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Permit (9) CITY OF TIGARD MECHANICAL PERMIT IN 1 . COMMUNITY DEVELOPMENT Permit#: MEC2023-00255 Date Issued: 4/27/2023 T I[;A R f? 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112DC00701 Jurisdiction: Tigard Site address: 15989 SW 72ND AVE Project: Momo Sushi&Grill Subdivision: FANNO CREEK ACRE TRACTS Lot: 39 Project Description: New walk-in cooler. Contractor: ACTIVE REFRIGERATION Owner: PACIFIC REALTY ASSOCIATES 13150 SW FOOTHILL DR ATTN: N PIVEN PORTLAND, OR 97225 15350 SE SEQUOIA PKWY#300 PORTLAND, OR 97224 PHONE: 503-333-7577 PHONE: FAX: FEES Specifics: Description Date Amount Permit Fee 04/27/2023 $235.31 Type of Use: COM Plan Review 04/27/2023 $58.83 Class of Work: ALT Type of Const: VB 12%State Surcharge-Mechanical 04/27/2023 $28.24 Occupancy Grp: E Info Process/Archiving-Lg$2.00(over 04/27/2023 $4.00 Stories: 1 11x17) Info Process/Archiving-Sm$0.50(up to 04/27/2023 $1.00 11x17) Fuel Fuel Types: Electricity Gas Pressure: Total $327.38 Required Items and Reports(Conditions) 1 Special Inspection(see plans) A This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. :.-cialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow:' 'e 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 obt7 'a copy of the rules � f Issued By: Permittee Signature: 4�/1I�'. I, � = liL41isl r Call 503.639.4175 by 7:00 a.m.for the next available inspection dat=r 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 rOR()FFICF I SE()NEV N i Received Permit o.: I 11111 City of Tigard Date/By: Pi `d a), �.r� _r a4 13125 SW Hall Blvd.,Tigard,OR 9722RECEIVE PlanRevie I i Phone: 503.718.2439 Date/By: ---)Sir" 2 , Other Permit: L 1 r I(, I,1 t Inspection Line: 503.639.4175 APR 1 0 2023 Date Ready/By: S See Page 2 for Internet: www.tigard-or.gov Notified/Method: ASupplemental Information IlliTYPE OF WORGITY OF TIGARD COMMERCIAL FEE« DIn.E IISE CIwCKIdsT BUILDING DIVISION Mechanical permit fees*are based on the value of the work ❑New uction Other:Addon/alteratlon/rep acement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition mechanical materials,equipment,labor,overhead,and profit. CATEGORY"OF CONSTRUCTION Value $ j1 0 00 'RESIDENTIAL Et21<IIPMENrJ SYSTEMS FEES ❑ 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 AND LOCATION Heating/cooling: Job site address: ' 5 41sei 3s.,(,), '7_2 G)GI Ave Air conditioning 46.75 7 Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: T j G 2 I) i ()rz -i g 2 2.(( Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: iJ.its H 1 11.Co At() Heat pump 61.06 Duct work 23.32 Cross street/directions to job site: �7Hydronic hot water system 23.32 upp r 8E>c)les err j A '4 2n r Avenue. 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: Tax map/parcel no.: Water heater 23.32 DESCRIPTION OF'WORK Gas fireplace/insert IN�� 33.39 �� Flue vent for water heater or gas I I) (lt�'�i c J'2 ls I k • ,Il ( fireplace 23.32 10? I' Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 o PROPERTY OWNER ,l TENANT"". Other: 23.32 • � Environmental exhaust and ventilation: Name: k C v j� I.-0ni 61 Range hood/other kitchen Address: t�5 9 Ci 2e.44 !e equipment 33.39 O ca.) ,� Clothes dryer exhaust 33.39 City/State/ZIP: poiLTI 4..A.)2) ®JZ. q 72 Z-Y Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:( ) Fax:( ) Attic/crawlspace fans 23.32 pi APPLICANT I CONTACT PERSON Other: 23.32 Business name: A c T v e j�,g I •:, r a+`J t') � Fuel piping: t' $14.15 for first four;$4.03 for each additional Contact name: 5 f Il) y(,(s(j c.)t/ / Furnace,etc. .Address: ) I `I V .� J 129 t t^ 1 / Gas heat pump Ci /State/ZIP: ( ,{� L1 Wall/suspended/unit heater t3 i 1 /t S✓r2 j Water heater Phone:(C u ) '2j' 3.3 '-qs 07-4 Fax::( ) Fireplace E-mail: Range Barbecue CONTRACTO Clothes dryer(gas) Business name: c L7 ‘./e P.e I' e!pz 66.-1 2. iirC Other: Address: , / (,t i 2 `? P/ MECHANICAL PERMIT FEES* Subtotal City/State/ZIP: T"I IC/2.6OR_ �l T C..23 Minimum permit fee($90.00) Phone:(S i) ?J';,3 ' Fax:( ) Plan review(25%of permit fee) Z( � ��� State surcharge(12%of permit fee) _g CCB lic.: TOTAL PERMIT FEE /c117,� This permit application expires if a permit is not obtained ithin 180 days after it has been accepted as complete. Authorized signature: Fee methodology set by Tri-County Building Industry Service Board _Print name: S 1i--; l u s Li rU V Date: ©1-// i 0/2 3 I.\Building\Permits\MEC_PennitApp 082520.doc 440-4617T(I 1/02/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 k Minimum fee$69.06 $500JM o$5,000.06 $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. $1 0,000.01 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. I:\Building\Permits\MEC_PermitApp_082520.doc 2