Permit CITY TI GARD MECHANICAL PERMIT
I DEVELOPMENT SERVICES PERMIT #: MEC2004 -00037
cal I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/20/04
PARCEL: 1S135BD-01200
SITE ADDRESS: 09802 SW SHADY LN
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS: 3
OCCUPANCY GRP: A3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 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: 1 AIR ANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: 0 GAS OUTLETS:
> 10000 cfm:
Remarks: HVAC for TI.Rooftop unit & 3 exhaust fans, $4250.00 valuation.
Owner: FEES
FORBES, DONALD CAROLYN Description Date Amount
BURDICK, DONALD LINDA [MECH] Permit Fee 2/20/04 $72.50
LAA KE E OSWEGO, OR 97034
434 O RD [MECPLN] Plan Rev 2/20/04 $18.13
[TAX] 8% State Surchart 2/20/04 $5.80
Phone: Total $96.43
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 692 - 1565
Mechanical Insp
Reg #: LIC 5193 Heating Unt Insp
Duct Inspection
Final Inspection
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
Issued By: (1„n Permittee Signature:
Call (03) 639 -4175 by 7:00 P.M. for inspections needed the next business day
98oz S w S#,sor 44N6
FOR OFFICE USE ONLY
Mechanical Per lit', •z 1 i 1 1 M1 Received 2 Mechanical _',,,
/NGNW YOU SQ1r, Date/By: / — • (� 1 7V 'I�
Permit No. 0e -Vi" - OGv3 7
Planning Approval Building
City of Tigard JAN 30 200 Date/By: Permit No. ; �(��r}c,O —007&) k
13125 SW Hall Blvd. Plan Revi w Other
Tigard, Oregon 97223 CITY OF TIG' ' 0 Date/By: /9 O S I Permit No.:
Phone: 503- 639 -4171 Fax: 50teftlgiSM DI 4 1 13.,`. Post- Review Land Use
��e 1 � 1 ( C ontact Case No.:
No , ®
Internet: www.ci.tigard.oi.us ■ r.! Contact Juris.: See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 - _� Name/Method: Supplemental Information.
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
IN Addition/alteration /replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
CATEGORY OF CONSTRUCTION mechanical materials, equipment, labor, overhead and profit.
❑ 1 & 2- Family dwelling ii Commercial/Industrial Value: $ 4 Z.50 ..--‘ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* SCHEDULE
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
JOB SITE INFORMATION and LOCATION Furnace - add - air conditioning ** 14.00
Job site address: 91OZ S W SPA AY L4148 Gas heat pump 14.00
Suite #: Bldg. /Apt. #: Duct work 14.00
Project Name: ME W Yo 2 e— S u G.S Hydronic hot water system 14.00
R esidential boiler "" O
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 1,
Flue /vent (for any of above) 10.00
Subdivision: I Lot #: Repair units 12.15
Other Fuel Appliances
Tax map /parcel #: Water heater 10.00
• DESCRIPTION OF WORK Gas fireplace 10.00
0
/JVS -iA'C( ') (, o0F76P 6(14 P.G� DucT watt Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
f-'11 ' Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
® 'PROtER-TYlOWNER : • 1 ® TENANT Other: 10.00
Name : Vat le SUES Environmental Exhaust & Ventilation
Range hood/other kitchen equipment 10.00
Address: 1K S W S Z-? P bu L f) ,x16 Clothes dryer exhaust 10.00
City /State /Zip: 'it 6 (A a L n Single duct exhaust
Phone: Fax: (bathrooms, toilet compartments,
' D MPP,LICANT ® CONTACT PERSON utility rooms) 6.80
Name: 7A 14 RoAc (-.? Attic /crawl space fans 10.00
Other: 10.00
Address: 13 3 6 W TX, P4 L P i� p ' ( Fuel Piping
!
City /State /Zip: T41 pr., n-lre (,\R ri n 6 z„ * *($5.40 for first 4, $1.00 each additional)
Phone: .5-Q3 ( ® q Z`I ,s[ns I Pax: 4 . Q3 . gI — / $ ig Furnace, etc. **
Gas heat pump
E -mail: Wall/suspended/unit heater *•
CONTRACTOR Water heater *5
Business Name: fid ?? I. 1/i Mee (,' I) ;PC / Fireplace **
Address: ) D 3 3 0 S (!J T tA is c, 41 7.® Ai, k d ri VI Range a*
City /State /Zip: 77A a 1, Iq 7- `I op_ r' 70 6 ?.< Clothes dryer (gas) **
Phone: SC 6,4 2 - /S"6 ( Fax: 3793 G, / -/ F79 Other: **
,
CCB Lic. #: O 5 I pQ13 Total:
M ec h an i cal Permit Fees*
Authorized
� I f / Subtotal: $
Signature: / �� ;:� f, f ro- Dater '� Minimum Permit Fee $72.50 $ 71.,�d
J m $S D4 t4( ve. `tit, r Plan Review Fee (25% of Permit Fee) $ is . /3
(Please print name) State Surcharge (8% of Permit Fee) $ 3
TOTAL PERMIT FEE $ s g . 403
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information i 4 �' p � 4 x '
•
Commercial Fee Schedule: ' - .�;, i
Total Valuation: • Permit Fee: , , ; I
$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 Valuations 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 I-4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION:
is \Dsts\Permit Forms\MecPermitAppPg2.doc 01/03
. 7650 SW Beveland St., Suite 100
M 1� 'TM RIPPEY Tigard, Oregon 97223
1Z CONSULTING ENDS Phone: (503) 443 -3900
Fax: (5
LLD 1 i
LETTER OF TRANSMITTAL
1 g FEB 1 a 26114
Date: February 11, 2004 Project Number: 4051
To: Arrow Mechanical Co.
10330 SW Tualatin Road
Tualatin, OR 97062
Attn: Dan Roach
Project Name: New York Subs - Mechanical Units
Enclosed: Plans Shop Drawings
X Calculations Specifications
Details Copy of Letter
X Other
Number of Copies: Description:
1 Set Sketches and General Notes
1 Set Structural Calculations
X For Your Use For Your Review
For Your Approval As Requested
Remarks: Copy of Sketches and General Notes faxed 2/11/04
Copy to: Mark Hemmingson, Hemmingson Construction
Signed: Brent Cornelison
��
X Mailed City of Tigard
Delivered Approved Plans
To be picked up v Pig Date Z-114 �f
/� �
OFFICE \TM�2I.TR.FRM /I t c z — DOo 37
1902- 5 w fy4D' cam!