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Permit CITY OF TIGAR® MECHANICAL PERMIT a a COMMUNITY DEVELOPMENT Permit #: MEC2010 -00352 41:9:A RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2010 Parcel: 2S 112 DA00800 Jurisdiction: Tigard Site address: 15115 SW SEQUOIA PKWY 110 Subdivision: Lot: 0 Project: Spec Space Project Description: Move (2) supply grilles Owner: FEES PACIFIC REALTY ASSOCIATES Description Date Amount 15350 SW SEQUOIA PKWY #300 Permit Fee 07/21/2010 $69.06 PORTLAND, OR 97224 12% State Surcharge - Mechanical 07/21/2010 $8.29 PHONE: 503 - 624 -6300 Contractor: OREGON HEATING & AC PO BOX 241 DUNDEE, OR 97115 PHONE: 503 - 691 -9699 FAX: 503- 691 -8556 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 $77.35 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 da s of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by t Ore : n Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obt. a copy f the .les or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: /d Permittee Signature: / 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 Applicatio ti-,, - � ti ilr (--, ` 1 i)10, 1 Ic.l (SH (i� '. 1. i i 1 , . i Cl of Ti and a 3 R eceive d r� / „ � � `J g DateBy: / Pf /0 'A' Permit •/0 U /► 5 . 13125 SW Hall Blvd., Tigard, OR 97223 JUL plan Revie DateBy. 111 Phone: 503.639.4171 Fax: 503.598.1960 U 2 1 Z O O Other Permit oW 7,� /O .._040,37, f 1 G;\ k n ; Inspection Line: 503.639.4175 Date Ready/By: lin ® See Page 2 for Internet: www.tigard - or.gov CITY OFTIGA RD Notified/Method: Supplemental Information RUH rvjvc r TYPE .OF WORK , , COMMERCIAL FEE* SCHEDULE - USE CHECKLIST 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, ovs.rhead, and profit. CA EGORY OF CONSTRUCTION . Value: $ �� RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family Master builder ❑ Other: Description 1 Qty. .1 Ea. 1 Total JOB SITE INFO RMATION AND LOCATION Heating/cooling Job site address: // / Air conditioning [ l �(°f� vQ (d , { (requires site plan showing placement) 46.75 City /State /ZIP: p v� C G A re k) 7 v iii Furnace 100,000 BTU (ducts/vents) 46.75 J Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: `/0 Project name: 7 I� J. e ,06Q Heat pump 61.06 Cross street/directions to job site: S /6 E-C �-C � r t /D/9 Duct work 23.32 �1 f /J Hydronic hot water system 23.32 e. vz 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 Tax map /parcel no.: Other fuel appliances �, / DESCRIPTION OF WORK Water heater 23.32 ( Gas fireplace 33.39 1/C `'V 1 ” J u ��� / )' 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 Chimney/liner /flue /vent 23.32 0/PROPERTY OWNER . I ❑ TENANT • Other: 23.32 Name: PdM414r 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 PER SON Attic /crawlspace fans 23.32 ©, d) / Other: 23.32 Business name: (� (, Fuel piping Contact name: /' � � j i #14 /. i #14 /. /„4T/ 04 j 514.15 for first four; 54.03 for each additional Address: �/ r 6/ t ` Furnace, etc. Gas heat pump City /State /ZIP: Wall/suspended/unit heater Phone: ( SJr j) 5 �` 4 rI/ Fax:: ( ) Water heater Fireplace E-mail: /� t l y e O , �1'- 1.1/tr ` n014.1. Range C� CONTRACTOR J Barbecue Business name: O/'A Clothes dryer (gas) bb Other: Address: / 1, / :374 9 7)( / • . MECHANICAL PERMIT FEES* City /State /ZIP: / 1 /4 9 "� 9 71/' Subtotal Z 9 6 k, /✓ Minimum permit fee ($90.00) Phone: (,�) ?> �f . Fax: ( ) Plan review (25% of permit fee) CCB lic.: / / 7 , State surcharge (12% of permit fee) P. g G / TOTAL PERMIT FEE •7 7, ?s This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name: �t' / 1 7 7 Date: ` 7/2 l i> * Fee methodology set by Tri- County Building Industry Service Board � / I:\Building\Permits\MEC- PermitApp.doc 10/01/09 440-4617T (I /02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. • • 1:\Building\Pennits\MEC- PermitApp.doc 10 /01 /09 2 •