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Permit (8) II 1 CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Pe COMMUNITY MEC2023-00524 Date Issued: 6/28/2023 T I GAR.L 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112DC00701 Jurisdiction: Tigard Site address: 15989 SW 72ND AVE Project: Momo Sushi Subdivision: FANNO CREEK ACRE TRACTS Lot: 39 Project Description: Duct work only Contractor: EXCEL HVAC INC Owner: PACIFIC REALTY ASSOCIATES PO BOX 1188 ATTN: N PIVEN CANBY, OR 97013 15350 SE SEQUOIA PKWY#300 PORTLAND,OR 97224 PHONE: 971-930-7194 PHONE: FAX: FEES Specifics: Description Date Amount Type of Use: COM Permit Fee 06/28/2023 $398.51 Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 06/28/2023 $47.82 Occupancy Grp: Occupancy Load: Stories: Project Valuation: $12,000.00 Fuel Air Handlers Fuel Types: 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 $446.33 Hoods: Comm Incinerators: Required Items and Reports(Conditions) Woodstoves: Gas Fireplaces: Clothes Dryers: Other Mech Units: Gas Outlets: Other Desc: Duct Work: Fire/Smoke Dampers: This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted b the Oregon Utility Notification Center. Those rules are s t forth in OAR 952-001-0010 through OAR 952-001-0090. You may a a copy of r I Issued By: Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspection d This permit card shall be kept in a conspicuous place on the job site until completion of the p ect. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE USE ONLY' Cityof T 1 and Received /, g Date/By: (a�28lis 0 Permit No.:04„z ,,, ii 13125 SW Hall Blvd.,Tigard,OR 97223 ° c Plan Review I Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: T I G A R U Inspection Line: 503.639.4175 Date Ready/By: Juris: I iii See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information v ` TYPE O WORK IG0 IERCICAL FEE* DULE tJ$E'(l -C_,70i$T Mechanical permit fees*are based on the value of the work ❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition Other: mechanical materials,equipment,labor,overhead,and profit. co.,. GORY OF CONSTRU("i'ION Value:$ ii•4200- RESIDENTIAL E6titiMENT 1 SY3rkMS 1!EES'� . ❑ 1-and 2-family dwelling Commercial/industrial 0 Accessory building For special information use checklist ❑Multi-family 0 Master builder 0 Other: Description P Qty. Ea. Total JOB;SITE INFORMATION AND'LOCATION` Heating cooling: Air conditioning 46.75 Job site address: / S—Ci c -9 3 eA/ 72040 ,i(ve- Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: rl�77ji„Q T 1 viz., 97 2''ii Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name: M 0-in 0 Si/ Sil i 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: Tax map/parcel no.: Water heater 23.32 DESCRI)PIION OF WORK Gas fireplace/insert 33.39 Flue vent for water heater or gas iDa57Xi Bur1 J O✓C7' I-O n- Gat) -ix i STIN fireplace 23.32 ` CIO PT8P VA'i r-5 Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 PROPERTY OWNERi ❑ TENANT Other: 23.32 �r Environmental exhaust and ventilation: Name: ! I Range hood/other kitchen S/ ' equipment 33.39 Address: 3s 5Lt/ 5 t/©r e P h M Z 3 CO Clothes dryer exhaust 33.39 City/State/ZIP: '7 50„47z,z) - 9' Z/ Single-duct exhaust(bathrooms, / toilet compartments,utility rooms) 23.32 Phone:(J d /3) C,ay"Cp 3 00 Fax:( ) Attic/crawlspace fans 23.32 APPLICANT Other: ONTACT PERSON 23.32 1 yi(� Fuel piping: Business name: r(/c CL !/ $14.15 for first four;$4.03 for each additional Contact name: ��yLe-ynl,� A,I Furnace,etc. Address: f Gas heat pump Wall/suspended/unit heater City/State/ZIP: Water heater Phone:(p ) 33 O _ 7<94/ Fax: :( ) Fireplace Range E-mail: eyy d._, Cee.• /40 , tVC-01:1- Barbecue CONTRACTOR Clothes dryer(gas) Business name: L j, or4- ��e Other: MECHANICAL PERMIT'FEES* Address: i 0 /3 0, //81 - Subtotal City/State/ZIP:Cd7,.,s�y l -0y2_, '7073 Minimum permit fee($90.00) Phone:(97/ ) 9 3 7/elj/ Fax:( ) Plan review(25%of permit fee) State surcharge(12%of permit fee) �'� CCB lic.: a/S ge./ TOTAL PERMIT FEE l-)t-1(p =J This permit application expires if a permit is not obtained within 180 c.2'.-.1days after it has been accepted as complete. Authorized signature: /Jj * Fee methodology set by Tri-County Building Industry Service Board 5-.Y7.c.7 "- �y/Print name: ' /( N Z ' Date: altgs.,J2 3 IBuilding\Permits\MEC_PermitApp_040113.doc 440-4617T(I1/02/COM/WEB)