Permit j ! 4 CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00454
Date Issued: 09/17/2010
T [ GAR.b 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 200
Subdivision: TIGARD MEDICAL MALL Lot: 0
Project: Tigard Medical Mall
Project Description: 3 ton split system.
Owner: FEES
MCFADDEN, ARTHUR L Description Date Amount
BY ERIC SKLARZ, 621 SW MORRISON ST STE
Permit Fee 09/17/2010 $249.36
#800 Plan Review 09/17/2010 $62.34
PHONE: 12% State Surcharge - Mechanical 09/17/2010 $29.92
Contractor:
WILLAMETTE HVAC
3075 SW 234TH AVE. #206
HILLSBORO, OR 97123
PHONE: 503 - 628 -6841
FAX: 503 -848 -2597
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 $341.62
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You mayain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 01i Permittee Signature:
tip
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 �® FOR OFFICE USE ONLY
� �� R eceived
City of Tigard �e \Q R e e ive �i •
114 q
13125 SW Hall Blvd.- T OR 97 �Q �,
P lan Rev ie 1 /
_ -' Phone: 503.639.4171 Fax: 503.598 6 1 A \ Q Date/By • ! 74 ��� Other Permit
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TIGARD Inspection Line: 503.639 CJ�Q �vr`` Olt Date Rea.y :y:y: H See Page 2 for
Internet: www.tigard- or.gov OF \ �` e -- NotifiediMethod: Supplemental Information Iffl O
TYPE OF WORK a `.0,,s+ Q,O COMMERCIAL , FEE* SCHEDULE - USE CHECKLIST
V 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. 1
CATEGORY OF CONSTRUCTION Value: $ $6,500.00
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning
Job site address: 9735 SW Shady LN
(requires site plan showing placement) 46.75
City /State /ZIP: Tigard OR Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite /bldg. /apt. no.: # 200 Project name: Tigard medical mall 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
Gas fireplace 33.39
push /pull 3 ton split system. Equipment weighs Tess than the old. 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
❑ PROPERTY OWNER ❑ TENANT
Other 23.32
Name: Environmental exhaust and ventilation
Range hood /other kitchen
Address: equipment 33.39
City /State /"LIP: Clothes dryer exhaust 33.39 _
Single -duct exhaust (bathrooms.
Phone: ( ) Fax: ( ) toilet compartments. utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: same as below
Fuel piping
Contact name: • 514.15 for first four; $4.03 for each additional
Furnace, etc.
Address:
Gas heat pump
City /State /ZIP: Wall /suspended /unit heater
Phone: ( ) Fax::( )
Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
•
Business name: Willamette HVAC, LLC. Clothes dryer (gas)
Other:
Address: 3075 SW 234' Ave Suite 206 MECHANICAL PERMIT FEES*
City /State /ZIP: H illsboro, OR 97123 Subtotal
Phone: (503) 628.6841 Fax: (503) 848.2597 Minimum permit tee ($90.00) ?..iii , 34
Plan review (25% of permit fee) (
CCB lic.: 56951 State surcharge (12% of permit fee) d.9. 40-
TOTAL PERMIT FEE Li 1 1 (4-
/ , � i This permit application expires if a permit is not obtained within 180
Authorized signature: `i' k _-`� , � days after it has been accepted as complete.
Print name: Michael Malstrom Date: 9/16/10 * Fee methodology set by Tri- County Building Industry Service Board
■: \Building \Permits \MEC- PermitApp.doc 10/01/09 440 - 4617T (11/02 /COM/WEB)