Permit •
CIT OF TIGARD MECHANICAL PERMIT
iA DEVELOPMENT SERVICES PERMIT #: MEC2001 -00348
" ��' I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/4/01
PARCEL: 1 S135BD -01100
SITE ADDRESS: 09780 SW SHADY LN
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B 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
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
GAS OUTLETS: 1
> 10000 cfm:
Remarks: Replacement of rooftop HVAC unit and gas piping.
Owner: FEES
LEWIS, GLORIA M + Type By Date Amount Receipt
LEWIS, GLORIA M TRUSTEE + PRMT CTR 10/4/01 $72.50 2720010000
LEWIS, ANDREW M ET AL 5PCT CTR 10/4/01 $5.80 2720010000
PORTLAND, OR 97225
Total $78.30
Phone:
Contractor:
OREGON AIRE INC
7921 SW NIMBUS AVENUE
BEAVERTON, OR 97008 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 626 -2000 Mechanical Insp
Reg #: LIC 64235 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 Notific. '• Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952 -001 •.80. Yo ay ob• o••-s of these rules or direc • s ! - C by 91 'ng
(Rn�)7 • R -Q1RQ
einge •
// i// •Permittee Signature:
Issu: � ,�,i: /��� i/l
Call (503) 6 • -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application
Date received: AI y et/ Permit no.://ft,Tel-G034.
T el-G034.
im,.,-*
t j . •1�! City of Tigard Project/appl.no.: Expire date:
City ofTigard Address 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commerciallindustrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 7 Sk) • 40 y /i-Ke Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suit no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: lock: 'Subdivision: *See checklist for important application information and
Project name: 40y (.q e 6{ , 6 jurisdiction's fee schedule for residential permit fee.
City /county: / ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
D scrip and location of work on premises: ISC'4'_Ma AND COMMERICAL /INDUSTRIAL EQUIPMENTSCHEDULE
� C j v( it e e / 0 4c_ u ei t l 04-5 ,/ , 15 Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? ❑ Yes ❑ No
space insulated? 0 Yes ❑ No Air rati conditioning (site HVC s required)
Is existing P Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
State boiler permit no.: •
Business name: 0 _,R 454-- J I t- HP Tons BTU /H
, Address: 7 ? JAI 33 t2, Fire /smokedampers/duct smoke detectors
City:0 art p1 -, l 0 '. ' State: o 21 ZIP: 9 7 - Heat pump (site plan required)
Phon 3 - 36- - �a, 5 ^”' f ax: 33( 7j E -mail: Install/replace furnace/burner BTUJH
Including ductwork/vent liner ❑ Yes ❑ No
i CCB no.: C-/ RD � Install/replace/relocateheaters- suspended,
/ City /metro lic. no.: eD C.5/ wall, or floor mounted
l/ Name (please print): t C � /t
L(_ Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU /H
Name: I , JA_ L (__ Chillers _ HP
ress
Address: e"-- � 5 e U C Co ors HP
o mpress ental exhaust and ventilation:
City: J ' e: ' ZIP: Appliance vent
Phone: Fax: E - mail: Dryer exhaust
OWNER Hoods, Type I/ II/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: 'State: 'ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil /
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace
City: 1 State: 1 ZIP: Insert - type
Phone:
si nne: g Fax: E t tt tl I: ve/pellet stove
A
� ' Other:
Name (print): R ► C et L Other:
C�J ( Date: f D " y^ 9O —
_ •
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 7A 17 U
0 Visa 0 MasterCard Notice: This permit application Minimum fee $
Credit card number:
/ expires if a permit is not obtained Plan review (at %) $ •
Ex ires w ithin 180 days after it has been d
p State surcharge (8 %) .... $ �• g
Name of cardholder as shown on credit card accepte as complete. TOTAL $
i lAi& P
Cardholder signature Amount I 440-4617 (6J00/COM) til
MECHANICAL PERMIT FEES A.
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 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+
$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 induding vent 14.00
fraction thereof, to and induding 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
Minimum Permit Fee $72.50 SUBTOTAL: $ to 100K BTU 14.00
8) 3 -15 HP; absorb
8% State Surcharge $ unit 100k to 500k BTU 25.60
9) 15 -30 HP; absorb
25% Plan Review Fee (of subtotal) $ unit .5 -1 mil BTU 35.00
Required for ALL commercial permits only 10) 30 -50 HP; absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1 -1.75 mil BTU 52.20
11) >50HP: absorb
unit >1.75 mil BTU 87.20
12) Air handling unit to 10,000 CFM
ASSUMED VALUATIONS PER APPLIANCE: 10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, induding 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
101k 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 Other Inspections and Fees:
Hood served by mechanical exhaust 656 1. Inspections outside of normal business hours (minimum charge -two hours)
Domestic incinerator 1,170 $72.50 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 $72.50 per hour
3. Additional plan review required by changes, additions or revisions to plans (minimun
inserts, etc. charge -one -half hour) $72.50 per hour
Gas piping 1 outlets 360
Each additional outlet 63 "State Contractor Boiler Certification required for units >200k BTU.
"Residential NC requires site plan showing placement of unit.
TOTAL COMMERCIAL $
VALUATION:
is \dsts \forms\mech - fees.doc 08/06/01
.2 I-6
a GMs rn e
90 / "b a s Pp r c t - ��sp
3J t
L _____ Ex►sT/ NG R
u
T`/ g4i/
II � t
• 1 1
ii11--- 1 1
. RepLr-cc CrKpiew So Rcpoo4, /-{ekT f 0 - 3-1 his'
» H iv? c4 Al it E ot) ( G 4kSpre---k - ..s oS' t..bs
C pica t e2 ...c -T r GA -
T
glact YVrE one x /ST . / A/Cc- ReoF Top 1 vac L- A - yds.;
14.e �T 1 I5 o / od 1FP • - oggn y Z A-ne (Wee. 6 404 • q78 S w vGAo 691) )
C
oo L t 000 D 'V M
*CALL: AIIOVIM Ill IN
DRAWN El lilt PDS /a 30 J 0 OAT:: R<tlIRtO
�r°*C L.b 5' ,
`� e'ahT OREGONAIRE, INC.
y 7921 SW Nimbus Ave. Beaverton, OR 97005 ""wuw MU."
•Ir i 11 MOM ON MO. ~011•• A.1AwAl1IT IAO11•01"