Permit CITY TIGARD MECHANICAL PERMIT
'k DEVELOPMENT SERVICES PERMIT #: MEC2000 -00440
`- r �' I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/6/00
PARCEL: 2S 110BA -05300
SITE ADDRESS: 11815 SW WILDWOOD ST
SUBDIVISION: SHADOW HILLS ZONING: R -2
BLOCK: LOT: 012 JURISDICTION: TIG
CLASS OF WORK: OTR 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:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: 1
> 10000 cfm: GAS OUTLETS: 1
Remarks: Installation of natural gas insert and associated gas piping.
Owner: FEES •
SIBLEY, BARBARA D • Type By Date Amount Receipt .,
11815 SW WILDWOOD ST PRMT CTR 11/6/00 - $72.50 2720000000
TIGARD, OR 97224 • 5PCT CTR 11/6/00 $5.80 2720000000
Total $78.30
Phone:
Contractor:
LUDEMAN'S FIREPLACE + PATIO,
12675 SW BEAVERDAM RD '
BEAVERTON, OR 97005 -2129 REQUIRED INSPECTIONS
Gas Line Insp
Phone: 646 -6409 Mechanical lnsp
Reg #: LIC 51469 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 No • ' • ' 'on Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You m obtain
co i of these rules or direct questions to OUNC by calling (503 46 -9189.
Issue Permittee Signature: _444 _age -,02
ej-
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next b iness day
136
.._
Mechanical Permit Application
,_ 4
t� 7 Date received: / / -5 -00 Permit no::ifg - 005/9
,4,�1' City of Tigard RE Project/appl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 972Z� ® ® Date issued: By:H�1 /C.I Receiptno.:
Phone: (503) 639 -4171 AN
Fax: (503) 598 -1960 �� O Z Case file no.: Payment type:
Land use approval: `O � A ��N�� Building permit no.:
TYPE OF PERMIT
I & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
" ❑New construction ► • ddition/alteration/replacement U Other.
JOB SITE INFORMATION COi liV1ERCIAL VALUATION SCHEDULE
Job address: jly����� Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: 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: '5` / / jurisdiction's fee schedule for residential permit fee:
City/county: if . ( 6 ZIP: 0 - 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMM ERICAL/INMISTRIAL EQUIPMENTSCITEDULE
/A) J&& (J Ji t.S7 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? 0 Yes 0 No - Air conditioning (site plan required) • • - - - • -
Is existing space insulated? 0 Yes 0 No Alteration of existing HVAC system _ .
MECIIANICAL CONTRACTOR Boiler /compressors __ _ -._ ,_.__... .. -, - . -. - . _ . _ _
Business name: _ ,D� . 'S Q ,E� � ' ?Apo State boiler permit no.:
'/ HP Tons BTUM - -_
Address: 2'('J q5 j ,, e / ' f : ' /et .. . , Fue/smoke dampers/duct smoke detectors E
City: , , s. ! G,.%1A State: I ! ZIP: o mi 5 ■. ■ ... frPrITIIIIIIMINII=
Phone j 3 ( -4t/o/ F: o r 3-6 -$, r mail: ns . rep ace furna • umer BT
� _ oZ$ 3 �_ Including ductwork /vent liner 0 Yes O No
CCB no.
5 ) Install/replace/relocate heaters -suspended,
City/metro lic. no.: wall, or floor mounted
Name (please print): 4 let D6'..14 I Vent for a . • fiance other than furnace
CONTACT PERSON °n •
Absorption units BTU/H
/ 1 rs� � Chillers HP
Address: Co • 'tenors HP
Fn 1 . nmental exhaust and ventilation:
City: State: ZIP: - Appliance vent
Phone: Fax: E -mail: • -- " Dryer exhaust -
r__ _ t1f�FLit� = y. -_ Toods,Type► res. 'tc -e a� .t
� hood fire suppression system
Name: S �' T � Exhaust fan with single duct (bath fans) -
Mailing address: s t )/) Exhausts stem .. art from heating or AC .
� , litr `� L �_ 0. o_ , e pp ,: an .T 5 ∎ , .on up ou ets 5,4/0 e State: ZIP. 'Type: LPG NG Oil
Phone:5 , 03 al Fax: E-mail: - Fuel .1. ing each additional over 4 outlets
ENGINEER p p (schematic required) Mill s e: Number of outlets
Iiiiiir Other listed appliance or equipment:
- Decorative fireplace
- ... - _. - _ State: ZIP: - . Insert -type l U111111111 0 . •00
one: Fax: ail: oodstove/pelletstove• ,.: III:1111111
-- = - - -gar _ =, a ' : AO 3000 O Other.
er: --
Nam f Not Qia
all juriaioos accept - -..t . • , please call juri rare information Permit fee $ i 5",q0-
O Visa 0 MasterCard Notice: This permit application Minimum fee $ 72_ 3
Credit card nmnber / / expires if a permit is not obtained Plan review (at _ %) $ .
Expires within 180 days after it has been State surcharge (8%) .... $ .
of cardholder as shown on credit card accepted as complete.
$ TOTAL $ '711
Cardholder signature Amount ., 440.4617 (6100/COM)
• MECHANICAL PERMIT FEES
- COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING 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+
$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 j 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
ASSUMED VALUATIONS S PER APPLIANCE: to 100K BT;1 _ - t , y _ 14.00
8) 3-15 HP; adsorb
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
Furnace > 100,000 BTU including 1,170 10) 30-50 HP; absorb
ducts & vents unit 1 -1.75 mil BTU 52.20
11) >50HP: absorb
Floor furnace including vent 955
unit >1.75 mil BTU 87.20
Suspended heater, wall heater or - 955
floor mounted heater 12) Air handling unit to 10,000 CFM
Vent not included in applicance 445 10.00
13) Air handling unit 10,000 CFM+
permit
17.20
Repair units 805
< 3 hp; absorb. unit, 955 14) Non - portable evaporate cooler
to 100k BTU • 10.00
15) Vent fan connected to a single duct
3-15 hp; absorb. unit, 1,700 6.80
101k to 500k BTU
15-30 hp; absorb. unit, 501k to 1 2,310 16) Ventilation system not included In
mil. BTU appliance permit 10.00
30-50 hp; absorb. unit 3.400 17) Hood served by mechanical exhaust
1 -1.75 mil. BTU 10.00
18) Domestic incinerators
>50 hp; absorb. unit, 5,725 17.40
Air >1.75
handling mil. BTU 19) Commercial or industrial type incinerator
Air handling unit to 10,000 dm 656 69.95
Air handling unit >10,000 cfm 1,170 20) Other units, Including wood did stoves
Non-portable evaporate cooler 656 X 10.00 • 6-11 Vent fan connected to a single duct 446
21) Gas piping one to four outlets r'-' Vent system not included in 656 / - 5.40 D- , 7Q
appliance permit
Hood served by mechanical exhaust 656 22) More than 4-per outlet (each) V. 1.00
Domestic incinerator 1,170 Minimum Permit Fee $72.50 SUBTOTAL:
Commercial or industrial incinerator 4,590 • `�'`' $ 7P.5a
O eer unit, i ncluding wood stoves, 656 8% State Surcharge " _ $
Gas piping 1-4 outlets 360
Each additional outlet 63 25% Plan Review Fee (of subtotal) $
Required for ALL commercial permits only, d-
TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: • ;: :- S." 30
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 NC requires site plan showing placement of unit.
iNdsts\formslmech- fees.doc 10/11/00