Permit CIS OF TIGARD MECHANICAL PERMIT
` .; m `> • COMMUNITY DEVELOPMENT Permit #: MEC2010 00401
T t G'ARO 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/12/2010
Parcel: 1 S135DC00400
Jurisdiction: Tigard
Site address: 11795 SW GREENBURG RD
Subdivision: Lot: 0
Project: Dr. Gebeau Dental
Project Description: RTU installation.
Owner: FEES
GREENBURG LLC Description Date Amount
BY STEVEN & MELISSSA BLACK, PO BOX 1891 permit Fee 08/12/2010 $411.21
LAKE OSWEGO, OR 97035 Plan Review 08/12/2010 $102.80
PHONE: 12% State Surcharge - Mechanical 08/12/2010 $49.35
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
TIGARD, OR 97224
PHONE: 503 - 453 -4822
FAX: 503 - 968 -7224
Type of Use: COM
Class of Work: ALT Type of Const: VB
Occupancy Grp: B 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 - HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $563.36
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
issuanc • I work is , •ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopt -.• by the Oregon
Utili otification Center. lose les are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obt - opy of the rules
or •, uect questions to OUNC 1; call; g 5 . 46.6699 or 1.800.332.2344.
ued By: / Permittee Signature: i AII " . .•
Call 503.639.4175 by 7:00 a.m. for an inspection that business da .
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.
.........*1..a1 a ca 11111 ttppIICUILIUfI
FOR OFFICE USE ONLY
City of Tigard Received % '
li • 13125 SW Hall Blvd., Tigard, OR 97223 � � Date/By:,, �(� 1O Permit No.: ^� 2t�10 ,00 �(,' _
I Phone: 503.639.4171 Fax: 503.59:
y t D /B / A
` l�f
( IC, Other Permit:
T I G A R D Inspection Line: 503.639.4175 �
Internet: www.tigard- or.gov ® I Date Ready /Hy: ) ?ars ® See Page 2 for
`� �h' ) �. N v Notified/Method: �' / r � I Supplemental Infor
' is ( I _ NO 1. 0\ /
TYPE'OF ORK . ,� � z "'� �r •: -x -
W. ii .0 _ . , COM *4 :0IAL :FEE! SC HEDULE U8E 4-04)p jgT
❑ New construction XAddition/alteratiolment Mechanical permit fees* are based on the value of the work ~
❑ Demolition �y performed. Indicate the value (rounded to the nearest dollar) of all
❑ Other:
mechanical materials, equipment, labor, overhead, and profit.
.. ,CATEGORY OF - CONSrRU,CTION " : > : Vale: $
is l a 'f0? . pv
u t
, and 2- family dwelling Commercial /industrial , ❑ Accessory building m$QI�'l'. /3Y�1
❑ Multi- family ❑ Master builder ❑ Other: For special information use checklist.
JOBS 131TE Description I Qty. I Ea. I Total
~ , r...,. IItiMfRMATION(AN1D LOCA�rION ' Heating/cooling
Job site address: ' 1 1 5 5k) G G reen bv � Air conditioning
T (requires site plan showing placement) 46.75
'I t l
City/State /ZIP: 64r0 O- 91 ZZ"3 Furnace 100,000 BTU (ducts /vents) 46.75
Suite/bldg. /apt. no.: I Project name: Dr G7°H.� -Y117� Furnace 100,000+ BTU (ducts vents) 54.91
T�� 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: I Lot no.: Flue/vent for any of above 23.32
Tax map /parcel no.:
Other: 23.32
Other fuel appliances
t�fi r {
y F l a . :s .. _,a-; ,'a V: ON OF WORK'' ' s ,9 , T' a.,t. W ater heater 2332
R oo F-D / PAck D ^,2 Con Gas fireplace 33.39
F- !-t' �/ Flue vent for water heater or gas
6/IC 7— fireplace 23.32
key-) / �, r, (T� Log lighter (gas) 23.32
6 Ne 1 to w /? -7 b a u CI' C 15 r( Wood/pellet stove . 33.39
�� Wood fireplace/insert 23.32
A> i-tv , ; . 11rlydt3x O - :'t v µl4. 1 - >f t � ? _- ,, 1,Q , . - LV NIr ?4 , `` Chimney/liner /tlue/vent 23.32
;.•x . c. � 23.32
Name: C l n burl
Environmental exhaust and ventilation
Address: e , , ' �9 I Range hood/other kitchen
L _ equipment 33.39
City/State/ZIP: k. " A/ ° J & 0C 9 9 Clothes dryer exhaust 33.39
Phone: ,: (�3) 3 3 Fax ( ) Single -duct exhaust (bathrooms,
�. i -- toilet compartments, utility rooms) 23.32
11CANl' . 4 c' ®rapM'ACI44IIat80N T':`',., Attic /crawlspace fans 23.32
Business name: L�.0 MATE- A (i O n TroL Mc_ 23.32
Fuel piping
Contact name: Ro 4 -f r 1
S $14.15 for first four; 54.03 for each additional
Address: 1 (0501) 51 —7-2.." �t , , 6 Furnace, etc.
City /State/ZIP: mil/ Gas heat pump
pp - rland 9-7 223 Wall/suspended/unit heater
Phone: ( 503) 1153. LJ8ZZ 1 tr Fax:: (b3)9( ZZ y Water heater
il: Fireplace
E -ma
i r'o €G c-- �t= cor4- r Inc . c onon
CO Range
N1[itACTOR ` �' r a i ` Barbecue
Business name: CLl VV1 a- T� 60 r ,. L /re Clothes dryer (gas)
Address: I (cSOo c Gv 7; n a VC t
MECHAM ,CAL P -1.rf4 -
City/State /ZIP: poor l a n d or G . ) .ZZy Subtotal
Phone: (5-D3) 1x5-3- jJ � ZZ I Fax: ( 9)3) q t0 � _ � Z Z t/ Minimum permit fee ($90.00)
/ � / / Plan review (25% of permit fee)
CCB tic.: IQ State surcharge (12% of
g ( permit EE /l eiri4 . TOTAL PERMIT FEE
Authorized signature: /Jr'� This permit application expires if a permit is not obtained within 180
/ G days after it has been accepted as complete.
Print name: A
0 Y I Date: O1 / pl / U I . Fee methodology set by Tri- County Building Industry Service Board
I: Building \Permits�MEC- permit App .doc 10/01/09 4 0 -461TT 111/02 /COM'WEB)