Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00397
T t G'A R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/06/2010
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 92
Subdivision: Lot: 0
Project: FANTASTIC SAMS
Project Description: Relocating gas line to water heater.
Owner: FEES
13500 PACIFIC CORP Description Date Amount
BY CAPOZZOLI ADVISORY FOR, PENSIONS Permit Fee 08/06/2010 $72.13
INC, 21500 HAGGERTY ROAD, SUITE 100 12% State Surcharge - Mechanical 08/06/2010 $8.66
PHONE:
Contractor:
CENTURY HEATING & A/C, INC.
25442 SUNCREST DR
GRESHAM, OR 97080
PHONE: 503 - 665 -6707
FAX:
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 $80.79
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 accofdance 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 questions to 0 by calling 503.246.6699 or 1.800.33
Issued By = f Permittee Signature:
Call 50 •y 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 ��� � „� _ , " �
City of Ti ga>nd �. � � n a r � s 10 y/ PamdNo_: , , 9 7
„ iiii - ,. ` 13125 SW Hall Blvd., Tigard, OR 97223: - Plan a Phone: 503.639.4171 Far 50339819 v� 'h V �p1 OtherPennic:
•
. :: ° Inspection Line: 503.639 4175
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TYPE OF WORK C. :. \ \�..-Y COMIVIERCIAL WE SCHEDULE — USE CHECKLIST
❑ New construction ArAAddition/alterati 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 verhead, z ftd Profit_
CATEGORY OF CONSTRUCTION
Value: $ (1(\
❑ 1- and 2- family dwelling "Commer ial mdustrial ❑ Accessory bu ldmg RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
;�
For special information use checklist
❑ Multi ❑ der ❑ Other: Description I Qty. I Ea. 1 Total
JOB. SITE INFORMATION AND LOCATION Herding/cooling
L 1 [,l Air conditioning
Job site address: 13 A 0 S'W Pact' '1-1 C w 1 I ° , (requires site plan showing placement) 46.75
City/State/ZIP: d / Furnace 100,000 BTU (ductstvems) 46.75
• ,f • Furnace 100,000+ BTU ((huts/vents) 54.91
Suite/bldg./apt. no.: r Project name: e " , a" _ :. -4._ I s e,,, Heat pump 61.06
w
Cross st reet /directions to job site: )') 14577 ..._ S00/ s Duct - work 23.32
Hydronic hot water system 2332
Residential boner (radiator or
hydronic) 23.32
61\\ Unit heaters (fuel -type, not electric),
d 0 W in-wall, induct, suspended, etc. 46 "75
n Flue/vent for any of above 23.32
Subdivision: 6 ' J �` I no.: Other 23.32
Tax map /parcel no.: \ Other fuel appliances
es
DESCRIPTION OF WORK Water heater 23.32
nn Gas fireplace 3339
1 o C t `f e CO G a 12i'h c 4% 4% Lu e t` Flue vent for water heater or gas
fireplace 23.32
j1--1,1!_ dfe? iS - Log lighter (Sas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
❑ PROPERTY OWNER I ❑ TENANT Chimneyllimer/flme/veurt 23.32
Other: 23.32 _
Name: Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment
3339
City/State/ZIP: Clothes dryer exhaust 3339
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
43 APPLICANT ❑ CONTACT PERSON Anidaawlspace fans 23.32
Other 23.32
S
Business name: C 4} .S c;a c/,, / _---
Contact name: \ 1415 for first four; $403 for each additional
Address: Furnace, dc.
Gas heat pump ,
City /State/ZIP: Wall/suspended/tmit heater
Phone: ( ) Fan : ( )
Water heater "�
Fireplace
E-mail: Range
CONTRACTOR Barbecue ,
Business name: s eem - 4 4(. / l �� dA /e Clothes dryer (gas)
7 Other
Address: Pc) / s Lc 7s 7 Ave MECHANICAL PERMIT FEES*
City/State/ZIP: 67 Aeon O R. 9.7-1) & tj Subtotal Q 6 �� 1 9, (4
p / Minimum permit fee ($90.00) r 7, i-5
Phone: (:93 ) 66x -671.7 I Far ( 13 to (
) — ���2 9 Plan review (25% of permit fee)
CCB lic.: P7/6 / State surcharge (12% of permit fee) ,a , GE
TOTAL PERMIT FEE j ,d�
Authorized signature: 0 1 e�� � days after This P apptieaf r it has b expires i<a c cepte is d a s ct complete.
c�witht I
r been ac expires
plete.
Print name: ta2, Ia rte i_ S ar.t.e.4— I Date: it- 6 _10 I = Fee methodology sit by Tri- County Building Industry Service Board
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