Permit IN i a CITY OF TIGARD MECHANICAL PERMIT
;' a COMMUNITY DEVELOPMENT Permit #: MEC2009-00686
Ai G ARb, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/24/2009
Parcel: 2S102AD03450
Jurisdiction: Tigard
Site address: 8777 SW BURNHAM ST
Subdivision: Lot: 0
Project: City of Tigard
Project Description: Placement of ground mount a/c unit. No land use review required and no building plan review
required.
Owner: FEES
TIGARD, CITY OF & Description Date Amount
TIGARD WATER DISTRICT ET AL, 13125 SW
Permit Fee 12/24/2009 $75.20
HALL BLVD 12% State Surcharge - Mechanical 12/24/2009 $9.02
PHONE:
Contractor:
RINU
19570 SW 90TH CT
TUALATIN, OR 97062
PHONE: 503 - 603 -0205
FAX: 503 -603 -0150
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Occupancy Load:
Stories:
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressue: 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: 1
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $84.22
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 N . ation Center. lose rules are set forth in OAR 952 - 001 - 0010 through OAR 952 - 001 - 0100. You may obtain a copy of the rules
or dir t questions to OUNC b call • • - 03.246.6699 or 1.800.332.2344.
Is ued By: L ` I i � ` Permittee Signature: / // / I/ /
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 Ap ,, ,I Ni FOR OFFICE USE ONLY
City of Tigard Received Permit No A Q�
`J g Date /By: /A Q /i , // ...co �l ,(
e 1 3125 SW Hall Blvd., Tigar , 7_23
i ' Plan Review
Phone: 503.639.4171 Fax: 503r4@E(Y9V4 2009 Date /By: Other Permit:
T I G A R D Inspection Line: 503.639 U C Date Ready /By: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: e" / (G Supplemental Information
TY1 D &K VISION
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 profit.
CATEGORY OF CONSTRUCTION Value: $ 6 / 7
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1 ❑ 1- and 2- family dwelling .® Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. I Total
�/ JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 777 � t4.r , St.
Air conditioning
(requires ite plan • Jb itdd
9 � 0.[^'l (requires site plan showing placement) 46.75
City/State /ZIP: f aY o f OQ 9 722_3 Furnace 100,000 BTU (ducts /vents) 46.75
� ) /- / Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: t ll*L WorGCS Stator Heat pump 61.06
Cr oss street/directions to job site: l Duct work 23.32
O Hydronic hot water system 23.32
Residential boiler (radiator or
\ . J 1 hydronic) 23.32
Unit heaters (fuel -type, not electric),
.k
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
•
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
/ ,t Gas fireplace 33.39
5 `/ uI ESS S� �/ / Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
® PROPERTY OWNER ❑ TENANT Chimney /liner /flue/vent 23.32
L
Other: 23.32
Name: C l l y cr r "T � r Environmental exhaust and ventilation
Address: 3 2 S 5b0 l� (� �� v Range hood /other kitchen
a equipment 33.39
City/State /ZIP: I' a r1{ 0 - q 7a 2,3
Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Vhone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
L. ® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business name: y / I Other: 23.32
Ke Atec Fuel piping
Contact name: ,12 /r i„' f $14.15 for first four; 54.03 for each additional
IPL J Furnace, etc.
Address: /1'5 70 560 7p/ Co._ r * Gas heat pump
40 City/State /ZIP: ) &Ja - ih c q7o (2 Wall/suspended/unit heater
Phone: (co )6o3 _0 2 Fax: : (S03 )E03 - 0/,510 Waterheater
n / Fireplace
E -mail: a (7 4 V i�G -- 01 � a i4 ;c J GON1 Range
CONTRACTOR Barbecue
— Business name: ,{.. I Clothes dryer (gas)
`n1 Pa P/y` u to cE` Other:
Address: J R5 70 SO gall, Lea r' MECHANICAL PERMIT FEES*
C( City/State/ZIP: 4i l dg, ?7D -7. Subtotal
Fax: Minimum permit fee (590.00)
Phone:
(Sr,3 ) 603 — 02 c� 5 (5 O ,5) £ 3 — O /SO Plan review (25% of permit fee)
CCB lic.: 1S3 770 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: i /,' i /9---- days after it has been accepted as complete.
Print name: /�4 r�s Date: /?lZcrlp q ' F ee methodology set by Tri -County Building Industry Service Board
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