Permit CITY TIGARD MECHANICAL PERMIT
PERMIT #: MEC2001 -00013
ik;��y� DEVELOPMENT SERVICES DATE ISSUED: 1/17/01
=`y 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 110BA -07400
SITE ADDRESS: 12195 SW WILDWOOD ST
SUBDIVISION: SHADOW HILLS NO.2 ZONING: R -2
BLOCK: LOT: 059 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
GAS 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: Replace heater with like kind
Owner: FEES
MERCER, DANIEL E/BETTY M Type By Date Amount Receipt
12195 SW WILDWOOD ST PRMT CTR 1/17/01 $72.50 2720010000
PORTLAND, OR 97224 5PCT CTR 1/17/01 $5.80 2720010000
Total $78.30
Phone: -
Contractor:
REQUIRED INSPECTIONS
Gas Line Insp
Phone: Mechanical Insp
Reg #: Final Inspection
EXPIRED
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 obtain copies of these rules or direct questions to OUNC by calling (503)246 -9189.
Issue By: ` Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
A il• Mechanical Permit Application
. Date received: 1-� 0 I Permit -, �.OD /- DOD / �,
Y 'I'I , � Ci of Tigard ' � g Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
I VP1. OF PI RiIIIT '
& 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Other:
.1011 SITE INFORi\IATION COMMERCIA1. VALUATION SCHEDULE
Job address: /2195 , (,,) L ; (cktiooc 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: Subdivision: 'See checklist for important application information and
Project name: o , dr_rLc_ jurisdiction's fee schedule for residential permit fee.
City /county: T'; • ZIP: - a I & 2FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COili\IERICA1.IlNDUSTRIAL EQUIPMIENfSCHEDULE
' • • "^1 1 Ke 1C1 4 Fee(ea.) Total
Est. date of completion/inspection: Descai on El Res.only Res.only
Tenant improvement or change of use: H C: ■ _-
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 o existing HVAC system
N1F:CI1AN1( ;AL CON'I'ItA(,f St Boiler/compressors
te e 1pre
boiler permit no.:
,■■
Business name: State boiler
HP Tons BTU/H
Address: 3'1 8 S born∎ t`\C . (1 Fire/smo a dampers/duct smoke detectors -
City: (3 r• State" o ZIP.1 00 5 Heat pump (site plan required) -
Phone: b
nsta ing ace tuna -rser BT H ■ --
`t3 - 5 5 3 5 Fax: E -mail: Including ace rn- ductwork/vent liner 0 Yes 0 No
CCB no.: 1 b
Install/repla relocateheaters- suspended,
City/metro lic. no.: --/ 3 wall, or floor mounted 14 .DO
Name (please print): 1*" 2 (1 Vent fora ..fiance other than furnace MN
CON "I ACI PERSON b = . ■ --
Absorption units BTU/H
Name: S her Chillers HP
Co i.ressors HP _
Address: I 398 5' Sul a ✓.nn■ no i-On
City: s ✓J Stay. d ZIP: D' amen : e : ust as ven on: ■ --
1 C • Appliance vent
Phone: ,' 3 , 55 3 5 Fax: E-mail: Dryer exhaust =
OWNER Hoods, Type lUres. 'tchen/hazmat ■ __
� me cc. hood fire suppression system
Name: Exhaust fan with single duct (bath fans) -
Mailing address: 1 c\ 5 S LLD 10 l 1 61 Lt-DtxCI St r Exhausts stem a. art from heating or AC =
StateO ZIP: 6 1 aaq 'e pp .: an .17 ; b. on up to • ou ets e - 5'8U
Phone: Type: LPG I NG Oil
(� " - b a D — Fax: ")3?' E -mail: Fuel . i . ing each additional over 4 outlets I=
ENGINEER ' . -, p p .: (schematic required) ■MINIIII
Name: Number of outlets -
• er I app I : ce or eq smart: ■ --
Address: Decorativefireplace
City: State: ZIP: i•
Phone: Fax: E -mail: • .. tov- pelletstove =
Applicant's signature: Date: Other: MI
Other: MI
Name (print): -
Not as urisdicdom Permit fee $ 'l . 5U
j credir cards. Please call Jurisdicdoo for mme tnformadoa Notice: This permit application
0 Visa 0 MasterCard expires if a permit is not obtained Minimum fee $
Credit card number: / / Plan review (at %) $
Expires within 180 days after it has been State surcharge (8%) .... $ 55.
Name of cardholder as shown on credit card accepted as complete.
$ TOTAL. $ "l 8.30
Cardholder signature Amount
EXPIRED
440-4617 (61001COM)
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 1 14.00 r q6,
$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
ASSUMED VALUATIONS PER APPLIANCE: to 1K BTU 14.00
3-
Value Total 8) 3 -15 HP; absorb
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
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 10.00
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725 18) Domestic incinerators
17.40
a mil. BTU
Air handling 19) Commercial or industrial type incinerator
Air handling unit to 10,000 dm 656 69.95
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler . 656 20) Other units, including wood stoves 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 ,j , L k)
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 $la
Other unit, including wood stoves, 656 8% State Surcharge $
inserts, etc. ,.. g
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: $ p
VALUATION: - �O' 3
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 Boller Certification required for units >200k BTU.
** Residential NC requires site plan showing placement of unit.
i:ldsts\formslmech- fees.doc 10/11/00