Permit C ITY OF TIGARD MECHANICAL PERMIT
:,� (1 DEVELOPMENT SERVICES PERMIT #: MEC2001 -00258
�` A !I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/16/01
PARCEL: 1 S136AC -02900
SITE ADDRESS: 10730 SW 72ND AVE
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -P
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: ALT 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:
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 OTHER UNITS:
FURN > =100K BTU: < =10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Installation of (1) gas outlet.
Owner: FEES
RICHARD BRHEM Type By Date Amount Receipt
4720 FIRWOOD PRMT CTR 7/16/01 $72.50 2720010000
LAKE OSWEGO, OR 97035 5PCT CTR 7/16/01 $5.80 2720010000
Total $78.30
Phone: 503 - 819 -0443
Contractor:
REQUIRED INSPECTIONS —
Mechanical lnsp —
Phone: Final Inspection
Reg #:
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 ca ing (50 246 -9189.
Issue By: �/ � ; ,
j Permittee Signature: /
Cali (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
MechanicalPerndt Application
Date received: (( �S / Permit no.: �a J,��5�
r �i 1 City of Tigard /C
___ U
X11. ty g Project/appl.no.: Expire date:
City ojTigard Address 13125 SW Hall Blvd Tigard OR 97223 Date issued: By: I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERT 1
❑ 1 & 2 family dwelling or accessory O Commercial/industrial O Multi- family ❑ Tenant improvement
0 New construction ❑ Addition/alteration/replacement O Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: 0 30 5Lv L 4 .1, - 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: jurisdiction's fee schedule for residential permit fee.
City /county: F, : a ZIP: "" ZZ, 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCHEDtJLE
Fee(ea.) Total
Est. date of completion/inspection: Descri , ' on Qty. Res.only Res. only
Tenant improvement or change of use:
A ir handling unit CFM .
conditioning --
Is existing space heated or conditioned? O Yes 0 No A
Air conditioning (site plan required) —
Is existing space insulated? O Yes ❑ No Alteration of existing HVAC system
MECFIr1NICAL CONTRACTOR Boiler /compressors I■■
State boiler permit no.:
» – HP Tons BTU/H
Address: Fire/smoke dampers/duct smoke detectors MN
City: State: ZIP: Heat pump (site plan required) _
Phone: Fax: E -mail: Install/replacefurnace/bumer BTU /H ■ --
CCB no.: Including ductwork/vent liner LI Yes 0 No
InstaWrepla - relocate heaters– suspended, III
City/metro lic. no.: wall, or floor mounted
Name (please print): Vent for a • • liance other than furnace =
'el CONTACI PERSON
Abs ,.e •on: � ��
orption units BTU/14
Name: Q CV/ - Chillers HP ME
Address: Co •ressors HP =
nmen e : ust an vtm 1 I on: ■ --
City: State: ZIP: Appliance vent _
Phone: Fax: E -mail: Dryer exhaust
OWN1 :11 Hoods, Type 1/11/res.kitchen/hazmat ■
i [_ `j hood fire suppression system
Exhaust fan with single duct (bath fans) -__
Mailing address: F - a . o i Exhaust system a • art from heating or AC =
e pp .g an. .l f ; on up to out ets ■ --
City: La /v !, e .M ZIP: 703 Type: LPG NG Oil
Phone: 03 ; /q o 4' 3 Fax: E -mail: Fuel • i • ing each additional over 4 outlets NM _
ENGINEER m be p p : (schematic required) -
Name: Number of outlets
O , er l - , app l i ce or eq , 1 pment: ■ -
Address: Decorativefireplace
City: - State: ZIP: Insert –type i
Phone: palmirrEMU Woodstove/pelletstove
Other: =I
• Applicant's signature: ;il Date: ��IEM 0 , er: —
Name (print) M�
•
Not an jurisdictions accept credit cards, please call jurisdiction for more information. . • Permit fee $
O Visa 0 MasterCard Not Th permit application Minimum fee $ '7 2 . so
expires if a permit is not obtained Plan review (at %
Credit card Humus /Expires / within 180 da after it has been ( %) $
State surcharge (8%) .... $ 'i V
Name of cardholder as shown on credit card $ accepted as complete. TOTAL $ 7g. 3a
Cardholder signature Amount 440.4617 (6/00/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) Fumace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Fumace 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 Fumace
$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
ASSUMED VALUATIONS PER APPLIANCE: to 100K BTU 14.00
8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount 9) 15 -30 HP; absorb
Fumace to 100,000 BTU, including 955 unit .5-1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Fumace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents 11) >50HP: absorb
Floor fumace induding 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 Boller Certification required for units >200k BTU.
** Residential A/C requires site plan showing placement of unit.
i:\dsts\forms.mech- fees.doc 10/11/00