16590 SW 93RD AVENUE IW;90 SNN to''I %A
CITYOF T'IGAR!� — MECHANICAL PERMIT
PERMIT MEC200200448
DEVELOPMENT SERVICES
13125 SW Hail Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/11/02
PARCEL: 2S 114AC-00300
SITEADDRESS- 1tJ:;�10 SVS✓ 93Rf� AVE
SUBDIVISION: CAFFATI-S CORNER ZONING: R-4.5
BLOCK: _ LOT: 003 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:
3T ORIES: BC11LERS/COMPRESSORSHOODS:
_FUEL TYPES_ 0 - 3 HP: _ DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS?: 30 - 50 HP: REPA'R UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU- AIR HANDLING UNITS CLO DRYERS:
FURN —100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Remarks: Run approx. 35'gas line and 1 connection for range.
Owner: --- Ff_E_S
DONALD A. HOOK Description Date Amount
16590 SW 93RD AVE — --
TIGARD, OR 9722.4 [MIA]I I Permit I-ce 10/11/02 $72.50
[Mk I II Permit Fee 10/11/02 $0.00
ITAX1 `0o StateTax 10/1 !/02 $5.80
Phone: 503-639-5271 I1AX1 x" Starc•1ax 10/11/02 $0.00
Contractor_ Total $78.30
OWNER
REQUIRED INSPECTIONS _
Phone: Gas Line Insp
Reg #: Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applir;able laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00
Issued By: Permittee Signature:_�._1_ � , ,•' ! ,
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next busingss day
Mechanical Permit Application
PiDla!ue reccivcd:1 i (, i- Permit no..
Ci of Tigard 1y g proje,Uappl,no.: Expiredate:
Cirq(Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By-> Receipt no.:
Phone: (503) 639-4171 —
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
U I &2 family dwelling or accessory U CommcrciaU;ndastrial U Multi-family U Tenant improvement
U New constniction �A Addi(ion/alteration/replacement U Other: _
1 1 1 1 1
_Joh address: /�(S�l! G, <' �. Jp r Indicate equipment quantities in boxes below. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: profit.Value$
Lot: Black: Subdivision: 'See checklist for important application information end
Project name: ,jurisdiction's fee schedule for residential permit fee.
City/county: . e ZIP: r 1 t '!I
Description and I ation of work on premises: r 1 I 1
1'ec(r'a.) Total
E. .date of completion/inspection: /o / JZ. DrWripliuu iJl). Res.onl Res.oul)
Tenant improvement of change of use, n t
Is existing space heated or condilioncd?6Yes U No Air handling unit
—
it conditioning(site plan require )
Is existing space insulated?m Yes U No Alteration of existing 11VAC system
of er compressors
iE f. State boiler permh no.:
Business name:
HP Tons It l t'!I I
Address: 'treasrno a impers/ uctsmo etecti)rs
City: State_ Z P: lleat pump site plan required)
Phone: I I ac E-mail: nsta l/rep r •:I"urnac urner B'
Including ductwork/vent liner U Ycs U No
CCB no.: nsta rep ac re Deal- Eaters-suspen e(,
Ci(y/metro lic.no.: wall,or floor mounted _
Name(please print) ant for appliance other t uui furnace -
1 1 e gerat on:
AbsorptionunitsBTU/II _
Name: Chillers _ HP
Address: - - Coni rrssnrs HP --
nv r; antal exhaust and ventilation:
City: Stale: _ ZIP: Apphan^cvent
Phone: Fax: E-mail: )ryercx oust
o(�ype /res. tr en iazmat
_ hood fire suppression system
Name: I„ ' �J f/ Cxhaust fan wish single duct(bath fans)
Mailing addres_:/��'�I' �-i, ! •� A, Exhaust system girt from heating or AU
Fuel piping an st ul on(up to 4 outlets)
City: r",, Stale:O; LIP: Ty LPO NO J011
Phone: I :i� E-mail: Fuel ti pin•each additional over 4 outlets
Process piping(sc ematic require(T)
Name: Number of outlets
Other listed appliance or equ pment:
Address: _ Decorative fireplace
City: ,tat,: 7.IP: Insert type —
—`�`-
I'honc "� oo(.clove. el stove
� f? x -mail:
Ut er.
Applicant's signature: Date:
Name. (print): --
Na all)tuimlicuono incept oath cmdn,plea,(can iunµtictinn far nuue infnnnouun Nonce Permit fee.....................$
U Vina U Afusteifard This permit application Minimum fee................It
Credit card numtrr __.____ ,_ / / expires if n permit is not obtained Plan review(at A Mfr) $
aplret within 180 days ane(it hes been Slate surcharge(8%) ....$ - �—
,
a m c n r u e own on con c its accepted as complete. "
Cudhuldet dltnuute _ Amount 440-4617 W1x11COM)
MECHANICAL PERMrr FEES
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
Description: Price Total
TOTAL VALUATION: PERMIT FEE: Table 1A Mechanical Code Qty (Ea) Amt
$1.00 to$5 000.00 Minimum fee$72t$ 1) Furnace to 100,wo BTU
$5,001.00 to,010,000.00 $72.50 for the first$ional 10 and includingducts& ,,-nts 14.00
$1.5:for each additional$100.00 or 2) Furnace 100,00 BTU+
fraction thereof,to and Including Including ducts&vents 17.40
$10 000.00.
3) Floor Furnace 1400
$10,001.00 to$25,000.00 $148.50 for thr,first$10,000.00 and Including vent
$1.54 for each additional$100.00 or
fraction Piereof,to and including 4) Suspended heater,wall heater 14.00
$25,000.00, or floor mounted heater _.._-
$25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and 5) Vent not included to appliance permit 6.80
$1.45 for each additional$100.00 or
fraction thereuf,to and including 6) Repair units 12.15
500 .)0.
$50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Boiler Heat Air
$1.20 fur each additional$100.00 or For Items 7-11,see or Pump Cond
Comp
fraction thereof, footnotes below. _
7)<3HP;absorb unit 14.00
Minimum Permit f=ee$72.50 SU@TOTAL: $ to 100K BTU -
6)3-15 HP;absorb 25.60
8°/.State Surcharge $ unit 100k to 500k BTU-
9)_15-30 HP;absorb 35.00
25%Plan Review Fee(of subtotal) $ unit.5-1 mil BTU
Required for ALL commercial permits onl 10)30-50 HP;absorb
TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.zo
11)>50HP;absorb
- - 87. 0
unit>1.75 mil BTU ---
----
- 12)Air handling unit to 10,000 CFM
ASSUMED VALUATIONS PER APPLIANCE: _ 10.0
Value Total 13)Air handling unit 10,000 CFM+
Desai tion• al Ea Amount 17.20
Fjmace to 100,000 BTU,including 955 14)Non-portable Evaporate cooler
t0.u0
dr cis&vents V
Fumace>100,000 BTU Including 1,170 15)Vent fan connected to a single duct
ducts&vents _ 6.80
Floor furnace including vent 955 13)Ventilation system not Included in
Suspended heater,wall heater or 955 a /lance permit 10.00
floor mounted heater 17)Hood served by mechanical exhaust
Vent not Included In appliance 445 10.00
P_ermit -- 5 18)Domestic Incinerators
80
Repair units 17.40 _
<3 hp;absorb.unit, 955 19)Commercial or industrial type incinerator
to 100k BTU _ 69.95 -
3-15 hp;absorb.unit, 1,700 20)Other un!ts,Including wood stoves
101k to 500k BTU _ 10.00 _-
15-30 hp;absorb.unit,501k to 1 2,310 21)Gas piping one to four outlets
mil.BTU 5.40
30-50 hp;absorb.unit, 3,400 22)More than 4-por outlet(each)
1.1.75 mil.BTU :�;�
-
>50 hp;absorb,unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL:
>1.75 mil.BTU
Air handlingunit to 10 000 cfm 656 8%State Surcharge $
Air handling unit>10,000 cfm 1,170
Non-portable eva orate cooler 656 - TOTAL RESIDENTIAL PERMIT FEE: I s
Vent fan connected to a single duct 446
Vent system not Included In 656
a (lance armOther InaaectI ns and Fees:
Hood served by mechanical-exhaust _656 t Inspections outside o1 normal bi,,mess hours(minimum charge-two hours)
Domestic Incinerator 1 170 $62 50 per hour
Commercial or industrial Incinerator 4L590 2 ind2 5 tipoenf„oor which no tea is specifically Indicated (minimum charge-half hour)
Other unit,Including wood stoves, 658
Inserts_elC. y� our
3 Additional plan review required by changes,additions or revisions to plans(minimum
360 charge-one-half hour)$82 50 per hour
Gas pi Inp g 1.4 out
-•
Each additional outlet_ 63 'Stale Conlractir Boller Certification required for units>200k BTU.
- "'Residential AIC requires site plan showing placement of unit.
TOTAL COMMERCIAL $
VALUATION: �� All New Commercial Buildings require 2 sets of plans.
I:\dstslformslmech-fees.doc 02/11/02
CITY OF TIGARD 24-Hour
BUILDING Inspection Linp: (503) 639-4175
INSPECTION DIVISION Business Line: (503)639-4171 NIST
BUP
Received - .3
------.Date Requested_ �- . C'