Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00592
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/17/2010
TIGARD Parcel: 2S101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY, STE# 220
Project: ACS Subdivision: FARMERS INSURANCE Lot: 0
Project Description: TI. South wing of second floor.
Contractor: HVAC INC Owner: TRIANGLE POINTE LLC
5188 SE INTERNATIONAL WAY 901 NE GLISAN ST #100
MILWAUKIE, OR 97222 PORTLAND, OR 97232
PHONE: 503 - 462 -4822 PHONE:
FAX: 503 - 462 -6555
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/17/2010 $1,312.91
Class of Work: ALT Type of Const: Plan Review 11/17/2010 $328.23
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 11/17/2010 $157.55
Stories:
Project Valuation: $48,000.00
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: 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 $1,798.69
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 i • a • 952 - 001 -0010 through OAR 952 -001'0 1 • i. Y. may obtain a copy of the rules
or direct questions to OUNC by calling 503.23 . : or .; I..' , 344.
1 '
Issued By: I S Permittee Signature: — ' •
Call 5 k�:* -. ; 5 by 7:00 a.m. for the next available inspecti.n .ate.
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 Applicatio an 4 ::FOR " OFF IJ o tw ., `: •. µ "'
City of Tigard i+, ! CE . E , . : 1 , Received _ l „
`J g I .t Date/By: Nr� , //J Permit No.. —
13125 SW Hall Blvd., Tigard, OR 97223 p R - 7 Phone: 503.639.4171 Fax: 503.598.1960 NO V 1 7 2010 Q Date/By �,�j � Other Permit:
T I G A &D Inspection Line: 503.639.4175 Date Ready/By: El See Page 2 for
a ' - :''''Vi '' Internet: www.tigard- or.gov Notified/Method: Supplemental Information
CITY ®FTI(;ARD
TYPE,OF � WOORK DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ,J 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: $ i..{ $ \) TO
RESIDENTIAL EQUIPMENT / SYSTEMS FEES* '
❑ 1- and 2- family dwelling ,Commercia1industrial ❑ Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other: Description Qty. + Ea. Total
JOB SITE INFORMATION AND LOCATION , ) Heating/cooling
Air conditioning or heat pump Job site address: 1 3 `+ � 93 " O Lei (requires site plan showing placement) 14.00
City /State /ZIP: 1 1 C\ RA G‘ ` 0-' Furnace 100,000 BTU (ducts /vents) 14.00
t �� - �G� V D . Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: f V 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.: 1 Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
- c � '- Gas fireplace 10.00
/- Y v ' �r U a y.��lliV[- \/!� Flue vent for water h or gas
� � ®_ r , - fireplace 10.00
°�— Log lighter (gas) 10.00 .
' Wood/pellet stove 10.00
Wood fireplace /insert 10.00
' t. Chimney/liner /flue/vent 10.00
El PROPERTY OWNER E,.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
d IZIAPPP l LICAN T x - I / CONTACT PERSON Attic /crawlspace fans 10.00
Business Warne:
1_V\) c) / ./ 1� l / Fuel piping
PP4g 10.0 _
Contact name: , I
b DA $5.40 for first four; 1.00 for each additional
,/� Furnace, etc.
Address: ' _ k.%,% ' V L \C` �U� Gas heat pump
City/State/ZIP: N `i» � 1k1')' �'� Wall /suspended/unit heater
• Phone: ( V� ( VI b)- '\'f b f J ( YYI ' v Fa ( x.. (.,�+ • � Y/� �✓ Fireplace ter
E -mail: .j D �� �i AN (A (J 1 Range
1 CO NTRACTOR Barbecue
Business name: l 1`) n, / /� )/� (---/ Clothes dryer (gas)
L' \ V I" tl/ J Y ' v Other:
Address: / /'� • •• MECHANICAL PERMIT FEES*
City/State /ZIP: �� / ` J v Subtotal
(/ � Minimum permit fee ($72.50)
• • _ Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
• ' CCB lie :. U V\ -1 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Auttprized signature: ' I I This permit application expires if a permit is not obtained ssithin 180
gtt days after it has been accepted as complete.
Print name: .- ( t ys Date: 1 1 a * Fee methodology set by Tri- County Building Industry Service Board
_ r ife
h\Building\Permits \MEC- Permit • 01/19/07 440 -4617T (1 I /02 /COM/WEB)
•
Building Division
Over- The - Counter (OTC) Mechanical Permit
T.IGA -RD Check List
Description of Project:
GENERAL INFORMATION
Class of Work:* Floor Furnace: Evap. Coolers:
• Type of Use:* Unit Heaters: Vent Fans:
• Occupancy Group: Vents w/o Appl.: Vent Systems:
Stories: 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: <_10,000 CFM: li Gas Outlets:
Furnace ?100k BTU: >10,000 CFM: ,1 ij(f 1
. Notes:
INSPECTIONS FEES DUE
• Post /beam mechanical $ I ?(2.. ( Permit Fee
Gas line $ I57i 5 State Surcharge
Mechanical rough -in $ ne , 22 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
• $ ' 7'? (—' Total Fees Due
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:\Building\Forms \OTC - MEC.doc 09/22/06