Permit )4 10 CITY OF TIGARD . MECHANICAL PERMIT
0 COMMUNITY DEVELOPMENT Permit#: MEC2010 -00368
r 3? Date Issued: 08/03/2010
•:fGWRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S102BD00600
Jurisdiction: TIG
Site address: 12725 SW PACIFIC HWY
Subdivision: Lot:
Project: Hafez Restaurant
Project Description: Replace gas line to existing range.
Owner: FEES
FARID ADRANGI Description Date Amount
4289 ORCHARD WAY Permit Fee 08/03/2010 $75.20
LAKE OSWEGO, OR 97035 12% State Surcharge - Mechanical 08/03/2010 $9.02
PHONE:
Contractor:
CLEARWATER PLUMBING LLC
11755 SE HOLGATE
PORTLAND, OR 97266
PHONE: 503 - 935 -0918
FAX: 503 - 761 -2143
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 -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 $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 No ' to Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir questions to OUN by ling 503.246.6699 or 1.800.332.2344.
Is ued By: _ Q?.pit - e Perm ittee Signature: y
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 Application cA,P 0" \'') l Oli'c) I ICF tJSl ONI \ ,
City of Tigard O A b Recei aatemy: ved 7 I � P erm i t N o. : . � , r
® 1 3125 SW Hall Blvd., Tigard, OR 97223 Y � .7 i, an Review
C!t -
' � Phone: 503.639.4171 Fax: 503.598.1960 ` s ateBy: Other Permit: 1 �. �l t,
T i c. n it I) Inspection Line: 503.639 ��� Date Ready/By: Juris: Ea See Page 2 for
Internet: www.tigard- or.gov 6 Notified/Method: Tr& Supplemental Information
' ' 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, overhead, and profit.
CATEGORY OF 'CONSTRUCTION . oa
Value: $ (r v
. 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. I Ea. 1 Total
• JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: (A 2S C vV ea (l (i C _ / w Air conditioning
J (requires site plan showing placement) 46.75
City /State /ZIP: - �( e l.d 0 I 0( 4.2 2 3 Fumace 100,000 BTU (ducts/vents) 46.75
��JJ �" Fumace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: S 11 6 I< O +'1 I (4 /1 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
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 ir;
-o 1 Gas fireplace 33.39
(- A r if oN ( o i ) lv k �e A O ( 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 1
❑ PROPERTY OWNER • I, X TENANT .
Other: 23.32
Name: `j In o,c. 0 )1 iG( 11 Environmental exhaust and ventilation
� G� \ S € v ' ' / e / / v Range hood/other kitchen
Address:
2 ! equipment 33.39 14
City /State /ZIP: t0.x e 6 S w qo O (, o - O 3 S Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (S63 ) 6 9" q -4$ O a Fax: ( ) toilet compartments, utility rooms) 23.32
. ❑ APPLICANT ❑ 'CONTACT 'PERSON Attic /crawlspace fans 23.32 ,
Business name: i7 a E e_ Z R < '�(,LekrOk ll Fu m 23.32
PP� l;
Contact name: API . i, `/' i * $14.15 for first four; $4.03 for each additional
Address: S q. 2 b 5 w s e v - '� �.e 4 V Q Fumace, etc.
Gas heat pump
j
City /State /ZIP: (0 V.._ e 6 S W e 1 36 6 fl c l q--- O 3 5' Walllsuspended/unit heater
Phone: 6 63) 6 q $ -1 a Fax: : ( ) Water heater
Fireplace
E -mail: Range
•
. CONTRACTOR Barbecue
Business name: C1 w i-r t , PLL _ Pp/ toil - - Clothes dryer (gas)
•
I c0 Other: 1.
Address: 111 5 - 5' •, /V-4- ` MECHANICAL PERMIT FEES*
City /State /ZIP: p (2._ p-te 4 Subtotal 7$.a0
Phone: ( G ,w c Fes; (5,2 �( ( Minimum permit fee ($90.00) -&
l �J D ( t$ 7 `f 3 Plan review (25% of permit fee) . .
CCB lic. State surcharge (12% of permit fee) L q, Oa _
TOTAL PERMIT FEE A// 2,4,..4.2
This permit application expires if a permit is not obtaided within 186:
Authorized signature: %' . days after it has been accepted as complete.
Print name: S j ► \ 0 e-.. S 0 1(o 11 II n Date: 7 _2_ g _2 • Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Permits\MEC- PermitApp.doc 10/01/09 440 -4617T (11 /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\Permits\MEC-PermitApp.doc 10/01/09 2
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LIVING AREA
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