Permit CITY TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2003 -00496
tt -1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/14/03
PARCEL: 2S112BC -01201
SITE ADDRESS: 14551 SW 81ST AVE
SUBDIVISION: DURHAM ACRES ZONING: R -4.5
BLOCK: LOT: 070 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: 1 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: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Replace furnace, add AC.
Owner: FEES
SCHIEBOLD, DELLA Description Date Amount
14551 SW 81ST AVE
TIGARD, OR 97224 [MECH] Permit Fee 8/14/03 $72.50
[TAX] 8% StateTax 8/14/03 $5.80
Total $78.30
Phone:
Contractor:
THERMAL FLO
14865 SW 74TH AVE. #190
TIGARD, OR 97224 REQUIRED INSPECTIONS
Phone: 503 Heating Unt Insp
Cooling Unt Insp
Reg #: LIC 151847 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 Notification Center. Those rules are set forth in OAR 952 - 001 -00
Issued By: ,52 - Permittee Signature: X�
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
. , - ' Mechanical'Permit Application
Date receivedg- /'/-03 M Permit no.: f F.) ,t8 - 0ip cl-
, � City of T><ga F CEIV Project/appl. no.: Expire date:
City of Tigard Address 13125 SW a lvd, Tigard OR 97223 Date issued: By: zp, Receiptno.:
Phone: (503) 639 -4171 AUG 14 2003
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Gay OF TIGtARD Building permit no.: TO
■ •k
TYPE OF PERMIT .
fa 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family Cl Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION. SCHEDULE
Job address: 14551 Sw • '1,1 5T A-`! • 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: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: ZIP: .. 1 & •2 FAMILY DWELLING °PERMIT FEE SCHEDULE
Description and location of work on premises: P-.Lp .to.P.tt_ AND COMMERICAL /INDUSTRIALEQUIPMENTSCHEDULE
rt] YlA.J A fX t A-0 0 Al C- Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air
Is existing space heated or conditioned? ❑ Yes El No conditioning handling (site plan required) I (9•, OU
Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system
• MECHANICAL` CONTRACTOR Boiler /compressors
State boiler permit no.:
Business name:
-- 54 4A- R ID, ti 1:K • HP Tons BTU /H
Address: (4GE Suj 7 Ate , it l Q Fire /smoke dampers /duct smoke detectors
City: rtt,p4.0 State:012, I ZIP:Ck7 Z-A Heat pump (site plan required)
Phone: ( • 63M Fax:00 -go6,. E -mail:
Install/replace furnace/burner C�MBTU /H
Including ductwork/vent liner J I Yes ❑ No 1 1 00
CCB no.: (5(8C{7 Install/replace /relocate heaters suspended,
City /metro lic. no.: '7 31.7 wall, or floor mounted
Name (please print): € - wy - Vent for appliance other than furnace l
' CONTACT PERSON Refrigeration:
Absorption units BTU /H
Name: G( R*C!_l<.U.S Chillers HP
Compressors HP
Address: SA its A42, c7'4 Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: 57L - 7 , Fax: E -mail: Dryer exhaust
Hoods, Type l/ 11/res. kitchen/hazmat
hood fire suppression system
Name: >li:, LA SHa.-COCA/0 Exhaust fan with single duct (bath fans)
Mailing address: (t4' e.465( u i 8 ( S-- 4.u. Exhaust system apart from heating or AC
City: r t() I State:C�I ZIP: C [E,Z Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: , ' - 41 Fax: E -mail: Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Phone: Fax: I E -mail: Woodstove /pellet stove
Other:
Applicant's signatur 1 1/�- Date: 'v - -U3 Other: .
Name (print): CA 1a_zrJ� uice.
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ tall
❑ Visa O MasterCard Notice: This permit application Minimum fee $ ?Z • Sc.)
expires if a permit is not obtained Plan review (at %) $
Credit card number: Expires within 180 days after it has been accepted as complete.
5 , 9
State surcharge (8 %) ..• $
Name of cardholder as shown on credit card p p TOTAL $ 78, 50
Cardholder signature Amount 440 -4617 (6/00 /COM)
•
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
•
' TOTAA VALUATION # PERMIT FEE: „ A; . ::'i-•::". D atil e 1 pA M . . , ' Qty., (Ea) ' , Total 'Amt
T
$1.00 to $5,000.00 Minimum fee $72.50
• $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 i Check all thatrapply R eoHer, ` ; Heat Air ,
$1.20 for each additional $100.00 or For item s 7-11 see " o
-a r- Pump; Condo , A
fraction thereof � _
o
fo tri otes below �- Comp
s , ,' ,.'1,:, . fix ',4 , , , :,
;_ ; .,�t _. 7) <3HP; absorb unit
Minimum Permit Fee $72.50 SUBTOTAL: $ to 100K BTU 14.00
8% State Surcharge $ 8) 3 -15 HP; absorb 25.60
unit 100k to 500k BTU
25% Plan Review Fee (of subtotal) $ 9) 15-30 HP; absorb 35.00
Required for ALL commercial permits only unit .5 1 mil BTU
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb 52.20
unit 1 -1.75 mil BTU
11) >50HP; absorb
unit >1.75 mil BTU 87.20
12 Air handling unit to 10,000 CFM
ASS.l1 MED, VALUATLONSP gPPLIANCE >� . ;; 10.00 -
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, including 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 appliance 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 •
101 k 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: $ $
>1.1. 75 mil. BTU 0
Air handling unit to 10,000 cfm _.
6 8% State Surcharge a $
Air handling unit >10,000 cfm 1,170 ` ‘' , ,
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE S ; : , _ $
Vent fan connected to a single duct 446 ,
Vent system not included in 656 ,'
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator 1,170
$62.50 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 $62.50 per hour
inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge -one -half hour) $62.50 per hour
Each additional outlet 63
State Contractor Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL ; . :
x ; $ '`{`Residential A/C requires site plan showing placement of unit.
VALUATION: i .. 1-,,!S .. , All New Commercial Buildings require 2 sets of plans.
i : \dsts \forms\mech- fees.doc 02/11/02
CONTRACTOR A/C -HEAT PUMP O/D UNIT SITE PLAN
THERMAL FLO, INC.
14865 SW 74TH AVE #190
TIGARD, OR 97224
503 -670 -8343 OFFICE --- TO BACK PROPERTY LINE
503 -670 -9064 FAX
TO SIDE PROPERTY LINE
I ss l
TO STREET
1
CUSTOMER INFORMATION
NAME l.LA Sai-'t E2a0uQ
ADDRESS f ASS l 5Q--) B IS�
f.