Permit CITY TIGARD MECHANICAL PERMIT
`s� DEVELOPMENT SERVICES
PERMIT #: MEC2002 -00278
5 �' l l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/1/02
PARCEL: 2S 104DA -05700
SITE ADDRESS: 13200 SW RAPTOR PL
SUBDIVISION: QUAIL HOLLOW - WEST ZONING: R -4.5
BLOCK: LOT: 043 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SFA UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of a/c unit.
Owner: FEES
GRELEWIEZ Type By Date Amount Receipt
13200 SW RAPTOR PRMT CTR 7/1/02 $72.50 2720020000
TIGARD, OR 97223 5PCT CTR 7/1/02 $5.80 2720020000
Total $78.30
Phone:
Contractor:
FOUR SEASONS HEATING & A/C
PO BOX 66409
PORTLAND, OR 97290 REQUIRED INSPECTIONS
Cooling Lint lnsp
Phone: 503 - 775 -5919 Final Inspection
Reg #: LIC 48283
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility I�otifcation Center. Those rules are set forth in OAR 952 - 001 - 0o • hrough AR
952-001 -0080. You ob • copies of these rules or direct quest'. a OU by c • g
( 1194R -U Rol
t
Issue By: 1 li A Permittee Signature: ,
Call (503 .39-4175 by 7:00 P.M. for inspections needed the next business day
(
`' Meohanical Permit A
Date received: 7 / 09— Permit no.:Wf Ago A,_Xi a7$
; ''Y.1 �' City of Tigard Project/appl.no.: ire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: B • I Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF P 'RMIT
y 1 & 2 family dwelling or accessory 0 CommerciaUindustrial ❑ Multi- family ❑ Tenant improvement
la New construction A Addition/alteration/replacement CI Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: /3 2..0 Sum le , • 3 l- Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: I Suite no.: K A • e >2 value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: (Block: Subdivision: *See checklist for important application information and
Project name: G, -, ( eta , jurisdiction's fee schedule for residential permit fee.
City /county: Tr�-.dd I ZIP: ` 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description 1 M
1 ation of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPENTSCIIEDULE
.4 .,, d ,,4- ( - 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? O Yes l] No Air handling unit CFM
o ndiing
Air conditioning (site plan required)
Is existing space insulated? O Yes ❑ No Alteration of existing HVAC system
M ECIIANICAL CONTRACTOR Boiler /compressors
/ State boiler permit no.:
Business name:
�� m,/ • 0 s 0 4 5 At t 7"f 0 , ' HP Tons BTU /H
Address: /oD_ is 66 yo Fire /smokedampers/duct smoke detectors
City: / , /4),,.
a..� I State: < I ZI : 47 0 /. 9 Heat pump (site plan required)
F ax: `E -mail: Install/replacefurnace/burner BTU /H
Phone: 77 9 I 7 ?� / /�/�I Including ductwork/vent liner O Yes O No
CCB no.: 4 QZ ' 3 Install/replace/relocateheaters- suspended,
City /metro lic. no.: • Oa e5 z ( wall, or floor mounted
Name (please print): $ a , .� ' • l,-i. Vent for a • I liance other than furnace
CONTACT PERSON Re :era Ion:
Absorption units BTU/H
Name: / ot..444 5;,16, 4 - Chillers HP
Address: Compressors HP
Environmental exhaust and ventilation:
City: I State: I ZIP: Appliance vent
Phone: 77 3 / Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U IUres. kitchen/hazmat
/ hood fire suppression system —
Name: , �i;�� ._ ., � 1 : / Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system a art from heating or AC
. Fue pip g an but on up to 4 out ets)
City: vey ' /e. 1, , -4� , State: IP:
Type: LPG NG Oil
Phone: - _ Fax: E -mail:
Fuel piping each additional over 4 outlets
ENGINEER Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: /' S . • I ZIP: - Insert -type
Phone: 0• r E -mail: Woodstovelpellet stove —
Other:
� _ _
Applicant's signatur � L Date: � r Other:
Name (print): e , I o .,r „
Permit fee $ 7 A #5 _
Not all jurisdictions accept credit cards, please can jurisdiction for more information.
CI Visa O MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Plan (at %
Credit card number: an rev ( %) $ G
Expires within 180 days after it has been State surcharge (8 %) .... $ G, eU
Name of cardholder as shown on credit card accepted as complete.
. $ TOTAL $ R
Cardholder signature Amount 440 -4617 (6R10/COM)
MECHANICAL PERMIT FEES µ "`
a,
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 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+ 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
i:\dsts \forms\rnech- fees.doc 10/11/00
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Case Activity Listing 11/10/2004
11:44:54AM
TIDEMARK Case #: MEC2002 -00278
COMPUTER SYSTEMS, INC.
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
MECB007 Application received 7/1/2002 None DONE DEB 7/1/2002
BLD
MECB008 Permit created 7/1/2002 None DONE DEB 7/1/2002
BLD
MECB730 Cooling Unt Insp None 7/1/2002
BLD
MECB799 Final Inspection 9/23/2003 None PASS KBS 9/23/2002
KBS
MECB060 (F) Issue permit 7/1/2002 None DONE DEB 7/1/2002
BLD
MECA800 Case Finaled 9/23/2002 None PASS KBS 9/23/2002
KBS
Page 1 of 1 CaseActivity..rpt