Permit y CITY OF TIGARD MECHANICAL PERMIT
,111 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00149
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/07/2011
Parcel: 1 S135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 306
Project: Advanced Acupuncture & Oriental Medicine Subdivision: TIGARD MEDICAL MALL Lot: 0
Project Description: Adding and relocating ducts and grills for TI.
Contractor: WILLAMETTE HVAC Owner: MCFADDEN, ARTHUR L
3075 SW 234TH AVE. #206 BY ERIC SKLARZ
HILLSBORO, OR 97123 621 SW MORRISON ST STE #800
PORTLAND, OR 97205
PHONE: 503 - 628 -6841 PHONE:
FAX: 503 - 848 -2597
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 04/07/2011 $136.60
Class of Work: ALT Type of Const: Plan Review 04/07/2011 $34.15
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 04 /07/2011 $16.39
Stories: Info Process /Archiving - Lg Sheet (over 04/07/2011 $2.00
11x17)
Project Valuation: $2,700.00
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 $189.14
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.23 1987 . = +a.- - r
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Issued By: •ermittee Signature:
Call 503.1/ 7:00 a.m. for the next available inspection date.
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
City of Tigard Received
- Permit No.: i
IN Date/By: 1 / II 1) /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: 7 / 4 j)-- U _.C)
TI GA RD Inspection Line: 503.639.4175 Date Ready/By: See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
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CYPF. OF WORK ' ,, ,< E
COMMERCIAL FEE* SCHEDULE USE CHECKLIST
e , x
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.
Value: $ $2,700.00
� .... RIJCT1ON 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. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 9735 SW Shady Ln (requires site plan showing placement) 46.75 -
Furnace 100,000 BTU (ducts/vents) 46.75
City/State/ZIP: Tigard OR Furnace 100,000+ BTU (duets/vents) 54.91 _
Suite/bldg. /apt. no.: 306 I Project name: Advanced Acupuncture Heat pump
(requires site plan showing placement) 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
Subdivision: I Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
Modify existing duct work to accommodate new office layout
Flue vent for r 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
.;, 3 at 'll a `. „ ,.:. . ii, z . ., ..: ,,. T ... Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
. _ ' . r..: ',, - ¢ 4 t k'''''4,1 Attic/crawlspacefans 23.32
Other: 23.32
Business name: same as below
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
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 \1ECHANI(AL PERMIT FEES* jam
City/State/ZIP: Hillsboro OR 97123 Subtotal
Minimum permit fee ($90.00)
Phone: (503) 628.6841 Fax: (503) 848.2597 Plan review (25% of permit fee)
CCB lic.: 56951 State surcharge (12% of permit fee)
. ....-- j
TOTAL PERMIT FEE '(. I
This permit application expires if a permit is not obtain with 180
Authorized siylature j �' days after it has been accepted as complete.
Print name: Michael Malstrom Date: 4/5/11 * Fee methodology set by Tri -County Building Industry Service Board
I:1 Building \PermitsVMEC- PemvtApp.doc 09 /09/10 440- 4617T(11 /02/COM/WEB)