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Permit CITY TIGARD MECHANICAL PERMIT All DEVELOPMENT SERVICES PERMIT #: MEC2001 -00384 13125 S W Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/1/01 PARCEL: 2S102BD -01701 SITE ADDRESS: 12830 SW PACIFIC HWY SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G BLOCK: LOT: OOA JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: OCCUPANCY GRP: A3 VENTS W/O APPL: VENT SYSTEMS: STORIES: 1 BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: 1 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: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: 1 <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Replace gas pack and swamp cooler. Owner: FEES GREG WHITE Type By Date Amount Receipt 12830 SW PACIFIC HWY PRMT CTR 11/1/01 $72.50 2720010000 TIGARD, OR 97223 PLCK CTR 11/1/01 $18.13 2720010000 5PCT CTR 11/1/01 $5.80 2720010000 Phone: Total $96.43 Contractor: ARROW MECHANICAL 10330 SW TUALATIN RD TUALATIN, OR 97062 REQUIRED INSPECTIONS Mechanical Insp Phone: 692 -1565 Final Inspection Reg #: LIC 5193 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. Y.0 may obtain copies of these rules or direct questions to OUNC by calling ( fl 94R_Q1R• Issue By: ow ' + Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day �� ' l, �( X I) -I -01 G L Mechanical Perm Appl / Date received: le �(� Permit no.:ik 'l -ce j6 / .,I �� City of Tigard , Project/appl. no.: Expire date: Cif o Tigard Address: 13125 SW Hall Blvd, Tigard, OR 972 rY l 8 __ , .e ,p,' Date issued: By: Receiptno.: \ Phone: (503) 639-4171 1 Fax: (503) 598 -1960 Case file no.: Payment type: O Land use approval: Building permit no.: TYPE OF PERMIT ❑ 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: 1 2..,f33D ,51,J AAA ( f1G ¢ I (,✓'I Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: I Suite no.: value of all mechapiial m;te s, equipment, labor, overhead, Tax map /tax lot/account no.: profit. Value $ [ -f C ' , oav , Lot: 'Block: I Subdivision: *See checklist for important application information and , Project name: f A-vi jj_50 ` ,S f '7- ) l,( eirN"] . jurisdiction's fee schedule for residential permit fee. City /county: , l MS -} I ZIP: C 17,3 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE Description and location of work on premises: (LEeL�ICT C QA AND COMMERICAL/INDUSTRIAL EQUIPMENTSCHEDULE %,., Sv✓AYVI C19r71 Fee(ea.) Total Est. date of completion/inspection: I ) - i 5----(9 ] 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 Air conditioning rati fxi (ingplan required) Is existing P Alteration of existing HVAC system MECHANICAL CONTRACTOR Boiler /compressors Business name: /a 2R0 t N'(Ec. - I ( A _ (t State boiler permit no.: t ] HP Tons BTU /H Address: I Cep 51 A ) ---1-1AA/ A77 N /2_0 , Fire/smoke dampers/duct smoke detectors City: TIA,41-4-71 M I State:0i2 I ZIP: 0170602_ Heat pump (site plan required) Phonet 2. - I cLOS I Fax6q I.-j 579 E -mail: Install/replace furnace/burner BTU /H Including ductwork/vent liner ❑ Yes ❑ No _ CCB no.: 5 q 3 1 tI Install /replace /relocate heaters- suspended, City /metro lic. no.: 1:7 10 wall, or floor mounted Name (please print): , i C ,_ Vent for appliance other than furnace CONTACT PERSON Refrigeration: -- Absorption units BTU /H Name: act_ pA -nalcK Chillers HP Address: 73 Compressors HP S� �u 2 Environmental exhaust and ventilation: City: -- IAA t,�-n II I tate ZIP: Cr-)0/02_ Appliance vent — Phony H. it, — Fa # i -I, j E -mail: Dryer exhaust OWNER Hoods, Type I/ II/res. kitchen/hazmat hood fire suppression system Name: G [2E6 wfli T4 Exhaust fan with single duct (bath fans) Mailing address: I Z_FR O s ( ,,,) p , L au) Exhaust system apart from heating or AC City: t r-A-03 1 Stat:. • '< I ZIP: 9 - 7 3 Fuel piping and distribution (up to 4 outlets) Type: LPG NG Oil Phone." 'f C Fax: E -mail: Fuel piping each additional over 4 outlets ENGINEER 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/pelletstove - Other: Applicant's signature: ! Date:I 0--,31 `01 Other: Name (print): ' f �t� A--ri i c v m Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ 72. to 0 Visa ❑ MasterCard Notice: This permit application Minimum fee $ Credit card number: / / expires if a permit is not obtained Plan review (at %) $ fig. (i Expires within 180 days after it has been State surcharge (8 %) .... $ �1 : Name of cardholder as shown on credit card accepted as complete. $ TOTAL $ ( /liter Cardholder signature Amount 440 -4617 (6100/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 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 induding 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. BT . 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 NC requires site plan showing placement of unit. is \dsts \forms\mech- fees.doc 10/11/00 11111.1111111111 /4723b c,60. Woo P 16tv tiP)