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Permit
loci 5 ._ 6- U/ 3r ,, ivo..,,,,..,,,..t...m,..„....?.,4,,,., . „,,r4;,i,,,,,,,4..:,,,c4t,..„.3„..,...,.,,,,:.::,,,,,,,, • Building Permit Ap • Date received: 2-.2_0/ Permit no.: }: City of Tigard ►- l s �� —o �t� 6 �' I Projectlappl. 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: 1 &2 family: Simple Complex: 1.-- ------ ' TYPE OF PERMIT 0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family r. ew construction 0 Demolition YAddition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler/. arm 0 Other. JOB SITE INFORMATION Job address: '7 g3 6. 60, eARci / 4 �Vl�//UA.a (?f Bldg. no.: /6 Suite no.: ,t)% Lot: '' Block: 4 Subdivision: 0 .5- P Tax map/tax lot/account no.: , Project name: ', tom _ ' A .mac 1A9— Description and location of work on premises/special conditions: itii✓ ct) 4o/we . OWNER FOR SP1A 1,11, l \l ORNI 1 ION, LSE (71E( MIS T II ,.0 '[ eo ( Iloodplaiu , septic capacity,solar,etc.) Mailing address: _ . 1• - QV ccuT 1 & 2 family dwelling: City: 'Lt I e , Staten ZIP: 71/ Valuation of work $ /3Z 63 9 Phone: , (fit ( anistmi E -mail: No. of bedrooms/baths 3 Owner's representative: ,- ajrtrallialliffil Total number of floors 7 • Phone: ,- vne New dwelling area (sq. ft.) j l`,3 (/ APPLICANT Garage/carport area (sq. ft.) -e7/6' Name: mL ��1 C Covered porch area (sq. ft.) Mailing address: Deck area (sq. ft.) City: State: ZIP: Other structure area (sq. ft.) Phone: Fax: E -mail: CommerciaUindustriaUmulti- family: CONTRACTOR Valuation of work $ Business name: Existing bldg. area (sq. ft.) �i4 5 � U� New bld area f Address: bldg. (sq. t ) City: State: ZIP: of stories Phone: Fax: E -mail: Type of constriction .. CCB no.: Occupancy group(s): Existing: City /metro lie. no.: New: y� Notice: All contractors and subcontractors are required to be ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under provisions of ORS 701 and may be required to be licensed in the Address: /3 , , ,, C jurisdiction where work is being performed. If the applicant is City: 4 /q,vd Stated / ZIP: 7Z/ exempt from licensing, the following reason applies: Contact person: 4„ E ke, ',ij Plan no.: / /3 Phone: _ , , Fax: E -mail: ENGINEER Name: Contact person: Fees due upon application $ Address: " ,411V2IIIWZAMIIMIIIIINMEMIN Date received: City: State: ZIP: Amount received $ Phone: Fax: E -mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information. attached checklist. All provisions of laws and ordinances governing this 0 Visa 0 MasterCard work will be complied et�et�hf r s i i. , ' ed erein or not. Credit card number: - / Authorized signatu �i�i -f + � " Date: Expires /l � � Name of cardholder as shown on credit card Print name: L/( ,C• pm $ Cardholder signature Amount Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6o00/COM) • • • • • Checklist Reference no.: .M.., ,, � Bu One- and Two - Family Dwelling Building Permit Application Checklist • Associated permits: City of Tigard City of Tigard 0 Electrical 0 Plumbing 0 Mechanical Address: 13125 SW Hall Blvd, Tigard, OR 97223 O Other: Phone: (503) 639 -4171 Fax: (503) 598 -1960 TItt >FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. 3 Verification of approved plat/lot. 4 Fire district approval required. . 5 Septic system permit or authorization for remodel. Existing system capacity 6 Sewer permit. 7 Water district approval. 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control ❑ plan 0 permit required. Include drainage -way protection, silt fence design and location of catch -basin protection, etc. 10 _ Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed _ if copyright violations exist. 11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size and location. _ 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing - member sizes and spacing such as floor beams, headers, joists, sub -floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for non - prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing locations. Show attic ventop H•Hn. 1 8 Basement and returning wails. Provide cross sections and details showing placement of rebar. For engineered systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists _ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required - for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review. s . • '. 1 n JURISDICTIONAL SPECIFICS 23 Five (5) site plans are required for Item 11 above. 74 25 26 , 27 . 28 Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440-4614 (6/00/COM) 4 4 Plumbing Permit Application MDatereceived: : A -a-o/ Penultno.:VIST:a / -AlO5/�j trr�y, City of Tigard lt1 no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 no.: Expire date: Fax: (503) 598 -1960 By: I Receipt no.: Land use approval: Payment type: TYPE OF PERMIT ❑ I. & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi - family 0 Tenant improvement New construction 0 Addition/alteration /replacement 0 Food service 0 Other: • JOB SITE INFORMATION FEE SCI IEDULE (for special information use checklist) Job address: 7983 ,t,..). e_ c t AiskS LI Description Qty. Fee(ea.) Total Bldg. no.: / f j I Suite no.: 4)/=1 New 1- and 2- family dwellings only: Tax map /tax lot/account no.: /U/t (includes 100 ft. for each utility connection) SFR (1) bath Lot: /B Block: ,4) q I Subdivision: 0 . P. SFR (2) bath Project name: Wit" - (AA m poi PA-AK SFR (3) bath City /county: 7 rt ect / kiiitslet I ZIP: q 7,1,75- Each additional bath/kitchen Description and Mcation of work on premises: Site utilities: /(`C0 fq- o/f7E Catch basin/area drain Est. date of completion/inspection: Drywells/leach line/trench drain Footing drain (no. lin. ft.) PLUMBING CONTRACTOR Manufactured home utilities Business name: kr • , J .hj 40 ' .A, Manholes Address: '7'731 S -Cc . ail /nbNS / Rain drain connector • City: C 641)F to A--Ol , I State:oe_ I ZIP: t 7 op 7 Sanitary sewer (no. lin. ft.) Phone: 60,/- /6 - g y 8 1 Fax: I E -mail: Storm sewer (no. lin. ft.) CCB no.: 7 (p(e t., I Plumb. bus. reg. no: g - /t(g D8 Water service (no. lin. ft.) City /metro lic. no.:S-d / Fixture or item: ? Absorption valve . Contractor's representative signature: 7, „ Back flow preventer Print name: c4 -- R -> j ,, - ' Date: / - 23 - c i Backwater valve CONTACT PERSON Basins/lavatory Name: Clothes washer �, lf\- `� � � Dishwasher Address: Drinking fountain(s) • City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank OWNER Fixture/sewer cap Name (print): t'g b .44' i ,iT � Go Floor drains/floor sinks/hub Mailing address: 1/6, 3 2 S, it) , UCR/)"lart;` Garbage disposal Hose bibb City: Par( 44iv(9- I State I ZIP: 9 724Cf Ice maker Phone: 0' /V - Q" J7(o I Fax: I E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation , will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump ENGINEER Tubs/shower /shower pan Name: Urinal Water closet Address: A)DLlt % /,/ n d Water heater City: l State: I ZIP: Other: Phone: I Fax: I E -mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ Notice: This permit application 0 Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: / / within 180 days after it has been State surcharge (8%) .... $ Expires TOTAL Name of cardholder as shown on credit card accepted as complete. $ $ Cardholder signature Amount 440 -4616 (6/00/COM) PLUMBING PERMIT FEES. . PRICE ` I TOTAL New 1 and 2-family dwellings only; ; _ (ea) ! AMOUNT I (includes all plumbing fixturesin I FIXTURES individual PRICE TOTAL Sink )� Q 16.bk, the dwelling and the firstlOO n QTY (ea) AMOUNT Lavatory 16.60 "- for each utility connection) One (1) bath 20 Tub or Tub /Shower Comb. 16.60 Two (2) bath ,.;: J.,AO Shower Only 16.60 Three (3) bath $399.00 Water Closet 16.60 - SUBTOTAL Urinal 16.60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 • • Floor Drain/Floor Sink 2" 16.60 3" " 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub /Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Other Fixtures (Specify) 16.60 Urinal Dishwasher Garbage Dispo-;al _, Laundry Room Tray _ Washing Machine Floor Drain /Sink: 2" Sewer- 1st 100' 55.00 - 3" - - , a;;:• additional 100' 46.40 4" _ Water Service - 1st 100' 55.00 Water Heater Water Service - each additional 200' 46.40 Other Fixtures _ (Specify) c,;;;. m & Rain Drain - 1st 1OU 55.00 r Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 . Residential Backflow Prevention Device* 27.55 Catch Basin 16.60 inspection of Existing Plumbing or Specially 72.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dv nlling 65.25 .. Traps 16.60 h QUANTITY TOTAL i Isometric or riser diagram is required if Quantity Total is > 9 *SUBTOTAL 8% STATE SURCHARGE *PLAN REVIEW 25% OF SUBTOTAL _ Required only if fixture qty. total is > 9 TOTAL $ * Minimum permit fee Is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge. ** All New Commercial Buildings require plans with Isometric or riser diagram and plan review. , i:\dsts \forms\plm - fees.doc 10/10/00 • Electrical Permit Application ` Date received: ,2 -a -di Permit no.:W5i.'�!-.p (,L City of Tigard Projcct/appl. no.: Expire date: City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 9722 Date issued: By: Receipt no.: Phone: (503) 639 -4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement 'PS New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial JOB SITE INFORMATION Job address: 7 '..(,D, �r4 !'1 Cr, Bldg. no.: /8 Suite no.:4)4 Tax map /tax lot/account no.: AY] Lot: /8 (Block: N/} ( J�ckrhAriv 4iAcoI P Project name: © S. p, 'Description and location of work on premises: AIcw ijc'.17 e Estimated date of completion/inspection: CONTRACTOR APPLICATION FEE SCHEDULE Job no: Fee Max Business name: eis-7 f e E / L -� 2 , f Description Qty. (ea.) Total no. insp Address: e / New residential - single or multi - family per /) ,IJ /Ub , ZoG dwelling unit. Includes attached garage. • City: (3„,,-- A I State:0Q I ZI q'79 ,2 Service included Phone: , _ •/1) I Fax: 1E-mail: 1000 sq. ft. or less 4 CCB no.: ,3'76 / I Elec. bus. lie. no: �h - 3 ( /6 �J Each additional 500 sq. ft. or portion thereof Limited energy, residential 2 City /metro lit. no.: '`/5$" Limited energy, non- residential 2 � — ,Z 3 / Each manufactured home or modular dwelling Signature of supervising eletxfcibian (re re ) Date Service and/or feeder 2 Sup. elect. name (print): X61 ' it) /n tthc License no: 5/2 Services or feeders - installation, PROPERTY OWNER alteration or relocation: 200 amps or less 2 Name (print): - 400 id0 ' eo 201 amps to 400 amps 2 401 amps to 600 amps 2 Mailing address: /f‘. 5 Z , . (t /. L / 'Iera/7 601 amps to 1000 amps 2 City: A(7 � A, CQ I State; je. I ZIP: C7,2/ Over 1000 amps or volts 2 Phone: ,� t/(/- o % I Fax:a -g5,, 1E-mail: Reconnect only 1 Owner installation: The installation is being made on property I own Temporary services or feeders - which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation: ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 amps 2 ENGINEER Branch circuits - new, alteration, Name: or extension per panel: NO A. Fee for branch circuits with purchase of Address: /l p ;V L j/L Ll I v C d service or feeder fee, each branch circuit 2 City: U1 State: I ZIP: B. Fee for branch circuits without purchase Phone: Fax: E-mail: of service or feeder fee, first branch circuit: 2 Each additional branch circuit: PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included): ❑ Service over 225 amps- commercial ❑ Health -care facility Each pump or irrigation circle 2 ❑ Service over 320 amps- rating of 1&2 ❑ Hazardous location Each signor outline lighting 2 family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2 ❑ Building over three stories ❑ Feeders, 400 amps or more *Description: ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above: ❑ Egress/lighting plan ❑ Other: Per inspection I I I I Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ Credit card number: I / within 180 days after it has been State surcharge (8 %) .... $ Expires accepted as complete. TOTAL $ Name of cardholder as shown on credit card $ Cardholder signature Amount 440 -4615 (6/00 /COM) Electrical Permit Fees: Limited Energy Fees: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy Fee $75.00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total `► Check Type of Work Involved: Residential - per unit 1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems Each additional 500 sq. ft. or portion thereof $33.40 1 n Burglar Alarm limited Energy $75.00 Each Manufd Home or Modular a Dwelling Service or Feeder $90.90 2 1 Garage Door Opener ` ? 0 rvices or Feeders 0 Heating, Ventilation and Air Conditioning System* ;nsiauation, alteration, or relocation 200 amps or less $80.30 2 201 amps to 400 amps $106.85 2 n Vacuum Systems 401 amps to 600 amps $160.60 2 601 amps to 1000 amps $240.60 2 n Other _ Over 1000 amps or volts $454.65 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY Installation, alteration, or relocation Fee for each system $75.00 200 amps or less $66.85 2 (SEE OAR 918 - 260 -260) 201 amps to 400 amps $100.30 2 401 amps to 600 amps $133.75 2 Check Type of Work Involved: Over 600 amps to 1000 volts, see "b" above. I I Audio and Stereo Systems Branch Circuits Boiler Controls New, alteration or extension per panel a) The fee for branch circuits with purchase of service or U Clock Systems feeder fee. Each branch circuit $6.65 2 n Data Telecommunication Installation b) The fee for branch circuits without purchase of service or feeder fee. n Fire Alarm Installation I I First branch circuit _ $46.85 Each additional branch circuit $6.65 n HVAC Miscellaneous I I (Servire or feeder not included) Instrumentation Each pump or irrigation circle $53.40 and Paging Systems Each sign or outline lighting $53.40 n Sicnol circuit(s) or a limited energy I p, :reel, alteration or extension _ $75.00 n Landscape Irrigation Control 1 Minor Labels (10) $125.00 Each additional inspection over n Medical the allowable in any of the above f � c 'er inspection $62.50 l l Nurse Calls — Per hour $62.50 In Plant ` _ $73.75 n Outdoor Landscape Lighting* Fees: n Protective Signaling Enter total of above fees $ I I Other 8% State Surcharge $ Number of Systems 25% Plan Review Fee See "Plan Review" section on $ * No licenses are required. Licenses are required for all other installations front of application. Fees: Total Balance Due $ Enter total of above fees $ ❑ Trust Account # 8% State Surcharge $ Total Balance Due $ i:\dsts \forms■elc- fees.doc 10/09/00 i Mechanical Permit Applicat Date received: A.: Permit no:: F1 T / - 5/1, ,714.-'",..._1' y g City of Tigard `J Projecdappl. no.: Expire date: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Date issued: B y: I Receipt no. Fax: (503) 598 -1960 Case file no.: Paymenftype: ' Land use approval: Building permit no.: TYPE OF PERMIT ❑ J.& 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement New construction ❑ Addition/alteration/replacement ❑ Other: JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE Job address: '`7� 3 ` ..1». (Arol ,9/UJ (. Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: / I Suite no.: ff lfl value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: /1J» profit. Value $ . Lot: / Block: n/44 I Subdivision: / Q,f j *See checklist for important application information and Project name: ek pia t}m � j oo ( ` A R IC jurisdiction's fee schedule for residential permit fee. City /county: ` k1 f /tir4:h I ZIP: 73__5 1 & 2 FAMILY DWELLING PERMIT F1JE SCHEDULE Description and l &ation of work on premises: � , AND COMMERICALIINDUSTRIAL EQUIPMENTSCIIEDULE nit:Fr/ h' 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? ❑ Yes ❑ No Air conditioning (site plan required) Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system ' MECHANICAL CONTRACTOR Boiler /compressors State boiler permit no.: Business name:. u,DfF./NE 6h7 C P'.1". HP Tons BTU/H Address: 9(/ ?4' / /6. ar. . eormeveE etreiE Fire/smoke dampers/duct smoke detectors City: (e) ■ l Sok) O ; n E I State:( I ZIP: cj 7D7 p Heat pump (site plan required) , Phone: Lea .,k, Y I Fax: I E - mail: Install/replace furnace/burner BTU /H CCB no.: a / Cl Including ductwork/vent liner CI Yes ❑ No Install/replace /relocate heaters - suspended, City /metro lic. no.: / 149 wall, or floor mounted Name (please print): 6 4( / ( E ,- f- Vent for pliance other than furnace efrigeratron: Absorption units BTU/H Name: c�,- , E , ,, L UL Chillers HP Address: Compressor HP Environmental exhaust and ventilation: City: I State: I ZIP: Appliance vent Phone: Fax: E -mail: Dryer exhaust OWNER Hoods, Type U IUres. kitchen/hazmat _ hood fire suppression system Name: . e , o I f fx f f C'Q Exhaust fan with single duct (bath fans) Mailing address: 6 32 6.4! // -R p 7 - Exhaust system apart from heating or AC ' Fuel piping and distribution (up to 4 outlets) City: �2/ lbyw t0 S tate: f�� ZI �J77/ Type: LPG NG Oil Phone: c 19 R . Fax: E - mail: Fuel piping each additional over 4 outlets - - .. ENGINEER Process piping (schematic required) Name: Number of outlets ' Address: 4 ,'Otis �� (�/ N C C Decorative tv fireplace listed appliance or equipment: Address: (, Decorative fireplace City: I State: I ZIP: Insert - type Phone: I Fax: I E -mail: Woodstove/pelletstove Other: Applicant's signatures / � I Date: /��3 d/ Other: Name (print): �"c1' . Not all jurisdictions accept credit cards, please / can jurisdiction for more information. Permit fee I ❑ Visa ❑ MasterCard Notice: This permit appli Minimum fee $ e if a permit is not obtained Credit card number: / / Plan review (at _ %) $ Expires within 180 days after it has been State surcharge (8%) .... $ Name of cardholder as shown on credit card accepted as complete. $ TOTAL $ 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 Tota $1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Ami $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 1 •i Hea Air , $1.20 for each additional $100.00 or For, items 91, see '* pufn •Cond Y fraction thereof. ' below `.'.. � ' _`' -- 7) <3HP;absorb unit ASSUMED VALUATIONS PER APPLIANCE: 8) 3-15 BTU 14.00 8) 3 -15 HP; absorb Vskie Total unit 100k to 500k BTU 25.60 Description: Qty (Ea) Amount 9) 15 -30 HP; absow 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 fleer mounted heater 10.00 II 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 s not includF 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 ' Novi sortable evaporate ca>'cr 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 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: $ mmercial or industrial Incinr �� 4,590 ,z'z ., [ DO unit, including wood stoves, 656 8% State Surcharge ; ' $ ncT -ts, etc. 4,: r q 1-4 outlets 360 25% Plan Review Fee (of subtotal) $ I Gr, additional outlet 63 Required for ALL commercial permits only \L COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE ; t $ ! 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 ovrevisions to plans (minims 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. is \dsts \forms\mech - fees.doc 10/11/00