Permit n CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00161
n : Date Issued: 04/13/2010
T f GxkLi 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9565 SW WASHINGTON SQUARE DR BO3A
Subdivision: Lot: 0
Project: Icing
Project Description: VAV box, ductwork & grilles. No plan review required per Dan N.
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Permit Fee 04/13/2010 $182.65
CARLSBAD, CA 92008 12% State Surcharge - Mechanical 04/13/2010 $21.92
PHONE:
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062
PHONE: 503 - 692 -1565
FAX: 503 -691 -1879
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:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $204.57
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 Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct .estions to • • C b -fling 503.246.6699 or 1.800.332.2344.
Issued y: � (14.-ii Permittee Signature:
CaII 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.
Z u l / 6' - 000
Mechanical Permit Applic FOR O FFI C E U ONLI'
ty of a ��� Date /B Y 5
�/ , / DD ,,Z, • 13125 SW Tig
Hall Blvd. , Ti OR 972
Ci y / He'd Q .
Phone: 503.639.4171 Fax: 503.598.1;. ! 3 Plan Review 0 Permit No.:
7
R 1 t7 r ; -; Date /By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date ReadyBy: luris: el See Page 2 for
Internet: www.tigard or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK 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: S $4 200.00
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I - 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
Air conditioning
Job site address: Washington Square Space BO3A
(requires site plan showing placement) 46.75
City /State /ZIP: Tigard, OR 97223 Fumace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: BO3A Project name: Icing
Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
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
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
Gas fireplace 33.39
VAV box, ductwork, grills. 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
Other: 23.32
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 33.39
City/State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 _
Other: 23.32
Business name: Arrow Mechanical Contractors, Inc.
Fuel piping
Contact name: Kevin Kruszewski 514.15 for first four; $4.03 for each additional
Address: 10330 SW Tualatin Road Furnace, etc.
Gas heat pump
City /State /ZIP: Tualatin, OR 97062 Wall /suspended/unit heater
Phone: (503) 692 -1565 Fax: : (503) 691 -1879 Water heater
Fireplace
E -mail: arrowmech Range
CONTRACTOR Barbecue
Business name: Arrow Mechanical Contractors, Inc. Clothes dryer (gas)
Other:
Address: 10330 SW Tualatin Road MECHANICAL PERMIT FEES*
•
City/State/ZIP: Tualatin, OR 97062 Subtotal ry
Phone: (503) 692 -1565 Fax: (503) 691 -1879 Minimum permit fee ($90.00) /3 ■
Plan review (25% of permit fee) d
CCB lic.: 5193 State surcharge (12% of permit fee) at( 'Z
TOTAL PERMIT FEE ,. ee S7
na re: This permit application expires if a permit is not obtained within 180
Authorized si
g`- --', `/Jill days after it has been accepted as complete.
Print name: Kevin Kruszewski Date: 4 /6/2010 * Fee methodology set by Tri- County Building Industry Service Board
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