Permit p CITY OF TIGARD MECHANICAL PERMIT
s COMMUNITY DEVELOPMENT Permit #: MEC2009-00401
• „TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2009
Parcel: 2S113A601201
Jurisdiction: TIGARD
Site address: 16505 SW 72ND AVE
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Liberty Mutual
Project Description: Install and relocate ductwork, grilles and (2) thermostats. No plan review required.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Permit Fee 08/05/2009 $77.10
#300 12% State Surcharge - Mechanical 08/05/2009 $9.25
PHONE:
Contractor:
GOHMAN MECHANICAL
14505 SE HWY 212
CLACKAMAS, OR 97015
PHONE: 503 - 658 -1892
FAX: 503- 658 -6925
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
Fumaces < 100K BTU: 0 -3 HP:
Fumaces >= 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 $86.35
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 • ' suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ification 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 • ect questions to OUNC, c Ilin 03.246.6699 or 1.800.332.2344.
Is ued By: I , e ' / Permittee Signature: xZ
/
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 RECEIVED FOR OFFICE USE ONLY'
City of Tigard
Received DateB Q .. 09
,
Permit No.: l � 9�
13125 SW Hall Blvd., Tigard, OR 97223 Irk Q 5 2009 Plan Rev `
G Date/
By: Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
T I G A It D Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: WI ® See Page 2 for
Internet: www.tigard-or.gov
DIVI SiO •Notified/Methbd: Supplemental Information
BUILDING
• TYPE OF WORK . • • COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ® Addition /alteration/replacement 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: $ 2,200
• 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. 1 Ea. I Total
. JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning or heat pump
Job site address: 16505 SW 72 °d Ave.
(requires site plan showing placement) 14.00
City /State /ZIP: King City, OR 97224 Furnace 100,000 BTU (ducts /vents) 14.00
Fumace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Lyberty Mutal 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
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances • •
DESCRIPTION OF WORK . • • Water heater 10.00
• Gas fireplace 10.00
Install and Relocate Ductwork, Grilles, and (2) Thermostats Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
❑ PROPERTY OWNER I 0 TENANT Other: 10.00
Name: Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment 10.00
City /State /ZIP: • Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
0. APPLICANT ® CONTACT PERSON •• Attic/crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: Jeremy Hunt $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address:
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: (503) 658 -1892 Fax:: ( ) Water heater
Fireplace
E -mail: jeremy@gohmanmechanical.com Range
. • 'CONTRACTOR . . 1 Barbecue
•
Business name: Gohman Mechanical, Inc. Clothes dryer (gas)
Other:
Address: 14505 SE HWY 212 MECHANICAL PERMIT FEES*
City /State /ZIP: Clackamas, OR 97015 Subtotal
Minimum permit fee ($72.50) 77 /Q
Phone: (503) 658 -1892 Fax: (503) 658 -6925 Plan review (25% of permit fee) ..—•
CCB tic.: 119952 State surcharge (12% of permit fee) ?, A 5.
TOTAL PERMIT FEE ' , f8 '
This permit application expires if a permit is not obtaine within
Authorized signature: ' — days after it has been accepted as complete.
Print name: Drew Gohman Date: 08/05/2009 • Fee methodology set by Tri- County Building Industry Service Board
1:\ Building \Permits\MEC- PermitApp.doc 01/19/07 440 -4617T (11 /02/COM/WEB)