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Permit ��_� -_ . 'fir- 11512 Mechanical Permit Applicati�n>f r �/ +" r-01R 0,.-,,,,( I. I sl.:(Iv 1.1 City of Tigard Received�y �C7... / /J r fe a2/ d 16, r yy nn qq (/� (/!�/ Permit No.: f/ V(l C7 i'" 13125 SW Hall Blvd.,Tigard,OR 97223 v -� 2 �► UG� Date/B Plan Rewe Phone: 503.718 2439 Fax: 503.598.1960 .._. , Date/Br ('"� t Other Permit: i I GARD Inspection Line: 503 639.4175 (i 4 vI O1 ►1t�,i1 1 + `�' '. M�y g�p� }f+nln i Date ReadyBy: tuns 65 See Page 2 for Internet: www.tigard-or.gov f UtLLfIIVt�ot <./a Notifie ethod: / U r 1 x& Supplemental Information TYPE OF WORK COMMERCIAL FEE* SCHED LE- USE CHECKLIST Mechanical permit fees*are based on the value of the work ❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition 0 Other: mechanical materials,equipment,labo overivd,and profit. Value:$ % b CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* 0 1-and 2-family dwelling X,Commercial/industrial 0 Accessory building For special information use checklist ❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: / Air conditioning 46.75 Job site address. / u iv./ 1, /1 ( l✓t R { F4rnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: // /24._.1.,_/ ©A L9.�22 4i Furnace 100,000+BTU(ducts/vents) 54.91 1 , f Heat pump 61.06 Suite/bldg./apt.no.: Project name: f w C-/ Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Flue/vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 Other fuel appliances: "l'ax map/parcel no.: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 _ �+ Flue vent for water heater or gas /i'l-ri /1 69 J-Y 21 )-) /j 10 411 d fireplace 23.32 eUC' +�V k G'. is r Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 0 PROPERTY OWNER . 'J"TENANT Other: 23.32 Environmental exhaust and ventilation: Name: p,,✓c. Range hood/other kitchen Address: / equipment 33.39 7�� Y lam- It C'�h G, 1--. /\ Clothes dryer exhaust 33.39 City/State/ZIP: �/ %f,.y / 0 k 9)21 y toilet compartments,le-duct ents(bathrooms, [ C' f toilet utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 .4 APPLICANT ❑ CONTACT PERSON Other: 23.32 Fuel piping: Business name: p f o7 n., 45-,r- .l 4-le-.T �/ 1` � 1 c $14.15 for first four;$4.03 for each additional Contact name: ®,, Y 0 Furnace,etc. Address: q 2 pd>. s'1- f 7 1 �r� Gas heat pump Wall/suspended/unit heater City/State/ZIP: tO v r 71/oriC( 0 9 7.221 Water heater S Phone:( D3)5/ q, Jo PJ JFax::(Th3 )a yp -• 9••.2c7 Fireplace Range E-mail: 10`/,U /J co 7&,y It,e 0!� Barbecue r ,v CONTRACTOR / Clothes dryer(gas) Business name: f"4 1,"1 t_ C�J 'J',,// G e,.1 other MECHANICAL PERMIT FEES* Address: Subtotal City/State/ZIP: Minimum permit fee($90.00) Phone:( ) Fax:( ) Plan review(25%of permit fee) State surcharge(12%of permit fee) CCB lie.: 31r? 6. TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Authorized signature: �. * Fee methodology set by Tri-County Building Industry Service Board Print name: A o c,/j 4 Y,n Date: 9 ^J s- 2 I:1Building1Permits\MEC_PermitApp_040113.doc 440-4617f(11/02/COM/WEB) City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT TIGARD' Building Permit Review — Commercial - No Land Use Building Permit #: kie-c2o2i- C757 Site Address: 2560 5(J Durham Rd, . Suite/Bldg#: Project Name: fJ CC (Name of commercial business occupying the space. If vacant,enter Spec Space.) Planning Review pp r,� Proposal: -J 4q,14 Ovtt 3,5 "TPA' lam' .� Y pt/A—wor`/ Existing Business Activity: - /v�/•r Proposed Business Activity: ulfit ® Verify site address/suite# exists and active in permit system. ® River Terrace Neighborhood: ❑ Yes X No g Zoning: ® Permitted Use: N) Yes ❑ No ❑ Spec Space • Confirm no land use required. .❑ Business /I A • • , n Notes: AO 1,a,v1.4 Approved by Planning: Date: PI Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Building Permit Submittal Original Submittal Date: &27.2-1 Site Plans: # 2- Building Plans: # 2— Building Permit#: ®'"Enter building permit#above. Workflow Routing: Ir'Planning ❑ Permit Coordinator 3uilding Workflow Sign-off: Sign-off for Planning(include notes from planning review) Route Application Documents: [ - uilding: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician: J�jr.y�� Date: ,/$ 2ti/ I:\Building\Forms\BldgPennitRvw_COM_NoLandUse 111819.docx 'ermit Coordinator Review El C.•ditions "Met"prior to issuance of building permit ❑ Approv- , NOT Released: Date: Notes: Revisions (after Building Submi' : only) Revision Notice 1: Date Sen 'pplicant: Revision Notice 2: Date S; t to A. -cant: Revision Notice 3: D. Sent to Applican ❑ SDC Fees Entered: Wash Co Trans Dev Tax: N es ❑ N/A Tigard Trans SDC: ❑ Yes El N/A Parks SDC: ❑ Yes N /A ❑ OK to I : e Permit Appr• ed by Permit Coordinator: II I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_111819.docx