Permit ,.
rs < CITY OF TIGARD MECHANICAL PERMIT
M DEVELOPMENT SERVICES PERMIT #: MEC2001 -00030
" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 DATE ISSUED: 1/24/01
PARCEL: 2S 112BD -00700
SITE ADDRESS: 14655 SW 76TH AVE 002
SUBDIVISION: MARCIENE II ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: MF UNIT HEATERS: VENT FANS: 6
OCCUPANCY GRP: R1 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
ELE 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:
> 10000 cfm:
Remarks: This permit is for 1 1/2 hours of inspection time to inspect the installation of vent fans inq nits 2 through 7T
Owner: - FEES
BOOTH - HEYDON LLC Type By Date Amount Receipt
PO BOX 1185 PRMT CTR 1/24/01 $93.75 2720010000
LAKE OSWEGO, OR 97035 5PCT CTR 1/24/01 $7.50 2720010000
Total $101.25
Phone:
Contractor:
STEVE REGALADO
13935 SE CALLAHAN RD
PORTLAND, OR 97236 REQUIRED INSPECTIONS
Misc. Inspection
Phone: 503 - 702 -8459 Final Inspection
Reg #: LIC 100271
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 -00 10 throng OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by
callin (503)246 - 9189 �- r,t , - /.
Issu B r: / /i i . Perm S nature:
Call (, s :39 -4175 by 7:00 P.M. for inspections needed the next business •ay
" Mechanical Permit Application
I ^ Date received: /41-0/ Permit no.: 1 jff l
..t
' _�_�� City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9722
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
1 TYPE OF PERMIT
•
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial L Multi- family • 0 Tenant improvement
❑ New construction 0 Addition/alteration /replacement ❑ Other:
. SITE INFORMATION I COMMERCIAL VALUATION SCHEDULE
Job address: /7 -74 2 Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I 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: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and location of work on premises: AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE
Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or conditioned? 0 Yes 0 No Al co ndt io unit CFM
Is existing space insulated? 0 Yes ❑ No Air conditioning (site plan required)
Alteration of existing HVAC system
MECHANICAL CONTRACTOR I Boiler /compressors
/ State boiler permit no.:
Business rlame: v E 6 t )60
HP Tons BTU /H
Address: J q 3s S' eh , , , /, , Fire/smoke dampers/duct smoke detectors
City: / A ' State / ZIP'"' • Heat pump (site plan required)
Phone:50.3-7/'2,- I •? Fax:. • E -mail: InstalUreplace furnace /burner BTU /H
CCB no.:�� Including ductwork/vent liner 0 Yes ❑ No
�t Install/replace/relocate heaters- suspended, 1
City /metro Iic. no.: wall, or floor mounted
Name (please print): _5j '(j- j(' Vent for appliance other than furnace.
. CONTACT PERSON I Refrigeration:
Absorption units BTU/H
•
Name: Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: 1 State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OwVNrER I Hoods, Type U IUres. kitchen/hazmat
/ 1 hood fire suppression system
Name: / if 0,..- 0,..— / - 4I // / Exhaust fan with single duct (bath fans)
Mailing address: / /0e/ S1(j r • , or 673 Exhaust system apart from heating or AC
Fuel piping and distribution (up to 4 outlets)
City. 40,' a A • t• ZIP: Type: LPG NG Oil
Phone: /fir TT r / Fax: E -mail:
�;y���/� Fuel piping each additional over 4 outlets
ENGINEER • 1 Process piping (schematic required)
Name: Number of outlets
Other listed appliance or equipment:
Address: Decorative fireplace .
City: • I State: I ZIP: Insert - type -
Phone: 1 Fax: 1 E -mail: Woodstove/pelletstove
Applicant's signature: I Date: Other:
Name (print): _
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee
$ r 75
rm
Notice: This permit application Minimum fee
❑ Visa ❑ MasterCard
$ -
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Expires within 180 days after it has been State surcharge (8 %) .... $ 7 56
Name of cardholder as shown on credit card accepted as complete. T OTAL ���
$ $ T° ."..0' 1 � _
Cardholder signature Amount
4.40-4617 (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) 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 = ,.`Heat; Air .
$1.20 for each additional $100.00 or For.items'7 -11., see ..'or Pump . ,,Cond
fraction thereof. footnotes below '., ' Cohlp* ', _ . '** ' . .
7) <3HP;absorb unit
ASSUMED VALUATIONS PER APPLIANCE: to 100K BTU 14.00
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
Fumace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents 11) >50HP: absorb
Floor fumace 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
10.00
Vent not included in applicance 445 13) Air handling unit 10,000 CFM+
permit 17.20
Repair units 805
< 3 hp; absorb. unit, 955 14) Non - portable evaporate cooler
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
mil. BTU 19) Commercial or industrial type incinerator
Air handling handling unit to 10,000 cfm 656
69.95
Air handling unit >10,000 cfm 1,170
20) Other units, evaporate cooler 656 , including wood stoves
10.00
Vent fan connected to a single duct 446
Vent system not included in 656 21) Gas piping one to four outlets 5.40
appliance permit
Hood served by mechanical exhaust 656 22) More than 4 -per outlet (each) 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 t ';` ':
TOTAL COMMERCIAL `' $ TOTAL RESIDENTIAL PERMIT FEE: ' ° $
y:
VALUATION: '' t"
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.
is \dsts \forms\mech - fees.doc 10/11/00