Permit CITY OF TIGARD MECHANICAL PERMIT
7 * COMMUNITY DEVELOPMENT Permit #: MEC2011 -00184
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/28/2011
Parcel: 1 S135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 203
Project: Aesthetic Medicine Subdivision: TIGARD MEDICAL MALL Lot:
Project Description: Push /pull condenser section of split system, 2.5 ton capacity.
Contractor: WILLAMETTE HVAC Owner: MCFADDEN, ARTHUR L
3075 SW 234TH AVE. #206 BY SKLARZ, ERIC
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 04/28/2011 $269.03
Class of Work: ALT Type of Const: Plan Review 04/28/2011 $67.26
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 04/28/2011 $32.28
Stories:
Project Valuation: $7,200.00
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 $368.57
•
Hoods: Comm Incinerators:
Required Items and Reports (Conditions)
Woodstoves: Gas Fireplaces:
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 N. a ion e Thos- les are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir• t questions to OUN by . ling 5' • 2.1987 or 1.800.332.2344.
Iss ed By: I �, � Permittee Signature:
Call 503.639.4175 by 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 9 , /,mot / j�
Pr Cl of Ti and JCEIV Received 7 l t%! 01F/�l ' `J g �� DateBy: 7 • 13125 SW Hall Blvd., Tigard, OR Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: #lg / Permit No.:
T I G A R D Inspection Line: 503.639.4175 A 2 8 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov 2011 Notified/Method: Supplemental Information
l'1=' .
TYPi ' <f}1 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
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: $ 7200
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. 1 Ea. Total
Jon OtrE 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 97223 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: 203 Project name: Aesthetic Medicine 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: 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
push /pull condenser piece of split system. 2.5 ton capacity
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
❑ PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32
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
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name: same as below
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each a dditional
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 MECHANICAL PERMIT FES • y
City/State/ZIP: Hillsboro OR 97123 Subtotal q.O
Minimum permit fee ($90.00) r —'
Phone: (503) 628.6841 Fax: (503) 848 2597 Plan review (25% of permit fee) 7. ge
CCB lie.: 56951 State surcharge (12% of permit fee) ,)A •
TOTAL PERMIT FEE 4g` „9
This permit application expires if a permit is not obtain 180
Authorized signature: n '✓L days after it has been accepted as complete.
Print name: Michael malstrom Date: 4/27/11 * Fee methodology set by Tri- County Building Industry Service Board
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