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Permit CITY OF TIGARD MECHANICAL PERMIT g COMMUNITY DEVELOPMENT Permit#: MEC2022-00311 Date Issued: 4/20/2022 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S136CD00100 Jurisdiction: Tigard Site address: 11705 SW PACIFIC HWY X Project: Jersey Mikes Subdivision: None Lot: None Project Description: Gas piping for water heater and grill. Contractor: DP PLUMBING INC Owner: PACIFIC CROSSROADS PROPERTIES INC 15825 NE SPRINGBROOK BY WYSE INVESTMENT SERVICES CO NEWBERG, OR 97132 810 SE BELMONT ST#100 PORTLAND, OR 97214 PHONE: 503-537-9492 PHONE: FAX: FEES Specifics: Description Date Amount Type of Use: COM Permit Fee 04/20/2022 $121.25 Class of Work: ALT Type of Const: VB Plan Review 04/20/2022 $30.31 Occupancy Grp: B Occupancy Load: 12%State Surcharge-Mechanical 04/20/2022 $14.55 Stories: Info Process/Archiving-Sm$0.50(up to 04/20/2022 $1.00 11x17) Project Valuation: $2,200.00 Fuel Air Handlers Fuel Types: Natural Gas Units< 10000 cfm: Gas Pressure: Units> 10000 cfm: Furnaces Boilers&Compressors Furnaces< 100K BTU: 0-3 HP: Furnaces>= 100K BTU: 3-15 HP: Floor Furnaces: 15-30 HP: Unit Heaters: 30-50 HP: Vents w/o Appliances: 50 or Greater HP: Air Conditioning: Heat Pump: Appliances Vent Fans: Vent Systems: Total $167.11 Hoods: Comm Incinerators: Required Items and Reports(Conditions) Woodstoves: Gas Fireplaces: Clothes Dryers: Other Mech Units: Gas Outlets: 2 Other Desc: Duct Work: Fire/Smoke Dampers: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules • Issued By: Permittee Signature: e7//j71 � Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE USE ONLY City of Tigard RECEIVEDDaceBed I '/��/i //,, ,,v,'�.2 ' 3 II w 13125 SW Hall Blvd.,Tigard,OR 972 Date/By: F+(/ Pe [ OC(/ /Y7 /� _ Plan Review (r�/ Phone: 503.718.2439 Date/By: Other Permit: T I G A R D Inspection Line: 503.639.4175 APR 2 0 2022 Date Ready/By: Juris: FE See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information CITY OF TIGAE(1 TYPE OF WiatAIDING DmSioN COMMERCIAL.FEE*SCHEDULE—USE CHECKLIST New construction ❑Addition/alteration/replacement Mechanical permit fees*are based on the value of the work performed.Indicate the value(rounded to the nearest dollar)of all ❑ Demolition ❑ Other: mechanical materials,equipment,labor,overhead,and rofit. CATEGORY OF CONSTRUCTION Value:S .< RESIDENTIAL.EQUIPMENT/SYSTEMS FEES* 0 1-and 2-family dwelling Commercial/industrial ❑Accessory building For special information use checklist. ❑ Multi-family ❑ Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION A LOCATION Heating/cooling: Job site address: l i S'J 5,5(.� `1 C r�CG �� Air conditioning 46.75 76 ((,1{ W Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 1 ©P' Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./aVet:1 fy X Project name: &R.se� rm.,i ge_'C Heat pump 61.06 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 Tax map/parcel no.: Other fuel appliances: Water heater 23.32 DESCRIPTION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas fireplace 23.32 6 pt pi njP Log lighter(gas) 23.32 fi Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 ❑ PROPERTY OWNER ❑ TENANT Other: 23.32 Name: Environmental exhaust and ventilation: Range hood/other kitchen Address: equipment 33.39 Clothes dryer exhaust 33.39 City/State/ZIP: Single-duct exhaust(bathrooms, Phone:( ) Fax:( ) toilet compartments,utility rooms) 23.32 Attic/crawlspace fans 23.32 ❑ APPLICANT 0 CONTACT PERSON Other: 23.32 Business name: 6 O -'41 �L e�-eltCS f i Fuel piping: 6 t� 1 � ��I � 7� Contact name: "/') $14.15 for first four;$4.03 for each additional A a r T e. ��t �(A iS Furnace,etc. Address: Pe r )h k'\ C{ Gas heat pump City/State/ZIP: UCtnCe.00 Vw t^CV�, wl ��6� : Wall/suspended/unit heater Water heater Phone:(360 7/9 84 l? Fax::( ,)�\ �� Fireplace E-mail: ci4 nYe- L Fe'r i.IT CC C ctcAoc . (C (y ; Range 6✓CONTRACTOR Barbecue Clothes dryer(gas) Business name: ) p j( j � JA�i''/T , ( Other: Address: ( C..e1J �6(� v o _G�.(:),,I 1/N J �y±,,, �/�i MECHANICAL PERMIT FEES* l L/ J\ 1 Jr ( rfl� � ) Subtotal City/State/ZIP: rpr t(� is t !/LA<.J-r Minimum permit fee($90.00) Phone:( ) Fax:( ) Plan review(25%of permit fee) CCB lic.: 2d ��� State surcharge(12%of pennit fee) [ TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. 'I -� * Fee methodology set by Tri-County Building Industry Service Board Print name: ONE._ 05 tt�j�S. Da e: 26/2 2_ I:\Building\Permits\MEC_Permi1App_082520.doc ` 440-4 17T(11/ /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Submittal Requirements: • (2) sets of plans, drawn to scale. • (2) sets of equipment cut sheets. • (2) copies of site plan for ground and roof top equipment location and screening per Tigard development code. Commercial & Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. 1:\Building\Permits\MEC_PennitApp_082520.doc 2