Permit CITY OF TIGARD MECHANICAL PERMIT
0 • COMMUNITY DEVELOPMENT Permit#: MEC2010 -00448
T l G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/09/2010
Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY
Subdivision: FARMERS INSURANCE Lot: 0
Project: Triangle Pointe
Project Description: TI
Owner: FEES
TRIANGLE POINTE LLC Description Date Amount
901 NE GLISAN ST #100
PORTLAND, OR 97232 Permit Fee 09/09/2010 $3,397.11
Plan Review 09/09/2010 $849.28
PHONE: 12% State Surcharge - Mechanical 09/09/2010 $407.65
Contractor:
HVAC INC
5188 SE INTERNATIONAL WAY
MILWAUKIE, OR 97222
PHONE: 503 - 462 -4822
FAX: 503- 462 -6555
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: B Occupancy Load:
Stories: 5
Fuel Air Handlers
Fuel Types: Units < 10000 cfm: 1
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 $4,654.04
Hoods: Comm Incinerators: Required Items and Reports (Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 1
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 adopt - • by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You m- obtain copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
AIM I
Issued By: / Permittee Signature:
jeer
Call 503.639.4175 by 7:00 a.m. for an inspection that busi ess d: y.
This permit card shall be kept in a conspicuous place on the job site until c p tion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application �� rr►li �)► l lcl: tl: tlN►_,
City of Tigard �� O Date q g' Q Permit No.: r / AV '
_ VO A
13125 SW Hall Blvd., Tigard, OR 9722 y , ✓C
, 4 111 Phone: 503.639.4171 Fax: 503.59. '1° p `�%
Plan Revr ` WSW. NE Other Permit: A r k
T I G n It. D Inspection Line: 503.639 0 0 �0 Date Ready/B - orris: El See Page 2 for
Internet: www.tigard -or.gov c Noti � Supplemental Information
TYPE OF WORK 0. < - % COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ig Addition/alteration/tOacc 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, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ 0-1 1 Qin)
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling Er Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 -53 -53 SW , f7-µ4 k , Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: '‘ ckkArk t 0(2 011 -el., 3 Furnace 100,000 BTU (ducts/vents) 14.00
CAS pi cutko c pi,- Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldgJapt. no.: Project name: k
ll Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
• in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue/vent for any of above 6.80
Other. 10.00 _
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
L 1 t — - Gas fireplace 10.00
��f�,Sk ,k. FQ (1C)1' C'C' V 111 ° vvt� Flue vent for water heater or gas
rt -� ' ^ , w r _ S{ 1 � / p fireplace 10.00
�,p p l/Y 01'p t t �� `^ 'C Log lig (gas) 10.00
Ct `� E 1 1J • S Wood/pellet stove 10.00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/State/Z1P: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
��` ' 9 Other: 10.00 _ TAA c_ Business name: V `/ COW ` Fuel piping
Contact name: t �v C �� J J $5.40 for first four; $1.00 for each additional
T� /t �Va k Furnace, etc.
Address: S Gas heat pump
City/State/Z1P \�` v 0) / Wall/suspended/unit heater 1 1
Phone: ( Y c o l - U , i s .-.4, l Fax: : (' ) V '), koS"7 Water heater
Fireplace
E -mail: t 1 % 0 0 k IW ^ V,V c �RA U - ( Range
CONTRACT ,01M Barbecue
Business name: F^ h) t) �V ` Clothes dryer (gas)
` Other:
Address: MECHANICAL PERMIT FEES*
City/State/Z1P: �� Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB Iic.: p" \) State surcharge (12% of permit fee) application expires if a permit is not TOTAL PERMIT FEE 1-165 oil
Authorized signature: This permit days after it has been accepted as complete.
within 180
,W
Print name: Da �N`� I Date: Q, I1) • Fee methodology set by Tri-County Building Industry Servi
I:\ Building \PmnitsUMEC- PermitApp.doc 01 /19/07 440 - 46171'(11 /02/COM/WEB) 4 ‘1173PLI
�
:s ° Building Division
Over- The - Counter (OTC) Mechanical Permit
TIGARD Check List
Description of Project: i ii (CAI 1 1
GENERAL INFORMATION
Class of Work:* ( Floor Furnace: Evap. Coolers:
Type of Use:* Unit Heaters: Vent Fans:
Occupancy Group: S Vents w/o AppL: Vent Systems:
Stories: r' Boilers, Comp, Heat Pump, A /C: Hoods:
Fuel Types: 0 - 3 HP: Domestic Incinerator.
ELC / GAS / NG / OIL / OTHER 3 - 15 HP: Com. /Ind. Incinerator.
Max Input: BTU: 15 - 30 HP: Repair Units:
Fire Dampers: 30 - 50 HP: Wood Stoves:
Gas Pressure: H / M / L >50 HP Clothes Dryer.
No. of Units: Air Handling Units: Other Units:
Furnace <100k BTU: 510,000 CFM: t Gas Outlets:
Furnace >_100k BTU: >10,000 CFM: �Qr. tAI 1
Notes: •
R YA P : )1 1?-7? PCO
INSPECTIONS 1 1 FEES DUE
Post /beatn mechanical $ " , Permit Fee
Gas line $ A X17. State Surcharge
Mechanical rough -in $ vii , ...; Plan Review Fee
Fire damper $ Additional Permit Fee
Duct work $ Additional Plan Review Fee
Smoke detector $ Investigation Fee
Investigation inspection $ Misc. Fee
Misc. inspection $ Hourly Rate Fee
Final inspection $ Hourly Rate State Surcharge
$ 14,504-Total Fees Due
1 OTHER PERMITS REQUIRED
Building Electrical
Plumbing Site Work
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings
or canopies); REP = repair.
I:\BuildingTorms \OTC- MEC.doc 09/22/06