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Permit ,. CITY OF TIGARD MECHANICAL PERMIT 1**4 1 a DEVELOPMENT SERVICES PERMIT #: MEC2001 -00038 ` - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/31/01 PARCEL: 1S134CA-01200 SITE ADDRESS: 11490 SW 121ST AVE SUBDIVISION: BURLWOOD ZONING: R -4.5 BLOCK: LOT: 005 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: GAS 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: WOODSTOVES: FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: 1 Remarks: Replace furnace Owner: FEES MILLER, LYMAN L Type By Date Amount Receipt 11490 SW 121ST AVE PRMT CTR 1/31/01 $72.50 2720010000 TIGARD, OR 97223 5PCT CTR 1/31/01 $5.80 2720010000 Total $78.30 Phone: Contractor: ROBBEN + SONS HEATING 2214 SE 8TH AVE PORTLAND, OR 97214 REQUIRED INSPECTIONS Gas Line Insp Phone: 233 -5841 Mechanical Insp Reg #: LIC 1884 Duct Inspection 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 -r -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUIIC by( a`ll /in�ng,(50 2 6 -91: Y s. Issue B : Permittee Signature: J��� r Call (50 639 -4175 by 7:00 P.M. for inspections needed :he next business ay T Mechanical Permit Application Date received: i 3 i / c I Permit n , j1 a DO l — oo 3t2 .f 0 City of Tigard Project/appl. no.: Expire date: City of Tigard Address 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.: Phone: (503) 639 - 4171 Fax: (503) 598 -1960 Case file no.: Payment type: Land use approval: rn c7-c4 =00 I . - Building permit no.: TYPE OF PERMIT II 1 & 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: j i 4. y 0 S',) / Z / S 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: 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: AND COMMERICALIINDUSTRIAL 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? ❑ Yes ❑ No Air handling unit CFM • space insulated? ❑ Yes ❑ No Alconditioning t ratif xiti plan required) Is existing P Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors Business name: �1y; 7 P State boiler Hrm no R u B 9 t�� Svw1 . Tons BTU/H _ Address: Z Z 14 5 L - = S ' A-V& Fire /smoke dampers /duct smoke detectors City: P t - ✓,) I State: orz I ZIP: 91 Z 14 Heat pump (site plan required) Phone: Z3 3 -,,r 5-11 I Fax: t3h-b'QY E - mail: Install/replace furnace/burner 45BTU /H Including ductwork/vent liner tares ❑ No I 14 tl/0 CCB no.: ( 8- y4- InstalUreplace /relocate heaters— suspended, City /metro lic. no.: wall, or floor mounted Name (please print): Vent for appliance other than furnace CONTACT PERSON Refrigeration: _ Absorption units BTU/H _ Name: /4 i �t�ft,2 /�;S' Chillers HP Address: 224 4 S az $' 'r4.1 Ave Compressors HP Environmental exhaust and ventilation: City: Pa 2 j t, I stater :0z I ZIP: 7 7 2 14 Appliance vent Phone: Z33 5 R4 / Fax: E -mail: Dryer exhaust OWNER Hoods, Type U IUres. kitchen/hazmat hood fire suppression system Name: 1' Y im h friel t L La /Z, Exhaust fan with single duct (bath fans) Mailing address: a r 4 5 j / z i s r Exhaust system apart from heating or AC Fuel piping and distribution (up to 4 outlets) City: T G e t f e a I State :Q 2 I ZIP: 5.7 72 3 Type: LPG ✓ NG Oil I 5)4° Phone: '703 . 9 19 Fax: E -mail: Fuel piping each additional over 4 outlets Process piping (schematic required) Name: Number of outlets -- Other listed appliance or equipment: Address: Decorative fireplace City: I State: I ZIP: Insert — type Phone: I Fax: I E -mail: Woodstove/pellet stove Other: Applicant's signature: I Date: Other: Name (print): Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ rm ❑ Visa ❑MasterCard Notice: This permit application Minimum fee $ 12.56 Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $ Expires within 180 days after it has been State surcharge (8 %) .... $ 5,. 2 s� 0 Name of cardholder as shown on credit card accepted as complete. �-t O TOTAL $ I f V 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) Furnace to 100,000 BTU $1.52 for each additional $100.00 or including ducts & vents t 14.00 `.4, 0� - 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. Comp *" 7) <3HP;absorb unit to 100K BTU i 14.00 i 4 r u,) 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 i 5.40 5/4b 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