Permit CITY OF TIGARD MECHANICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: MEC2010 -00268
G RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/15/2010
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 92
Subdivision: Lot: 0
Project: Fantastic Sam's
Project Description: (1) gas water heater, (1) dryer exhaust & gas piping for water heater.
Owner: FEES
13500 PACIFIC CORP Description Date Amount
BY CAPOZZOLI ADVISORY FOR, PENSIONS Permit Fee 06/15/2010 $148.88
INC, 21500 HAGGERTY ROAD, SUITE 100 12% State Surcharge - Mechanical 06/15/2010 $17.87
PHONE:
Contractor:
CREATIVE CONTRACTORS & DESIGN
15357 UNION SCHOOL RD
WOODBURN, OR 97071
PHONE: 503 - 984 -3220
FAX: 503 - 981 -7784
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Occupancy Load:
Stories:
Fuel Air Handlers
Fuel Types: Natural Gas Units < 10000 cfm:
Gas Pressue: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 - 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 $166.75
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 the rules
or direc estions UNC by calling 503.246.6699 or 1.800.332.2344. !
Issue By: . A Af &A L Permittee Signature: /
Call 503.639.4175 by 7:00 a.m. for an inspection t at b, ess 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 Application ��
' /6 _ , o �'OFtFIC II S :
City of Tigard RECEIVED Date /By: Permit No.: 0 Q� o 2�Q&
13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
LA 'Phone: 503.639.4171 Fax: 503.598.1960 f Other Permit 4QfO'40/pZ9
Inspection Line: 503.639.4175 JUN 1 5 Z010 Date /By:
TPGARD Date Ready /By: Juris: ® See Page 2 for
. _ Internet: www.tigard - or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPE OF vaiiii.DING DIVISION COMMERCIAL FEE* SCHEDULE - •USECHECKLIST
❑ 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: TENANT IMPROVEM mechanical materials, equipment, labor, overhead,apd profit.
CATEGORY OF CONSTRUCTION Value: $ 1 too � J
•
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
Job site address: SUITE 92, 13500 PACIFIC HWl Air conditioning
(requires site plan showing placement) 46.75
City /State /ZIP: TIGARD, OR Furnace 100,000 BTU (ducts /vents) 46.75
Furnace 100 ,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: 92 Project name: FANTASTIC SAM'S Heat pump 61.06
Cross street/directions to job site: 99 W Duct work 23.32
IN TIGARD MARKET PLACE NEXT TO ISLANDS TANNING & STARBUCKS lydronic 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 1 23.32 23.32
Gas fireplace 33.39
BUILD OUT TENANT SPACE
Flue vent for r water heater or gas •
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
Chimney /liner /Flue /vent 23.32
❑'PROPERTY OWNER ® TENANT
Other: 23.32
Name: FANTASTIC SAM'S Environmental exhaust and ventilation
Range hood/other kitchen
Address: J 5 q 3 /_ IJ w (1._ s Or equipment 33.39
City /State / /_IP: P 0 L T 1 4 M p o /� q 1 2 ,� C.1 Clothes dryer exhaust 1 33.39 33.39
C7� ��t q / Single -duct exhaust (bathrooms,
Phone: (561'5 ) 3.-i ..G t . ( C1, Fax: ( -}-- toilet compartments, utility rooms) 23.32
. ® APPLICANT O ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: CREATIVE CONTRACTORS & DESIGN
Fuel piping
Contact name: JOSHUA TITTLE $14.15 for first four; $4.03 for each additional
Address: 15357 UNIONSCHOOL RD Furnace, eta 14.15 14.15
Gas heat pump
City /State /ZIP: WOODBURN, OR 97071 Wall /suspended /unit heater
Phone: (503 -) 984 -3220 , Fax: : (503) 981 -7784 Water heater /
Fireplace
• E -mail: JOSH @CREATIVECONTRACTORS.COM Range
CONTRACTOR • Barbecue
Business name: CREATIVE CONTRACTORS & DESIGN Clothes dryer (gas)
Other:
Address: 15357 UNIONSCHOOL RD MECHANICAL PERMIT FEES* __
City /State /ZIP: WOODBURN, OR 97071 Subtotal /1/8 St
Minimum permit fee ($90.00)
Phone: (503) 984 -3220 Fax: (503) 981 -7784 Plan review (25% of permit fee) ,--6t-- '
CCB lie.: 171728 State surcharge (12% of permit fee) 1747 1
/ TOTAL PERMIT FEE `�t .75'
Authorized signature: / // � This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: JOS IA 'TLE Date: 6 -15 -2010 * Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \Penn its \MEC- PermitApp.doc 10/01/09 440 -4617T (1 l /02 /COM /WEB)