Permit CITY TIGARD MECHANICAL PERMIT
4-44 °I DEVELOPMENT SERVICES PERMIT #: MEC2001 -00084
' I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/8/01
PARCEL: 2S110AA -03100
SITE ADDRESS: 14040 SW 105TH AVE B
SUBDIVISION: EMMET'S WEST ONE ZONING: R -12
BLOCK: LOT: 003 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:
ELE 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:
Remarks: Installation of exterior heat pump. Unit cannot be placed within the required setbacks.
Owner: FEES
KENDLER, ILA V Type By Date Amount Receipt
14040 SW 105TH #B PRMT CTR 3/8/01 $72.50 2720010000
TIGARD, OR 97224 5PCT CTR 3/8/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
CENTRAL VALLEY AIR
1355 DAVIS ROAD SOUTH
SALEM, OR 97306 REQUIRED INSPECTIONS
Final Inspection
Phone: 503 - 351 -7541
Reg #: LIC 127032
EYPIIPpin
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 c of these rules or direct questions to OUNC by calling 03)246 -9 89.
Issue By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
• Mechanical Permit Application
Date received• 2 /cP /C)/ Permit no.:/jE, 4 /_daAP
A)4,' '.hl. City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW W Hall Blvd, Tigard, OR 97223 Date issued: B '- � I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 j Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
g 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family LI Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other:
JOB SITE I NFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: / O 4 J 0 j 6/ / 05.417 ✓Y- , 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 profit. Value $ lot/account no.: '
Lot: IBlock: I 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: j AND COMMERICAL /INDUSTRIAL EQUIPMENT SCHEDULE
/ / Fee(ea.) Total
Est. date of completion/inspection: 3 p - U / Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Is existing space heated or c nditioned? les ❑ No Air handling unit CFM
g p Air conditioning (site plan required)
Is existing space insulated? es ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
/ State boiler permit no.:
Business name: U
�Q. CJ t: l r HP Tons BTU /H
Address: /3 ,r5' j 0 /I f . s, Fire/smoke dampers/duct smoke detectors
City: 1 ' f 7 4 Slat p�I Z IP: _Heat pump (site plan required) /
Phone: 3 f a ^/ J/ / I Fax: I E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner LI Yes ❑ No
CCB no.: / e? 7 tr 3 Install/replace/relocate heaters -suspended,
City /metro lic. no.: / ff2 S3 9 wall, or floor mounted
Name (please print): rjp hats, Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units _ BTU/H
Name: / , j vr,, Chillers HP
Com ressors HP
Address: A ��
Environmental exhaust and ventilation:
City: 1 State: I ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U II/res. kitchen/hazmat
hood fire suppression system
Name: __ T /0 — JP..#.4 [$✓ Exhaust fan with single duct (bath fans)
Mailing address: j 9 p LI 0 s tv /0 54 ,I VL 13 , Exhaust system apart from heating or AC
City: e....., c..1 State: D eel ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: / 1) 9 Fax: E - mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: 'State: I ZIP: Insert -type
Phone: Fax: E mail: Woodstove/pelletstove
Other:
Applicant's signature:pe ,v , I Date: 1 f- cV Other.
Name (print): -1;1, !��- 5- 4a+. ,
Permit fee $ 2 - 2 - S a
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This erltrlt application
❑ Visa 13 MasterCard p Minimum fee $
expires if a permit is not obtained Plan review (at , % ) $
Credit card number: Ex s within 180 days after it has been (
Name of cardholder as shown on credit card p accepted State surcharge (8%) .... $ s
1RE ^TOTAL $ 3
- Cardholder signature Amount _ ^ r � 440 (6/011/COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: FEE: Description: Price Total
Table 1A Mechanical Code Qty (Ea) Amt
$1.00 to $5,000.00 Minimum fee $72.50 1) Furnace to 100,000 BTU
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and including ducts & vents 14.00
$1.52 for each additional $100.00 or 2) Furnace 100,000 BTU+
fraction thereof, to and including 17.40
$10,000.00. including ducts & vents
$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. Comp **
7) <3HP;absorb unit
- to 100K BTU 14.00
ASSUMED VALUATIONS PER APPLIANCE: 8) 3 -15 HP; absorb
Value Total 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 - 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 Boiler 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
02/25/2031 09:28 5035136475 GORDON LENT PAGE 04
SEARS"YOUR HEATING & CUQLIAIG SPECIALIST"
PAGE ,
NAME: La_ (ej( r CONTACT DATE:
ADDRESS: 1 `IDWO S1 !OS Ac' 1ST APPT. DATE; 2.— 3 -0
CITY: "r c.rc ZIP: 1?� PHONE: S 74/f DATE SOLD:
TYPE OF CURRENT SYSTEM: EL li:ri".-c P TYPE SOLD: _ I t �+ d.P Ht
4/F
EXISTING EQUIPMENT
CONDENSER FURNACE/ABU EVAPORATOR HtL T - STAT
BRAND -----
MODEL # ---- -- — -
CAPACITY - -
BREAKER SIZE
MISCELLANEOUS
UTILITY COMPANY PANEL, BRAND SERVICE CAPACITY DISCONNECT CRAWL SPACE
AIR HANDLER SPACE MEASUREMENTS PAD CHAS E PLATFORM
3 At 3 Tcro
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