Permit (30) CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit#: MEC2022-00161
T I(A R,O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/17/2023
Parcel: 2S102BD00100
Jurisdiction: Tigard
Site address: 9905 SW MCKENZIE ST
Project: St.Anthony's Church Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 52
Project Description: Install(3)Mitsubishi ductless heat pumps with(5)interior units in pre-school building.
Contractor: COLUMBIA NW HEATING Owner: ST ANTHONY CATHOLIC CHURCH TIGARD ORE
PO BOX 1528 9905 SW MCKENZIE ST
BOTHELL,WA 98041 TIGARD, OR 97223
PHONE: (503) 701-6042 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 03/18/2022 $756.65
Class of Work: ALT Type of Const: VB Plan Review 03/18/2022 $189.16
Occupancy Grp: A-3 Occupancy Load: 12%State Surcharge-Mechanical 03/18/2022 $90.80
Stories: 1 Info Process/Archiving-Sm$0.50(up to 03/18/2022 $3.00
Project Valuation: $26,032.00 11x17)
Fuel Air Handlers
Fuel Types: Electricity 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: 3
Appliances
Vent Fans: Vent Systems: Total $1,039.61
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: 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 C
enter. hose rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a cop of the rules
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next availabl spection 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 Applicati I (1l( (11 1 1( 1 I ,1 t 1%I ,
TtECEIVED _
City of Tigard Receives -2. .'
13125 SW Hall Blvd.,Tigard,OR 97223 Una3ly: �J 2Q� .�� Permn\o �'�� �b
Phone 503 718.2439 Fax: 503.598.1960 FEB 22 2022 Plan Rev ew
n.te/6y: 3.....ask-�. Other. Peanut:
Inspection Line. 503.6394175 CITY OF TIGARD Due Re+dY�r '" H See Pa i
Internet ww v tigard-or.govdim �r �r
BUILDING DIVISION � �Z �� Supplemental Information
TYPE OF WORK 1 , RCIAL FEE" SCHEDULE- USE CHECKLIST
Mechanical permit fees'are based on the value of the work
0 New construction IS Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S 2,10s OSZ
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES`
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building For
special lq jornwlon are checklist
❑Multi-family 0 Master builder ❑Other: Description I Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Headaglcodivg:
3 Air conditioning 46.75
Job site address: _ CIqS 'SW
Wicj{C,evale. 11-. Furnace 100,000 BTU(ducts/vents) 46,75
City/State/ZIP: --r,p)aVOt 0 R, °I,ZZ3 Furnace 100,000+BTU(dmts/vents) 54.91
Suite/bldg./apt,no.: �J I Project name: S4. 0,44�p f / _/- Duct pork 23.32
/� .1 G�IGG► Duct work 23.32
Cross street/directions to job site: 4) i,c 4 fj G q l W Hydmnic 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: I Lot no.: Other 23.32
Other feel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
s Flue vent for water heater or
gas
1 Ns1-+t h L3) IM){•5(AbSi/li ots4. w
ss trv4-imvefS fireplace 23.32
Log lighter )
Vii (S) t w 04.0r t� "1"5 i vi .'►rC" S�1Q7l t7W(d:H ' Wood/pellet(
ood/ lel(s as
23.32
O$ (i (5 ���� �II) Are, b€ PtPA14-se4 se CAW33.392
J ' 3 �• Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY OWNER I 0 TENANT Other: 23.32
F.nviroaneelal exhaust and ventilation:
Name: Range hood/other kitchen
Address: equipment 33.39
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments.utility rooms) 23.32
Phone:( I Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT ErCONTACT PERSON Other: 23.32
Business name: C'p win ti: la 1,14j frier 1-{tn7 Fuel piping:
:
Sic Is for lint four,S4.63 for nett additional
Contact name: _Kill gi 1 Furnace,etc.
Address: •Po eal OLL Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: 5444,loose, of- 011VS(0, Water heater
Phone:(503)olifot -121 2-, Fax::( ) Fireplace
E-mail: 110 c.2la._�L 1 Gorbt Range
w1AC7-��• Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: f nLuwl b{a. 'lull 4-tef-V1 Other
MECRANlCAL PERMIT FEES`
Address: 10 61 (5'2 Subtotal
City/State/ZIP: Q�o,NncAt ( j a- 1gbt4.i Minimum permit fee(590.00)
k. Plan review(25%of permit foe)
Phone:(rrjpi) rJ'43 ' 3 I►y-F Fax:( ) State surcharge(12%of permit fee)
CCB lie.: 131e4152_, TOTAI.PERMIT FEE
Thta permit application expires if a permit is nor obtained within In
days after it has been accepted as complete.
Authorized signature. r y� • For methodology set by Tri•Counry Building Industry Service Board
Print name: T 41(4) rr�O(V(f71 Date: Zl f r.102:24
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