Permit Ip 'r , - o CIT O TIGARD MECHANICAL PERMIT
q COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00381
'" DATE ISSUED: 7/23/2008
TI 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102C B -03101
SITE ADDRESS: 12950 SW PACIFIC HWY 225 ZONING: C -G
SUBDIVISION: HUDSON PLAZA LOT: 021 JURISDICTION: TIG
PROJECT: MARILYN HENDERSON CONSTRUCTION
Project Description: Replacing existing roof top gas pack unit. Valuation: $18,332
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: 1 COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP:
WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
HENDERSON, MARILYN DOROTHEA Description Date Amount
JENSEN HUDSON TRUSTEE
11795 SW KATHERINE ST [MECH] Permit Fee 7/23/200E $344.90
TIGARD, OR 97224 [MECPLN] Plan Rev 7/23/200E $86.23
[TAX] 12% State Surch 7/23/200E $41.39
Phone: Total $472.52
Contractor:
SPECIALTY HEATING & COOLING
7500 SW TECH CENTER DR #130
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact #: FAX 503 - 598 -0718
PRI 503- 620 -5643
Reg #: LIC 66578
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B : - . • Permittee Signature: --
Call • 9.4 175 by 7:00 a.m. for inspections that busines y.
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 IiSE ONLY
City of Ti and Received
a g ®� Date/By; 0 i ' J Permit No.: Ai � ' -- U w/
.
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.196 V Other Permit:
T . G' K , . , Inspection Line: 503.639.4175 � DO� Date/ByIN
:
a ate Ready/By: runs: H See Page 2 for
Internet: www.tigard or.gov -4 • i � ,
`\ e d/Method: Supplemental information
TYPE OF WORK ®� �` COMMERC F LE EE * SCHEDU ,SE CH
UECKL 1ST
r�\v Mechanical permit fees' are bas on the value of the work
❑ New construction [� Addition /altera[ion/rel`
W. performed. indicate the value (rounded to the nearest dollar) of all
•
❑ Demolition ❑ Other: • mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: 8 l8 ‘33,2-
❑ 1- and 2- family dwelling 1ommercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT /S FEES*
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling _
q { / ` ) Air conditioning or heat pump
Job site address:
/() 7 J v 7 6-W //,�,t=- ( /G /�/,,_2/. (requires site plan showing placement) 14.00
City /State /ZIP: A 0/ OR 97aa? Fumace 100,000 BTU (ducts/vents) 14.00
77:i /
Furnace 100,000+ BTU (ducts/vents) • 17.90 _
Suite/bldg. /apt. no.: .g,,5" Project name: /kW' p% .a Gas heat pump 14.00
Cross street/directions to job site: / J / Duct work . 10.00
v � Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, induct, suspended, etc. 14.00
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
,�J / Gas fireplace 10.00
fie /14 c e t°)(/ J / , 7 A 5 i �! (/ / $ e UI7 . Flue vent for water heater or gas
// 0 0 / fireplace 10.00
/4J J t>"Gj 5G frn e CCt�a C/)7 ) re �j i' e cT J'/,c1 of--- Log lighter (gas) 10.00
e /eG /rr cer 76. fieLJ /1.7o1 11 d ' Ci - /y9 Wood/pellet stove 10.00
• / Wood fireplace /insert 10.00
[} OWNER ❑ TENANT
Chimney/liner/flue/vent 10.00
Other: 10.00
Name: ///f�, - n . `��oerJ-o,) Environmental exhaust and ventilation
/ - ` � Range hood/other kitchen
Address:
l/ (f /4/ 1,-,--
, 7 /e/" me 5 equipment 10.00
City/State /ZIP: 7744 r e/ ore 9 70 3 Clothes dryer exhaust 10.00
rl Single -duct exhaust (bathrooms,
Phone: (-S Z1 ).$'10 - 0139Y Fax: 0 ) $ f - ,5-6 3 2 toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: _ 10.00 _
Business name: �'Qe6 tLLt,( pie - t t,l q eD6 ii nil /
net Fuel piping
m
'� R
Contact name: $5.40 for first four; $1.00 for each additional
Address: 75 0 7 ) 5 id - T ' e - (lea) e_ ' ,Or. 5-1e, 136 Furnace, etc.
Gas heat pump
City /State /ZIP: 11 qa_ret. o 1 - 7 c2a3 Wall/suspended/unit heater
Phone: (563) ta p - 4 3 Fax:: ( 563 ) 59 8 - 1S? Le Water heater
Fireplace
E -mail: an ea/ „�Speetaliq L, e aftn , P 41'V) Range
` ` -
CONTRACTOR Barbecue
/ 1 �y > Clothes dryer (gas)
Business name:
5 e e , .Ll tat t t,t i ell_t tr 3-- e0111_((4 j n Other: •
Address: 7566 so 1 e Ch (p.n- er r . 51 f' /,3() MECHANICAL PERMIT FEES*
City /State /ZIP: 1 i Ct Qrd 62. `170202 3 Subtotal
Phone: ( ) J Fax: ( ) Minimum permit fee ($72.50) 3104, NJ
Plan review (25% of permit fee) 5
CCB lic.: , , 57 e State surcharge (12% of permit fee) I 41 . 3
TOTAL PERMIT FEE H 7 ?...54
Authorized signature: � / - / — Tbis permit application expires if a permit is not obtained within 180
, t ✓ days after it bas been accepted as complete.
Print name: $7/e ,7 4 Z - Date. '7/,?. 3701 S • Fee methodology set by Tn -County Building Industry Service Board
1: Building \Permits'MEC•PermilApp.doc 01/19/07 /- 440 -4617T (I 1/02/COM/WEB)