Permit l6
CITY TIGARD MECHANICAL PERMIT
kisp , r l
i DEVELOPMENT SERVICES PERMIT #: MEC2004-00083
c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/27/04
PARCEL: 2S104AB -10300
SITE ADDRESS: 12300 SW 132ND CT
SUBDIVISION: MORNING HILL NO. 6 ZONING: R -4.5
BLOCK: LOT: 132 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:
LPG 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: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Gas furnace replacement.
Owner: FEES
MOYER, FRED J + PAULINE M TRS Description Date Amount
12300 SW 132ND CT
TIGARD, OR 97223 [MECH] Permit Fee 2/27/04 $72.50
[TAX] 8% State Surchart 2/27/04 $5.80
Phone: 503 - 590 - 9229 Total $78.30
Contractor:
D + R HEATING +AIR COND
PO BOX 1292
27251 S DAVE RD REQUIRED INSPECTIONS
CANBY, OR 97013
Phone: 503 Heating Unt Insp
Final Inspection
Reg #: LIC 84489
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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: ' � y j �� � Permittee Signature: Al: -
• Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business • all
Mec h a nical Permit Application ' FOR OFFICE USE ONLY
Rece
• ived i W Mechanical _ ,
Date/B Permit No.: -- � i 3
Planning • ppro al Building
City of Tigard Date /B : Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/B : Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 i1�
Post - Review Land Use
/ ar Nl� l� ( DateB Case No.:
Internet: www.ci.tigard.or.us . 11 Contact ®See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ' ' Name /Method: Su lemental Information.
- ' "§ " TVPE;OF:WORK' ; :: ' ' `ks r. V !' COMMERCIAL TEE *iSCHEOVLEGIUSE.GHECKLIST V
❑ New construction ❑ Demolition _ Mechanical permit fees* are based on the total value of the work
Addition/alteration/replacement ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
0.1., 1 .�t�' _ 4,XATEGORYtOF COI!1S'TRiJCT'IQNW n;� a� :, „. w, mechanical materials, equipment, labor, overhead and profit.
, ,,ird & 2- Family dwelling ❑ Commercial /Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family
ItESIDENTFAL;'EQ IIPMENT/SY.STEMS SCHEAME u .
Description J Qty Fee(ea.) Total
❑ Master Builder ❑ Other: _, - .... , 'Heating/coofing'. _
We „fi /Furnace - . '
r„ J.OB"SITE1INFORiMIATIONMand LOCATION, , 'n dd -on air conditioning ** ) 14.00
Job site address: A7200 , jV /.2 e--1 C ■Gas =heat pump 14.00
Suite #: I Bldg. /Apt. #: Duct work 14.00 _
Project Name: Hydronic hot water system 14.00
Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
� Gade `ivior4-- 655-3 -`1 Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
:,:,;, . ` Otlier Fuel'Applian`"cess ' ; . .
Tax map /parcel #: Water heater 10.00
t rkial ; _ i DESCRtP -TION OPIMORK ` .°` tl i , -': Gas fireplace 10.00
ie � /A-e-,, Y /, ,fc ,fr/4-6e-- Flue vent (water heater /gas fireplace) 10.00
/ Log Log lighter (gas) 10.00
/ 14/ Wood/Pellet stove 10.00
Wood fireplace /insert 10.00
_ Chimney /liner /flue /vent 10.00 •
Rt RTY OWNR
E' TA ED TENA'Nl , ` l r ' ,_ :. , ,, Other 10.00
Name: ,'5d' �O �� n,1.. ! ., 'Enyii onmei ►tat °Eihausif.V.Ventilation _ _L ' ., •.
Range hood/other kitchen equipment 10.00
Address:. , ,2p j it/ /92 G/� Clothes dryer exhaust 10.00
City /State /Zip: %j�4 Q,Q 90 Single duct exhaust
Phone: 4,0 ,2,,2 9 Fax (bathrooms, toilet compartments,
< CONTACT'PERSOO Nip.. utility rooms
' PPI ICANT_, , 6.80 .
Name: //,yr/i0! 1� //9 -iilS Attic /crawl space fans 10.00
Other: 10.00
, /2 Z
Address: / , , x� °��. - `_ > = °� >� ki ; r ; .
4,y�j,
City /State /Zip: / ��e /� * *($5.40 for
first 4, $1.00 each additional)
a)/?ail--/9 / Furnace, etc. **
Phone: Fax:
Gas heat pump **
E -mail: Wall /suspended/unit heater **
yam "' ttr ` `g CONTRAGTOR;O '`, .,, ,�',: Water heater **
. t. ��.�...w� ��__
Business Name: /, x_,77%/•4- Fireplace **
Address: ° O Range **
�or' /2 � BBQ **
City /State /Zip: _9 � // ��_ Clothes dryer (gas) **
Phone :Jj / 1 69 , 6 252 Fax5 a0% l Other: **
CCB Lic. #: f Ve/g7 Total:
Meehanical P,ernrifFees *`
Authoriz �� 2 Q
[/ Subtotal: $
Sign Date: /7 / Minimum Permit Fee $72.50 $ 7, - 50
�i_ ` d /6 „"” :��� Plan Review Fee (25% of Permit Fee) $ v
4, (Please print name) State Surcharge (8% of Permit Fee) $ • Y
TOTAL PERMIT FEE $ 75 . 3.07
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
Mechanical Permit Application - City of Tigard _
Page 2 - Supplemental Information
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Commercial Fee Schedule:
Tbtal Valuat on; ` Eerm t; Fee .
$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 $1.52
for each additional $100.00 or fraction
thereof, to and including $10,000.00.
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and
$1.54 for each additional $100.00 or
fraction thereof, to and including
$25,000.00.
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and
$1.45 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,001.00 and up $742.00 for the first $50,000.00 and
$1.20 for each additional $100.00 or
fraction thereof.
°Assumed_ Valuations Appliance: "`
Value Total
Description: Qty (Ea) Amount
Furnace to 100,000 BTU, including 955
ducts & vents
Furnace > 100,000 BTU including ducts 1,170
& vents
Floor furnace including vent 955
Suspended heater, wall heater or floor 955
mounted heater
Vent not included in appliance permit 445
Repair units 805
< 3 hp; absorb. unit, 955
to 100k BTU
3 -15 hp; absorb, unit, 1,700
101k to 500k BTU
15 -30 hp; absorb. unit, 50Ik to I mil. 2,310
BTU
30 -50 hp; absorb. unit, 3,400
1 -1.75 mil. BTU
>50 hp; absorb. unit, 5,725
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656
Vent fan connected to a single duct 446
Vent system not included in appliance 656
•
permit
Hood served by mechanical exhaust 656
Domestic incinerator 1,170
Commercial or industrial incinerator 4,590
Other unit, including wood stoves, 656
inserts, etc.
Gas piping 1 -4 outlets 360
Each additional outlet 63
TOTAL COMMERCIAL $
VALUATION:
is \Dsts \Permit Forms \MecPermitAppPg2.doc 01/03