Permit ..._,
CITY OF TIGARD MECHANICAL PERMIT
,1A DEVELOPMENT SERVICES PERMIT #: MEC2001 -00041
"`- ' �� JI 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/2/01
�_.
PARCEL: 1 S125DB -00400
SITE ADDRESS: 09305 SW 70TH AVE •
SUBDIVISION: SHADY DELL ZONING: R -4.5
BLOCK: LOT: 004 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: 1 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: CLO DRYERS:
FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Installation of furnace to replace existing furnace, and installation of exterior NC unit. A/C unit cannot be
placed within the required setbacks.
Owner: FEES
WINCZEWSKI, OLIVER BARBAR Type By Date Amount Receipt
9305 SW 70TH PRMT CTR 2/2/01 $72.50 2720010000
TIGARD, OR 97223 5PCT CTR 2/2/01 $5.80 2720010000
Total $78.30
Phone:
Contractor:
ANCTIL SHEET METAL CO.
4320 N WILLIAMS AVE
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Gas Line lnsp
Phone: 503- 281 -0752 Mechanical lnsp
Reg #: LIC 8897
EXPIRED
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 obtain copies of these rules or direct questions to OUNC by
calling (503)246 -9 • ,
Issue By: Q� • i - Permittee Signature: .. / �/I,J /� � • �// Call (503) 639 -4175 by 7:00 P.M. for inspections ne: ed the ext business day
• .
Mechanical Permit Application
Date received: a /V,0 / Permit no.: /J Z(10/ ao rr/
...
' „,,'. City of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: 4ftReceiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
"1'YI'E OF PERMIT
X 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ./1 Addition/alteration/replacement ❑ Other:
JO11 SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
)( Job address: • 0 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: Block: Subdivision: •See checklist for important application information and
Project name: _, m (01-tt/ - , , jurisdiction's fee schedule for residential permit fee.
City /county: • - ZIP: • _ 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE
Description and 1. ation of work on premises: .b/ s 4 .0.1. e4CF
AND COMi 1ERICALIlNDUS7 R1:1L EQUII'i9ENTSCIIEDULE
Fee(ea.) Total
Est. dat ^ • f • • 1 ti • • . 2 - 5 ■ Description Qty. Res. only Res. only
Tenant improvement or change of use:
Air H ' ha n ■ --
Is existing space heated or conditioned? Glees ❑ No Air co nditng unit CFM conditioning (site plan required) IV] Is existing space insulated? a'Yes ❑ No Alteration of existing HVAC system
MECIIANICAL CONTRACTOR Boiler/compressors b
State boiler permit no.:
E - % HP Tons BTU/H
A Address: - • . - .to Fire/smoke dampers/duct smoke detectors _
ELSW•• NNCMIMMIll MIMI ZIP: _ a / 7 Heat pump (site plan required) _
Phone: Ob_ . 2. Fax: E -mail: Install/replacefurnace/burner , BTU /H M --
97 Including ductwork/vent liner r• Yes CI No
CCB no.: ; InstalUreplace/relocate heaters - suspended, ■ --
City/metro lic. no.: wall, or floor mounted -
Name (please print): Vent for a • • liance other than furnace -
CONTACT PERSON
Absorption units BTU/H
Name: Chillers HP MO
Address: Com • ressors HP ME
vuonmen exhaust an ■ ven :ton: ■ --
City: State: ZIP: Appliance vent
Phone: Fax: E -mail: Dryer exhaust
OWNER Hoods, Type U IUres. kitchen/hazmat ■ __
hood fire suppression system
Name: Exhaust fan with single duct (bath fans) -
Mailing address: Exhaust system a • art from heating or AC MN
City: State: ZIP: ye p : a°' •'t` ' ut on up to 4 ou es ■ --
Type: LPG G NG Oil
Phone: Fax: E -mail: Fuel • i • ing each additional over 4 outlets MI
ENGINEER ' 1 essp p .: (schematic required) = ==
Name: Number of outlets
Ot er app or eq pment:
II
Address: Decorative fireplace
City: State: ZIP: Insert - type =
Phone: OMNI= E -mail: Woodstove/pellet stove I
Other:
x Applicant's signature 7 t/. 1 , ,� ,�� ' Date: a-, - Other: MI
/ Name (print): - ;irirMa �7
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $ / 2 -c)
0 Visa 0 MasterCard Notice: This permit application Minimum fee $
expires if a permit is not obtained Plan review (at %
Credit card number: Ex
Expires with 180 days after it has been ( %) $
p State surcharge (8 %) .... $ _S .P0
Name of cardholder as shown on credit card accepted as complete. TOTAL $ 7,?", 3 v
Cardholder signature Amount EXPIRED 440-4617 (6100 /COM)
r '-cam
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) Fumace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts &vents 14.00 /
fraction thereof, to and including 2) Fumace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Fumace
$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 /
ASSUMED VALUATIONS PER APPLIANCE: to 3- 1K BTU 1 / 14.00 /
8) 3 -15 HP; absorb
Value Total unit 100k to 500k BTU 25.60
Description: Qty (Ea) Amount 9) 15-30 HP; absorb
Fumace to 100,000 BTU, including 955 unit .5-1 mil BTU 35.00
ducts & vents 10) 30 -50 HP; absorb
Fumace > 100,000 BTU including 1,170 unit 1 -1.75 mil BTU 52.20
ducts & vents 11) >50HP: absorb
Floor fumace 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. 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 YO 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: $R� 4V
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: $ 7if 30
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 Boller Certification required for units >200k BTU.
** Residential NC requires site plan showing placement of unit.
i:\dsts\forms\mech- fees.doc 10/11/00
FROM : ANCTIL Heating & Cooling PHONE NO. : 503 2825722 Feb. 02 2001 12:45PM P1
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