Permit A CITY OF T I GA R D MECHANICAL PERMIT
' aw DEVELOPMENT SERVICES PERMIT #: MEC2000 -00410
A. '� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/19/00
PARCEL: 1 S134BC -00300
SITE ADDRESS: 12286 SW SCHOLLS FERRY RD
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM 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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: < =10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS:
Remarks: Refrigeration unit. - Welkin Cooler
Owner: FEES
BURNHAM PACIFIC Type By Date Amount Receipt
10135 SE SUNNYSIDE RD PRMT CTR 10/19/00 $72.50 2720000000
SUITE 250 5PCT CTR 10/19/00 $5.80 2720000000
CLACKAMAS, OR 97015 PLCK CTR 10/19/00 $18.13 2720000000
Phone: Total $96.43
Contractor:
COMMERCIAL REFRIGERATION INC
5920 SE GLISAN STREET
PORTLAND, OR 972133790 REQUIRED INSPECTIONS
Mechanical lnsp
Phone: 234 -6445 Final Inspection
Reg #: LIC 65271
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 m 1 tf :1 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utili Notification C- ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
Yo may obtain copi - of to rules or direct questions to OUNC b car'g (503) 6 -9189.
Iss a By: ' ��dL _! ! Permittee Signature: K- (() /Il`
Call (503) 639 -4175 by 7:00 P.M. for inspections needed a next bu mess day
Or e c4"" `e1t7l`b
Mechanical Permit Application
. � 4, Date received: /61•4-00 Permit no.: /f A900 -- p0 0
3yJ � ' ' ;• �� � Cit of Ti Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: 6316 Receiptno.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
0 1 & 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 COMMERCIAL VALUATION SCHEDULE
•
Job address: k 2 ?( 9. (j 5 c /AOG S ieu' V 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: (Block: I Subdi 'See checklist for important application information and
Project name: `3(}a F 5� jurisdiction's fee schedule for residential permit fee.
City /county: 'Trl' o I ZIP: I & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICALIINDUSTRIAL EQUIP'S ENTSCIIEDULE
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? 0 Yes 0 No Air handling unit CFM
space insulated? 0 Yes 0 No Air conditioning rata n of xi (site plan required) y
Is existing P Alteration of existing HVAC system
M [CI IAN I CAL CONTRACTOR Boiler /compressors
: Optitett ce' '' FA-Ira-WO 'cif./ HP Tons BTU/H
State boiler permit no.:
Business name
R V
Address: �O /. (- L t •sA /( - J Fire/smoke dampers/duct smoke detectors
City. .,r IRj r Staten ZIPq 72/ 3 Heat pump (site plan required)
Phone: • ' � E - mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner 0 Yes ❑ No
CCB no.: 65 / Install /replace/relocate heaters - suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): , e /Lot e CO ( 1 G /. Vent for appliance other than furnace
CONTACT PERSON etrtgerahon: __
Absorption units BTU/H
Name: Q2lt- / a Co MAI C:/� Chillers HP
Address: j`q2 ) 4.) (54 Compressors 3 HP
r , Environmental exhaust and ventilation:
City: Y �L� O , I State: I ZIP: q 7.2 / L Appliance vent _
Phone: - 4, (7 Fax: —t9 ' - mail: Dryer exhaust
OWNER Hoods, Type U Illres. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
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 signature: I Date: Other:
Name (print): n
Not all jurisdictions accept credit cards, please call jurisdiction for more informations Permit fee $ /,
Notice: This permit application Minimum fee $ p l
❑ Visa ❑ MasterCard b
Credit card number: / / expires if a permit is not obtained Plan review (at %) $ ,
Expires within 180 days after it has been State surcharge (8 %) .... $ f "/
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440-4617 (6/00/COM)
k
MECHANICAL PERMIT FEES
G FEE SCHEDULE
1 & 2 FAMILY DWELLING COMMERCIAL 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 -11, see or Pump Cond
_ fraction thereof. footnotes 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 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: $
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656 8% State Surcharge $
inserts, etc.
Gas piping 1-4 outlets 360 25% Plan Review Fee (of subtotal) $
Each additional outlet 63 Required for ALL commercial permits only
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $
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