 1,170 $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 piping 1 - 4 outlets 360 charge- one -half hour) $62.50 per hour
Each additional outlet 63 *State Contractor Boller Certification required for units >200k BTU.
TOTAL COMMERCIAL $ **Residential NC requires site plan showing placement of unit.
VALUATION:. All New Commercial Buildings require 2 sets of plans.
is \dsts\forms\mech - fees.doc 12/26/01
01/16/2002 15:55 5036393771 CITY OF KING CITY PAGE 02/02
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KING CITY
II&
15200 S.W. 116th Avenue, King City, Oregon 9'7 4 -2693
mon■now Phone: (503) 639.4082 • FAX (603)639-3771
Notice To Contractors Working In King City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King City are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff. The King City staff will
collect all fees and fax the application to the City of Tigard_ City of Tigard staff will then a eate
the permit, issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is ready for issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returned to King City staff for correction and no processing will occur until a ;
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicating land,use approval.
Take this signed form to the City of Tigard Development Services Counter located at 1312 SW
Hall Blvd. Tigard, to submit applications and plans. Development Services Technicians are:
available 639 -4171 Ext. 304 should you have any questions concerning submittal . •
requirements. All permit fees will be assessed and collected at the City of Tigard.
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The City of King City hereby authorizes applicant to pursue permits at the City of Tigard
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Building Department for the following ro ect: ch
P j n+ . ,0,,� 0i1,
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&AYE 7
located at: 1(970 5•0 710 '1�+� ( .
King City Representative 1 /4;-4I
I DSTS'KCINST DOC