Permit — ,, CITY OF TIGARD MECHANICAL PERMIT
111 1 • COMMUNITY DEVELOPMENT Permit #: MEC2011 -00206
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/11/2011
Parcel: 1 S135BA00100
Jurisdiction: TIGARD
Site address: 10205 SW WASHINGTON SQUARE RD
Project: Thirsty Lion Subdivision: DAVE & BUSTERS Lot:
Project Description: Installation of (4) radiant tube heaters.
Contractor: HVAC INC Owner: PPR SQUARE TOO LLC
5188 SE INTERNATIONAL WAY BY THOMSON PROPERTY TAX SERVICES
MILWAUKIE, OR 97222 ATTN HILARY RAYMOND
CARLSBAD, CA 92008
PHONE: 503 - 462 -4822 PHONE:
FAX: 503 - 462 -6555
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 05/11/2011 $408.67
Class of Work: ALT Type of Const: VB Plan Review 05/11/2011 $102.17
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 05/11/2011 $49.04
Stories: 1 Info Process /Archiving - Lg Sheet (over 05/11/2011 $4.00
11x17)
Project Valuation: $12,400.00 Info Process /Archiving - Sm Sheet (up to 05/11/2011 $1.00
11x17)
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 $564.88
Hoods: Comm Incinerators:
Required Items and Reports (Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc: Radiant
Duct Work: Heaters
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 enter. Those rules 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 • NC • ca 'ng 503.232.1987 or 1.800.332.2344.
Issue By: _ , / // Permittee Signature: , I ill °
Call 503.639.4175 by 7:00 a.m. for the next available inspecti .
This permit card shall be kept in a conspicuous place on the job site until co , . ion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application RECEIVE FOR OFFIC E USE ONLti • .
`J
Ci of Ti and
}� g ' r Date/By.� Received /I 1� Permit No.: e� iee, ,� O� i0
/ I (U —p� /�O
u 13125 SW Hall Blvd., Tigard, OR 97223
M
P hone: 503.639.4171 Fax: 503.598.1960 A
ill
Plan Review Ni
x... y Date/By � �� Other Permit
T,LG AR's Inspection Line: 503.639.4175 1 1 l` i Date Ready :y: luris: iii See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK
CITY OF TIG R
BUILDING DI D
ViSIGN COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction 0 Addition/alteration /replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
- • CATEGORY OF CONSTRUCTION Value: $ VD-- q O p
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ 1 and 2 family dwelling in Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. , Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: O -A S t!V U \ -' `' `1 ^ Air conditioning or heat pump
t J V 1 s c� r (requires site plan showing placement) 14.00
City/State /ZIP: 1 r (7J v l c\ 1 q 3 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU ( ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: -k 1 -®\ Gas heat pump 14.00
Cross street/directions to job site: V\- V '`'p 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 ,
Subdivision: Lot no.: Flue/vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
p ,(
tV\ T� rAa) ,Le4 {A/S Gas fireplace
water heater or gas
e 10.00
�/�/f �' l �/ V Flue vent fo
W / v ` _ , 1 . s ' h ,,_p fireplace 10110
/ �(`� A � 1 1 1/ lA/t V'� Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
El PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00
Other: 10.00 _
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen ,
equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON, Attic /crawlspace fans 10.00
Other: 10.00
Business name: ` \/ I j p L, Fuel piping
Contact name: JA $5.40 for first four; $1.00 for each additional
Address: S , I `% ' tom- -Q�� � ',/ Furnace, etc.
�/ 1 t Gas heat pump
City /State /ZIP: [V`(l\\A/U�/` ki�. Ci 7j ") / Wall/suspended/unit heater
Phone: (5 y' 4 b }' \4 %- Fax: : (53 )\4 \Ci"-) Water heater
1 • °k VA Fireplace
E -mail: .C. � C&) AV Ol �v)tC 1' , wry) J CONTRACTOR Barbecue
Business name: `1v A � I tA,� Clothes dryer (gas)
ON) l Other:
Address: (� \ MECHANICAL PERMIT FEES*
City/State /ZIP: (% f� -. V" tV Y Subtotal Ifog. 407
Phone: ( ) Fax: ( ) Minimum permit fee ($72.50) ---
Plan review (25% of permit fee) /OA , 17
CCB lie.: . S -1 ) f State surcharge (12% of permit fee) 1(9.i
i TOTAL PERMIT FEE ��
Authorized signature: This permit application expires if a permit is not obtained within 180
' 0
d ays after it has been accepted as complete, f., 5,,e0
Print name: _do (ksi ' . );(1( Date: 5 / I II ) ) • Fee methodology set by Tri- County Building Industry Service as
1: \Building \ Permits \MEC- PermiApp doc 01/19/07 440-4617T (I1 /02/COM/VEB) 41 6 I I b
B uilding Division
Over- The - Counter (OTC) Mechanical Permit
TIGARD Check List
Project Description: Rt t 1
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work:, 6 Occupancy Group: Type of Construction:
*Type of Use: cry7i{,` Oregon Specialty Code: a, (0
Number of Stories:
FUEL FURNACES
Type: Furnace < 100K BTU Furnaces >= 100K BTU
Gas Pressure: Roof Top Unit (RTU) Tons
Floor Furnaces Unit Heaters
Vents without Appliances Air Conditioning
Heat Pump
AIR HANDLERS HOODS
Units <= 10000 cfm Type 1 Hood Type 2 Hood
Units > 10000 cfm Grease Duct 1 Hour Shaft
Fire Wrap
APPLIANCES
Boiler (BTUs) Vent Fans Gas Line
Solid Fuel Fireplace/ Clothes Dryers Gas Outlets
Woodstove Duct Work Gas Fireplace
Fire /Smoke Dampers Other Mechanical Units – Describe: l }OZ — `��j
Total Project Valuation: $ 15" FEES DUE
$ Mechanical Permit Fee
$ Plan Review
$ 12% State Surcharge
$ Info Proc /Arch, Lg (over 11x17 $2.00)
$ Info Proc /Arch, Sm (up to 11x17 $0.50)
$ Misc. Admin Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ Other:
Building Staff:
Date /Time: $ TOTAL FEES DUE
*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.docx 01/13/2011