Permit 74 CITY OF TI MECHANICAL PERMIT
a� COMMUNITY DEVELOPMENT PERMIT #: MEC2006 -00624
DATE ISSUED: 12/7/2006
a TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
""�` °"' PARCEL: 2S102BD -01900
SITE ADDRESS: 12920 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: HUDSON PLAZA LOT: OOD JURISDICTION: TIG
Project Description: HUDSON PLAZA. Ventilator. Valuation: $2000.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
REPAIR REPA UNITS:
FIRE DAMPERS ?: 30 - 50 HP: RE AIR OYES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Owner: FEES
HENDERSON, MARILYN DOROTHEA Description Date Amount
JENSEN HUDSON TRUSTEE
11795 SW KATHERINE ST [MECH] Permit Fee 12/7/200E $72.50
TIGARD, OR 97224 [TAX] 8% State Surcha 12/7/200E $5.80
Total $78.30
Phone:
Contractor:
GL HEINTZ HEATING & COOLING, INC.
20871 SW 216TH PL.
SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 625 -6798
Reg #: LIC 102831
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: � ( Ar Permittee Signature: )
Call 503.639.4175 by 7:00 a.m. for inspections 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.
• 21VIechanical Permit Application FOR OFFICE USE ONLY
CI of Tigard - , Received _
}�� 7 , 7 �) Permit No. 9 L
` g � / , _- i; � r � DateBy: � ,,.,� // / (/ � � �liU (� G� 61
13125 SW Hall Blvd., Tigard, OR 972 ' ; A: ``_.: -J Plan Rev
' Other Permit:
Phone: 503.639.4171 Fax: 503.598.1 /tt I ,+A Date/By:
Inspection Line: 503.639.4175 L r F/ 2 G06 � 4- r.!f I Date Ready /By: orris fi4 See Page 2 for
Internet: www.ci.tigard.or.us ` Notified/Method: 1 Supplemental Information
I
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X1'1 �c i i Jt:r ")
C�,(°C'' 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.
Value: $
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ I- and 2- family dwelling Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
S ii Air conditioning or heat pump
Job site address: I� (� ((� �Y7� l�C (requires site plan showing placement) 14.00
V"�
City/State/ZIP: `s q cc O���L � 77 Fumace 100,000 BTU (ducts /vents) 14.00
I j
i � OIL Fumace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: 14kcl5 eufpr_ Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
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. 10.00
Flue /vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
1 61( /d(yf9 1 '1 6 170, /57— �, Crm Flue vent for water heater or gas
vv 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 OWN ER ❑ TENANT Other: 10.00
Name: vvkA42 ) I (k) 1—}C v5 U 1-) Environmental exhaust and ventilation
1 ` J 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
r PPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: fC,1 k kit (fit f, ' 10.00
Business name: 7/44 /j N /- (CKcZ'K 5 Fuel piping
Contact name: 0/ , de 'l de it ScJ< --, $5.40 for first four; 51.00 for each additional
Fumace, etc.
Address: a9/-•--) 5it2 c / %te � G #4412 Gas heat pump
City/State /ZIP: 7 _4.v c, 0)4, 4 71 Z-3 Wall /suspended /unit heater
/ Water heater
Phone: (S p) ) (,3 SS3? Fax: ( ) Fireplace
E -mail: Range
CONTRACTOR Barbecue
'
ij � L K (� n d � Clothes dryer (gas)
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Business name: , 0 / d 6f� Other:
II
Address: 2n87 „...< „...< A, /_x, MECHANICAL PERMIT FEES*
City/State/ZIP: Lh y74)6 kt/ O/ - 97/e/461 Subtotal
t/ Minimum permit fee ($72.50)
Phone: Kb3) as_ b) 9 Fax: (60) 67c ? (�(4 Plan review (25% of permit fee)
� CCB lic.: 1 0 � ,� 1 6 State surcharge (8% of permit fee)
TOTAL PERMIT FEE , 5 61. This permit application expires if a permit is not obtained within 180
tthorized signature: z . d ays after it has been accepted as complete.
.me: ( L. (4r ( (,t Date: a..? _6 r * Fee methodology set by Tri- County Building industry Service Board
,ding\Permits \MEC- PermitApp.doc 12/03 440- 4617T(11 /02 /COM/WEB)
Mechanical Permit Application - City of Tigard #
Page 2 - Supplemental Information
Commercial Fee Schedule:
Total:Valuati<on =Permit
$1.00 to $2,000.00 Minimum fee $72.50
$2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30
for each additional $100.00 or fraction
thereof, to and including $5,000.00.
$5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and
$1.80 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and
$1.35 for each additional $100.00 or •
fraction thereof, to and including
$50,000.00.
$50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and
$1.25 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $1,396.50 for the first $100,000.00 and
$1.10 for each additional $100.00 or
fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
i:\Building\Pernvts\IvIEC- PermitApp.doc 12/03 2 •
CITY OF TIGARD
BUILDING DIVISION PERMIT #: M1EC �0Q5 00
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/7/2005
Phone: (503) 639 -4171 i� ripA 1,
Inspection Requests (24 Hrs.): (503) 639 -4175 4 __.. , f& a.QO, -CO
INSPECTION WORKSHEET FOR DATE: 128/2006 TIME: 7 :01AM PAGE: 24
SITE ADDRESS: 12920 SW PACIFIC KW CLASS OF WORK:.
SUBDIVISION: HUDSON PLAZA LOT #: I3OI) TYPE OF USE:
PROJECT NAME: HUDSON PLAZA
DESCRIPTION: HUDSON PL A. [ eist NI X.1' I 'ation: $2000,
OWNER: HENDERSON, MARILYN DOROTHEA, PHONE #:
CONTRACTOR: HEINTZ HEATING & COOLING, INC., GL PHONE #: 503 - 626-679B
Inspection Request Scheduled For: Date: 1218/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
615 Mechanical rough -in 040853 -01 503- 313 -5123 N
Corrections /Comments /Instructions:
•
PASS PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED (�
Inspector: Date.) Lo Phone #: (503) 718-