Permit 4,, CITY OF TIGARD MECHANICAL PERMIT
PERMIT #: MEC2000 -00403
`L DEVELOPMENT H B S R 2 63 -4171 DATE ISSUED: 10/11/00
PARCEL: 2S101 DD -00400
SITE ADDRESS: 06825 SW SANDBURG ST
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: C -P
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS: 1
FURN > =100K BTU: < =10000 cfm: GAS OUTLETS: 5
> 10000 cfm:
Remarks: Gas Piping
Owner: FEES
TOC MANAGEMENT SERVICES Type By Date Amount Receipt
6825 SW SANDBURG STREET PRMT CTR 10/11/00 $72.50 2720000000
TIGARD, OR 97223 PLCK CTR 10/11/00 $18.13 2720000000
5PCT CTR 10/11/00 $5.80 2720000000
Phone: -1710 Total $96.43
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON
STE 1 REQUIRED INSPECTIONS
PORTLAND, OR 97202 Gas Line Insp
Phone: 239 -4600 Final Inspection
Reg #: LIC 33135
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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 -0010 through OAR 952 - 001 -0080.
You may obtai copies of these rules or direct questions to OUNC b ailing 3)246 -9189.
Issue By: Permittee Signature:
Ca I (503) 639 -4175 by 7:00 P.M. for inspections needed the business day
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A' n'i 6 o ?D6-6 nS I dal-11,L, atiat. . L,,,kil, l °Atte) /a(alsP
Mechanical Permit Application
Date received: /Q / /D /Q O Permit no.: Z6� -zo /O3
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4,,+.p ra
.mil , ,.1 1 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: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ■Commercia1industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction Addition/alteration/replacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCIEDULE
. Job address: (D g a. G SAA) S Q,�d bU. r0( 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 $ A 00 - .
Lot: IBlock: I Subdivision: *See checklist for important application information and
Project name: - I „O C C. (T-O y �I� • r O .trd, 5 Ci)bt , n jurisdiction's fee schedule for residential permit fee.
City /county: ,�1I h Af,� t-A I ZEP. 97a- .23 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and loc on of work on premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
• Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned ?)1 Yes ❑ No Air conditioning (site plan required)
Is existing space insulated? M Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business name: F Yt L lln yeah . CJ State boiler permit no.:
HP Tons BTU/H
Address: 13 )1 5 G I u„ fit Fire/smoke dampers/duct smoke detectors
City: pr -1 I State: ae4 ZIP: to 1 LO7i Heat pump (site plan required)
PhoneQ344e I Fax: 34.7038 I E -mail: Install/replace furnace/burner BTU /H
Including ductwork/vent liner ❑ Yes ❑ No
CCB no.: 3 31 36 Install/replace/relocate suspended,
City /metro lic. no.: 1 0 , wall, or floor mounted
Name (please print): t nC / r -/ n .eV Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: - p tali 'G GQ,r /'lbw Chillers HP
Address: Compressors HP
Salk- Ctc � crate: ICI9 � � Environmental exhaust and ventilation:
City: I ZIP: Appliance vent
Phone: Fax: E - mail: Dryer exhaust
OWNER Hoods, Type If II/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets) i
Type: LPG X NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets 5
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert — type
Phone: Fax: E -mail: Woodstove/pelletstove
Other:
Applicant's signature: Date: OA3'C'D Other:
Name (print): j Q,n.Q, k Gar I l t'V
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ IL
❑ Visa O MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8 %) $
Name of cardholder as shown on credit card accepted as complete. TOTAL $
Cardholder signature Amount 440 -4617 (6/00/COM)
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Commercial Schedule
1 &2 Family Dwelling Schedule
ASSUMED VALUATIONS PER APPLIANCE
Description
Furnace to 100,000 BTU Table 1A Mechanical Code Oty Price Total
1) Furnace to 100,000 BTU
including ducts & vents 955 including ducts & vents 14.00
Furnace > 100,000 BTU 2) Furnace 100.000 BTUr
including ducts 8 vents 17.40
including ducts & vents 1,170 3) Floor Furnace
including vent 14.00
floor furnace 4) Suspended heater, wall heater
including vent 955 or floor mounted heater 14.00
suspended heater, wall heater 5) Vent not included in appliance permit 6.80
or floor mounted heater 955 6) Repair units 12.15
Check all that apply: 'Boiler Heat Air
Vent not included in appliance permit 445 For Items 7 -10, see or Pump Cond City Price Total
Re air units 805 footnotes 1,2 Comp ••
p 7) <3HP; absorb unit to
< 3 hp; absorb.unit 100K BTU 14.00
8) 3 -15 HP; absorb unit
to 100k BTU 955 100k to 500k BTU 25.60
3 -15 hp; absorb.unit una55 1 mil BTU 35.00
101k to 500k BTU 1700 10) 30 -50 HP; absorb
unit 1 -1.75 mil BTU 52.20
15 -30 hp; absorb.unit 11) >50HP; absorb unit >1.75 mil BTU
87.20
501k to 1 mil. BTU 2310 12) Air handling unit to 10,000 CFM
30 -50 hp; absorb.unit 10.00
13) Air handling unit 10,000 CFM*
1 -1.75 mil. BTU 3400 17.20
> 50 hp; absorb.unit 10.00
Non -portable evaporate cooler 1000
> 1.75 mil. BTU 5725 15) Vent fan connected to a single duct
6.80
Air handling unit to 10,000 cfm 656 16) Ventilation system not included in
appliance permit 10.00
Air handling unit > 10,000 cfm 1170 17) Hood served by mechanical exhaust
• 10.00
Non - portable evaporate coller 656 18) Domestic incinerators
vent fan connected to a single duct 446 17.40
19) Commercial or industrial type incinerator
Vent syst. not included in appliance permit 656 69.95
Hood 20) Other units, including wood stoves
ood served by mechanical exhaust 656
10.00
Domestic incinerator 1170 21) Gas piping one to four outlets
5.40
Commercial or industral incinerator 4590 22) More Than 4-per outlet (each)
1.00
Other unit, including wood stoves, inserts, etc. 656 Minimum Permit Fee $72.50 SUBTOTAL =glen
Gas piping 1-4 outlets 360 8% SURCHARGE oug Rasa
Each additional outlet 63 PLAN REVIEW 25% OF SUBTOTAL =i , - ' "
Required for ALL commercial permits only .
TOTAL'' 1r
Other Inspections and Fees:
1. Inspect 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
Total Valuation Fee 3. Additional plan review required by changes, additions or revisions to plans (minimum
charge-one-half hour) 372.50 per hour
'State Contractor Boiler Certification required
$ 1.00 to $5,000.00 Minimum $72.50 "Residential A/C requires site plan showing placement of unit
$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
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$50,000.00`and up $742.00 for the first $50,000.00 and $1.20
for each additional $100.00 or fraction
e3 thereof
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